Heart Disease and Heart Bypass Surgery

Heart Disease and Heart Bypass Surgery

Heart bypass surgery can be used to treat heart disease when your coronary arteries are blocked. Your doctor may treat the problem by giving the blood a new pathway to the heart.

During coronary artery bypass graft surgery (also called CABG, or "cabbage"), a blood vessel is removed or redirected from one area of the body and placed around the area or areas of narrowing in order to "bypass" the blockages and restore blood flow to the heart muscle. This vessel is called a graft.

These substitute blood vessels can come from your chest, legs, or arms. They're safe to use because there are other pathways that take blood to and from those tissues. The surgeon will decide which graft(s) to use depending on the location of your blockage, the amount of blockage and the size of your coronary arteries.

Heart bypass surgery is one of the most commonly performed surgeries in the U.S.

Which Blood Vessels Are Used for Grafts in Heart Bypass Surgery?

There are several types of bypass grafts used for heart bypass surgery. The surgeon decides which graft(s) to use, based on the location of the blockage, the amount of blockage, and the size of the patient's coronary arteries.

• Internal mammary arteries (also called thoracic arteries). These are the most common bypass grafts used, as they have been shown to have the best long-term results. In most cases, these arteries can be kept intact at their origin since they have their own oxygen-rich blood supply. During the procedure, the arteries are sewn to the coronary artery below the site of blockage. This artery is located in the chest and can be accessed through the primary incision for the bypass surgery.
• Saphenous veins. These veins are removed from your leg, and then sewn from your aorta to the coronary artery below the site of blockage. Minimally invasive saphenous vein removal may be performed and results in less scarring and a faster recovery.
• Radial artery. There are two arteries in the lower part of the arm, the ulnar and radial arteries. Most people receive adequate blood flow to their hand from the ulnar artery alone and will not have any side effects if the radial artery is removed and used as a graft. Careful preoperative and intraoperative tests determine if the radial artery can be used. If you have certain conditions (such as Raynaud's, carpal tunnel syndrome, or painful fingers in cold air) you may not be a candidate for this type of bypass graft. The radial artery incision is in your forearm, about 2 inches from your elbow and ending about 1 inch from your wrist. Some people report numbness in the wrist after surgery. However, long-term sensory loss or numbness is uncommon.
• The gastroepiploic artery to the stomach and the inferior epigastric artery to the abdominal wall are less commonly used for grafting.

It is common for three or four coronary arteries to be bypassed during surgery. A coronary artery bypass can be performed with traditional surgery (see below) or with minimally invasive surgery (see below). Your surgeon will review your diagnostic tests prior to your surgery to see if you are a candidate for minimally invasive bypass surgery.

How Is Traditional Heart Bypass Surgery Performed?

During traditional heart bypass surgery, a surgeon makes an incision (about 6 to 8 inches) down the center of your sternum (breastbone) to get direct access to your heart. You are connected to a heart-lung bypass machine (called "on-pump" surgery), which allows for circulation of blood throughout your body during surgery. The heart is stopped and the surgeon then performs the bypass procedure described above. The heart is generally stopped for about 30-90 minutes of the 4-5 hour surgery.

After surgery, the surgeon closes the breastbone with special sternal wires and the chest with special internal or traditional externalstitches.

What Is Off-Pump Heart Bypass Surgery?

"Off-pump" or beating heart surgery allows surgeons to perform surgery while the heart is still beating. The heart-lung machine is not used. The surgeon uses advanced operating equipment to stabilize (hold) portions of the heart and bypass the blocked artery. Meanwhile, the rest of the heart keeps pumping and circulating blood to the body.

With present technology, all coronary arteries can be bypassed off-pump. The off-pump technique may be ideal for certain patients who have an increased risk of complications from being placed on the heart-lung machine, such as those who have vascular disease, heavy plaque buildup in the aorta (aortic calcification), carotid artery stenosis (narrowing or blockage in the arteries leading to the brain), prior strokeor transient ischemic attacks (TIAs), or breathing or kidney function problems.

Not all patients are candidates for off-pump surgery. According to the American Heart Association, about 20% of heart bypass surgeries are performed off-pump. The decision to use off-pump surgery is made at the time of surgery when the patient's heart and arteries can be evaluated more closely.

What Is Minimally Invasive Heart Bypass Surgery?

During minimally invasive bypass surgery, the surgeon performs the surgery through a small incision (about 3 inches) in the chest. It may be an option for some patients who require a left internal mammary artery graft to the left anterior descending artery.

Some patients are also candidates for surgery using robotic-assisted techniques, allowing surgeons to perform bypass surgery in a closed chest, beating-heart environment through even smaller keyhole incisions.

The benefits of minimally invasive bypass surgery include:

• A smaller incision, thus a smaller scar
• A shorter hospital stay; in some cases, only 3 days are needed (instead of the average 5 to 6 days for traditional surgery).
• Shorter recovery time

Other benefits may include:

• Less bleeding
• Less potential for infection
• Less pain and trauma

Talk to your doctor to see if minimally invasive heart bypass surgery is right for you.