Why Is Bypass Surgery Necessary?
Heart bypass surgery, also known as coronary artery bypass graft, or CABG, surgery, becomes necessary when a person's coronary artery becomes partially or completely blocked because of plaque buildup, a condition known as coronary artery disease. There are also other names for this condition, including ischemic heart disease and atherosclerosis. This form of heart disease reduces blood flow to the heart, which may cause a heart attack. To rectify this problem, surgery is sometimes necessary to create a pathway around the blockage in the coronary artery. This allows the blood and oxygen to properly flow to the heart.
How Is the Surgery Performed?
To complete the surgery, which takes between four and six hours, surgeons must remove a portion of a healthy vein or artery from elsewhere in the body. The saphenous vein from the leg; the internal mammary artery, the left IMA that runs along the chest wall; or the radial artery, which runs through the arm to supply the hand with blood, are among those which may be used for grafting. Some patients have their heart stopped, and are connected to a bypass pump, or heart-lung machine during the surgery. This machine continues to circulate blood throughout the body even while the heart is not beating. Other patients may receive off-pump coronary artery bypass, or OPCAB, in which they are not connected to the machine and their heart is not stopped. Once anesthetized, a patient is generally cut down the middle of the chest, separating the breastbone so the surgeons have access to the heart and aorta. However, with Minimally Invasive Direct Coronary Artery Bypass, or MIDCAB, smaller incisions are used and the breastbone is not separated. One end of the artery or vein used in the graft will be stitched to an opening below the blockage in the coronary artery. The other end is connected to the aorta. Some people may need multiple grafts done. This is determined based upon how many coronary arteries are clogged.
According to the National Institutes of Health, most grafts will remain open and functioning for 10 to 15 years. Recovery time in the hospital may last up to a week. During the first few days the patient and heart function are monitored very closely.
Other Things to Consider
Possible risks from bypass surgery include blood clots, heart attack, excessive bleeding, sternal wound infection and, in rare cases, death. After surgery, individuals may require the use of a breathing tube for a while and may receive medication to help regulate blood pressure and circulation. Patients should be aware that surgery does not prevent coronary blockage from returning. A person should make lifestyle changes that incorporate improving diet and exercise to try to maintain better health after receiving this surgery. CAD may be more common in males, diabetics, smokers and people with high blood pressure or high cholesterol.
