When and Why to choose coronary bypass surgery for CAD ?
Coronary bypass surgery is opted as the last choice for treating coronary artery disease (CAD). In case of CAD the arteries that supply oxygenated blood to the vital heart muscles get hardened and become constricted due to excessive deposit of plaque (atheroscelerotic plaque) which in extreme cases can only be rectified by grafting the artery.
Risk Factors for CAD
- Excessive smoking
- High blood pressure
- Elevated cholesterol
- Normal aging ( greater than 45 for men and 55 for women)
- Genetic predisposition to heart disease
Coronary artery bypass graft (CABG) is done only when there is a blockage of more than 75 percent. This elevates the possibility of heart attack during exercise when the body demands more oxygen which requires a higher blood volume to be pumped causing the plaque to rupture and a clot to be formed in the artery completely blocking it and starving the heart muscle of oxygen. An angioplasty is not feasible in this case since the excessive plaque getting squashed can actually facilitate the formation of a bigger plaque deposit and clot soon after the procedure.
CABG is actually an open heart procedure wherein the sternum is sawed through in the middle earning it the name of median sternotomy. The heart is then cooled with iced salt water and a preservative solution injected into the arteries preserves them from damage. This is to to minimize the damage caused by minimal blood flow during surgery. A cardiopulmonary bypass during the procedure is a must. The surgeons then remove the vessel to be grafted from usually the leg which is the saphenous vein. Chest wall arteries, mostly the left internal mammary artery can also be used a bypass graft.
Types of coronary bypass surgery
- Traditional coronary bypass surgery which has been explained above using the cardiopulmonary bypass machine
- Off- pump coronary bypass surgery wherein a specialized device other than the bypass machine stabilizes the heart during surgery
- Minimally invasive coronary bypass surgery which is not a open heart procedure and doesn’t involve opening the sternum. This is a relatively new method and facilitates less recovery time.
- Robot assisted coronary bypass surgery
- Port access robot assisted coronary artery bypass surgery
Types according to the graft material
- Internal mammary arteries – most common type as it shows best long term results
- Saphenous veins – veins removed from leg and sewn from the coronary artery to the aorta below blockage site. A minimally invasive procedure of saphenous vein removal can have less scaring and faster recovery.
- Radial artery – an artery from the lower part of arm can be removed and attaches and can have fewer side effect
An artery graft remains more viable after 10 years than a vein graft
Benefits of a successful coronary bypass surgery
- Blood flow to heart improves
- Alleviates the symptoms such as angina and excessive shortness of breath
- Increases the quality of life
- Increases longevity to a considerable extent when combined with a healthy diet
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