Title : Coronary Artery Bypass Graft Surgery
link : Coronary Artery Bypass Graft Surgery
Coronary Artery Bypass Graft Surgery
In coronary artery bypass graft (CABG) surgery, the cardiac surgeon takes a length of blood vessel from elsewhere in the body and uses it to shunt blood around a narrowed or blocked coronary artery. The attached vessel thus permits blood to bypass the blockage so the heart muscle ordinarily supplied by that coronary artery can once again receive nourishment. About 366,000 Americans undergo CABG surgery each year. The operation can dramatically improve the quality of life and boost life expectancy for some (but not all) people with coronary artery disease.
The latest guidelines from the American College of Cardiology and the American Heart Association recommend that physicians consider CABG surgery when there is a blockage of 50 percent or more in the left main coronary artery, alone, or 70 percent or more in all three other major coronary arteries. Bypass should be considered in such circumstances even when patients have few or no symptoms of angina. According to the guidelines, a CABG procedure can also be beneficial for patients who’ve had angioplasty but who continue to have symptoms caused by blocked arteries, as well as for patients who’ve already had bypass surgery but suffer from disabling angina.
In CABG surgery, the patient is under general anesthesia, and the surgeon cuts through the breastbone to gain access to the heart. In the conventional approach to bypass surgery, the heart is usually stopped with a solution called cardioplegia so that the surgeon doesn’t have to perform surgery on a heart that’s constantly moving. A heart-lung machine pumps oxygen-rich blood through the patient’s body, temporarily substituting for the heart. The surgeon takes a vein or an artery from another part of the patient’s body and stitches it into place to reroute blood around the blocked artery.
The replacement vessel might be an internal mammary artery taken from the patient’s chest wall, a radial artery from the patient’s arm, or a saphenous vein taken from the leg. In any case, the artery or vein is a “spare” vessel. The patient will suffer no major ill effects because that piece of artery or vein has been removed.
If the grafted vessel is a vein from a leg or a radial artery from an arm, one end is attached to the aorta and the other is sewn onto the diseased coronary artery, beyond the blockage. When an internal mammary artery is used, the upper end is usually left attached to a large artery called the subclavian artery, and the lower open end is attached to the diseased coronary artery, beyond the blockage. Artery grafts (particularly the internal mammary artery grafts) tend to last longer than vein grafts, and the use of artery grafts has been shown to prolong life.
After the surgery is completed, the patient’s heart is started again, and he or she is taken off the heart-lung machine. Most people stay in the hospital for four to five days after the operation, though within one to two days of surgery the doctor will probably ask the patient to get up and walk.
If you should undergo CABG surgery, you might also be scheduled for a cardiac-rehabilitation program, which you will attend after leaving the hospital. Cardiac rehabilitation helps you and your heart gain strength. It also teaches you heart-healthy practices that will help protect you from future heart disease, such as observing a low-fat diet and exercising regularly.
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