Coronary Artery Bypass

Coronary artery bypass is one of the basic therapeutic procedures in cardiac surgery. The procedure aims to bypass a narrowed coronary artery with a vascular graft.

Principle

The principle is very simple. The patient is put under general anesthesia, the chest is opened, and the heart is exposed together with aorta and the coronary arteries. The doctors take a blood vessel from another part of the patient's body (usually a vein from the lower extremity) and sew it on the coronary artery so it bridges the narrowed area. When the vein from the lower extremity can not be used, the doctors try to use mammary artery, which branches from the thoracic aorta. The blood flow freely through the newly created connector and supplies the heart muscle with oxygen and nutrients.

 

Coronary bypass

 

Principle of the coronary artery bypass - the closed part  of the coronary artery is successfully bypassed (blood flow in coronary arteries = red arrows)

 

Preparation

Coronary artery bypass surgery is a larger intervention and when planned, it usually needs cautious internal examination, which should evaluate the patient's ability to undergo the operation.

Indications

Coronary artery bypass is used in patients with ischemic heart disease with coronary arteries narrowed by the process of atherosclerosis, which can not be solved by therapeutic coronary angiography with angioplasty and stenting. Similar indication is acute heart attack that can not be solved by coronary angiography. The coronary angiography is the examination and eventually therapeutic method of first choice. It clearly shows the location of narrowing or total closure of coronary arteries. However, some of these findings can be located so inconveniently that the bypass surgery is the only option - either planned with a certain time delay or acute as soon as possible after the acute coronary angiography.

Disadvantages

Cardiac bypass surgery is a procedure carries all risks of extensive surgery and general anesthesia. The patient must also reckon with the fact that the operation leaves a significant vertical scar in the middle of the chest. In addition, we have to know that the operation should be followed by patient's cooperation in healthy diet and regular usage of prescribed medication. The cardiac bypass may stay functional for the rest of the life, or it may get also narrowed, or even closed similarly as the original coronary artery.

Advantages

The coronary artery bypass is a great method for solving narrowing or closure of coronary arteries in patients where the condition can not be solved by coronary angiography.