Coronary artery bypass graft surgery is a type of open-heart surgery used to treat one or more dangerous blockages in the heart arteries. If you have been recommended for, or have undergone, the surgery, it is because blockages in your heart arteries have been found to be restricting the flow of oxygenated blood to the heart. These blockages can cause symptoms such as chest pain (angina), fatigue, shortness of breath, and nausea, among others. These blockages can also cause a heart attack or other damage to the heart muscle.
It is likely that you have a family member, friend, or coworker who has had bypass surgery. According to the U.S. Centers for Disease Control and Prevention, 395,000 coronary artery bypass graft surgeries were performed in 2010. The surgery has been performed for over 50 years, and is a well-proven treatment for serious heart disease.
Read on for more about the disease process that can make bypass surgery necessary and for how bypass surgery is performed.
Treating Coronary Artery Disease
What Do the Different terms for Bypass Surgery Mean?
You may hear bypass surgery referred to by different names. Coronary artery bypass graft surgery, or CABG (pronounced “cabbage”), is one common term. This term accurately describes exactly what the surgery accomplishes: grafting (or sewing) a new blood vessel to a heart artery to re-route blood flow around a blockage. You will also hear CABG referred to simply as bypass surgery, and you have probably heard the term open-heart surgery. That is because the procedure is an open-chest operation, where the heart surgeon makes an incision in the chest, opens the sternum (or breastbone), and makes an incision in a membrane around the heart to expose the heart for the procedure. You have also probably heard the terms double or triple bypass or even quadruple or quintuple bypass. These terms refer to the number of heart arteries that needed to be bypassed with grafts.
Coronary artery bypass graft surgery treats hearts with coronary artery disease,in which fatty deposits build up in the coronary (heart) arteries, restricting blood flow to the heart and potentially leading to chest pain, or angina,. These deposits, or plaques, can also be vulnerable to rupturing. When a plaque ruptures, a blood clot can form at the site of the rupture, cutting off blood flow to the heart and causing a heart attack.
Think of a highway bypass that allows you to drive around traffic congestion in a city. Or a detour that takes you around a road that is obstructed and needing repair. The bypass or detour takes you from the normal road, goes around the blockage, and then brings you back to the smooth road. Bypass surgery takes blood flow around and away from the diseased portion of the blood vessel, and re-routes it to the healthy part of the vessel. The new blood vessel allows blood to bypass the diseased, clogged artery and travel freely to the heart.
During bypass surgery, a heart surgeon removes a blood vessel from one of several sites in the body to use as the bypass graft. The most successful bypasses use the internal mammary artery – the artery that runs just inside the edge of each side of the breastbone. During bypass surgery, the end of this blood vessel is removed from the chest wall to be used to attach to the heart beyond the blockage.
The beginning of the internal mammary artery is left in place, which is the artery beneath the collarbone. In this way, blood flowing in the normal route up toward the collarbone flows down the internal mammary artery normally, except now it is joined to the coronary artery of the heart. Like the road detour, it has bypassed the obstruction.
The surgeon may also remove a segment of blood vessel from the leg (saphenous vein) or wrist (radial artery). The surgeon then attaches this new blood vessel (the graft) to the aorta (the major artery originating from the heart). The other end of the graft is then attached to the coronary artery below the blockage that is being treated. The graft allows blood to flow from the aorta, down the graft to bypass the blockage, and restore flow to the heart muscle.
Coronary artery bypass graft surgery can save your life or that of a loved one, and it can improve your quality of life. If you are about to have bypass surgery or are recovering now, you probably have many questions about the procedure and the practical aspects of getting back to daily life. Learning more about the surgery can put your mind at ease and help you manage stress to move forward for a positive recovery.
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