Definition:
Heart bypass surgery creates a new route, called a bypass, for blood and oxygen to reach your heart. It is done to fix problems caused by coronary artery disease (CAD), in which the arteries that lead to your heart are partly or totally blocked. See also:
Alternative Names:
Off-pump coronary artery bypass; OPCAB; Beating heart surgery; Bypass surgery - heart; CABG; Coronary artery bypass graft; Coronary artery bypass surgery; Coronary bypass surgery
Description:
Before your surgery you will receive anesthesia. This will make you unconscious and unable to feel pain. The effects of the anesthesia will last the entire procedure. Once you are unconscious, the heart surgeon will make a 10-inch-long incision (cut) in the middle of your chest. Then your breastbone will be separated to create an opening that allows the surgeon to see your heart and aorta (the main blood vessel leading from the heart to the rest of your body). Most people who have coronary bypass surgery are connected to a heart-lung bypass machine, or bypass pump. - This machine does the work of your heart while your heart is stopped for the surgery. The machine adds oxygen to your blood, and circulates your blood through your body.
- Your heart is stopped while you are connected to this machine.
A newer method does not use the heart-lung bypass machine. The bypass is created while your heart is still beating. This is called off-pump coronary artery bypass, or OPCAB. This method may be used for patients who could have problems from being on the heart-lung machine. During this surgery, the doctor takes a vein or artery from another part of your body and uses it to create a detour (or graft) around the blocked area in your artery. - Your doctor may use a vein called the saphenous vein in your leg. To reach this vein, an incision will be made along the inside of your leg, between your ankle and the groin. One end of the graft will be sewn to your coronary artery. The other end will be sewn to an opening that will be made in your aorta.
- The internal mammary artery (IMA), in your chest, can also be used as the graft. One end of the IMA is already connected to your aorta, so just one end will need to be attached. It will be sewn to your coronary artery.
- Other arteries are also now being used for grafts in bypass surgery. The most common one is the radial artery, in your wrist.
After the graft has been created, your breastbone will be reconnected with wire, and your incision will be sewn closed. The wire will remain inside you. This surgery can take 4 to 6 hours. After the surgery, you will be taken to the Intensive Care Unit.
Why the Procedure Is Performed:
Coronary arteries are the small blood vessels that supply your heart with oxygen and nutrients that are carried in your blood. When one or more of the coronary arteries becomes partly or totally blocked, your heart does not get enough blood. This is called ischemic heart disease, or coronary artery disease (CAD). It can cause chest pain (angina). Coronary artery bypass surgery can be used to treat coronary artery disease. Your doctor may have tried to treat you with medicines only. You may have also tried cardiac rehabilitation. CAD varies a lot from person to person, so the way it is diagnosed and treated will also vary. Heart bypass surgery is just one treatment. It will be right for some people, but others may have other kinds of treatment.
References:
Ferraris VA, Mentzer RM Jr. Acquired heart disease: coronary insufficiency. In: Townsend CM, Beauchamp RD, Evers BM, Mattox KL, eds. Sabiston Textbook of Surgery. 18th ed. Philadelphia, Pa: Saunders Elsevier; 2008:chap 61. Fraker TD Jr, Fihn SD, Gibbons RJ, Abrams J, Chatterjee K, Daley J, et al. 2007 chronic angina focused update of the ACC/AHA 2002 Guidelines for the management of patients with chronic stable angina: a report of the American College of Cardiology/American Heart Association Task Force on Practice Guidelines Writing Group to develop the focused update of the 2002 Guidelines for the management of patients with chronic stable angina. Circulation. 2007 Dec 4;116(23):2762-72. Epub 2007 Nov 12. Hannan EL, Wu C, Walford G, Culliford AT, Gold JP, Smith CR, et al. Drug-eluting stents vs. coronary-artery bypass grafting in multivessel coronary disease. N Engl J Med. 2008;358:331-341.
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