Artery Bypass Surgery

Author : Bhadresh Bundela

Coronary Artery Bypass Graft Surgery

Coronary bypass surgery is a surgical operation where the blocked coronary arteries of the heart are bypassed using healthy blood vessels taken from the patient’s own body. Thus, an alternative route is provided for blood to flow freely into the heart muscles. Coronary Artery Bypass Graft (CABG) surgery is one of the commonest major surgical operations being performed for over 40 years.

Why Surgery?
Coronary bypass surgery is performed on patients who have significant narrowing or blockage in their coronary arteries. A thorough study is conducted on the patient to determine the blockages in coronary arteries. Patients who have blockages in Left Main Artery or severe blocks in all three branches of coronary artery get the best survival advantage after CABG. The surgery is also required for patients who have multiple or diffusely diseased coronary arteries. Bypass surgery is technically feasible for any type of blockage, but these days patients with discrete blocks in one or two branches of coronary arteries are recommended coronary angioplasty and stent implantation. Bypass surgery is also needed when, sometimes, the stents implanted in coronary arteries get occluded.

Arterial and Venous Grafts
In bypass surgery, the conduits which are used to bypass the blocks are called Grafts. Commonly, they are taken out from the leg veins and are referred to as venous grafts. Alternatively, an artery in the chest wall called Internal Mammary Artery (IMA) is also used as a conduit. Sometimes, other arteries of the body like Radial Artery (artery from the forearm) or Gastro Epiploic Artery (stomach artery) are also used.

The advantage with artery graft is that it remains patent for a much longer period. It does not get affected by the process of atherosclerosis or block formation and therefore it can function for a much longer period. However, there are a limited number of arteries available for bypassing all the blocks that could form in patients of coronary artery disease. So, in cases where there are multiple blocks, the internal mammary artery is used for bypassing the most important artery of the heart, and the leg vein or other conduits are used for bypassing the other blocks. Sometimes, the Radial Artery from the hand is also used. But the radial artery is not as efficient as the internal mammary artery, even though, the use of the radial artery has given very good results in some cases. The internal mammary artery is usually preferred over the radial artery.

Technique
The standard technique of CABG is to use cardiopulmonary Bypass (Open Heart Surgery) to stop the heart, and use the quiet, blood-less field for coronary anastomosis (surgical connection of two structures). However, in recent years, a new technique called Beating Heart CABG is being performed more often. In this technique, the heart continues to beat, and only a very small segment of the heart is stabilized for performing coronary anastomosis. By this technique, the potential risks of the use of Heart-Lung machine are avoided. However, opinions of cardiac surgeons are divided over the advantages of both standard and beating heart surgery techniques for Coronary Bypass Surgery.

Prognosis (outcome)
Coronary bypass surgery is now a standard procedure, and most centers performing regular bypass surgeries are consistently providing successful results in over 99% of patients. Surgical risk is higher in patients who have severely damaged heart muscles (LV dysfunction), usually due to long standing disease or due to extensive heart attack. Special care needs to be taken for patients who have other co-morbid conditions like renal failure, stroke, or lung damage due to chronic smoking, etc.

Life after Bypass Surgery:
Post bypass surgery, people can lead completely normal life a few weeks after the operation, without any restriction to their physical activities. Patients usually get discharged from the hospital 5 to 6 days after surgery, and are advised rest for a couple of weeks. During this time, they are encouraged to walk within the house, and indulge in routine, normal activities. They can go back to work 3-4 weeks after the surgery, and are allowed to drive and walk longer distances.

After complete recovery of 1-2 months, a person can perform unrestricted physical activities. Improving the quality of life is the major advantage of opting for coronary bypass surgery.

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