Heart bypass surgery
creates a detour or "bypass" around the blocked part of a coronary artery to restore the blood supply to the heart muscle. The surgery is commonly called Coronary Artery Bypass Graft, or CABG (pronounced "cabbage").
After the patient is anesthetized and completely free from pain, the heart surgeon makes an incision in the middle of the chest and separates the breastbone.
Through this incision, the surgeon can see the heart and aorta (the main blood vessel leading from the heart to the rest of the body). After surgery, the breastbone will be rejoined with wire and the incision will be sewn closed.
ARTERY AND VEIN GRAFTS
If a vein from the leg, called the saphenous vein, is to be used for the bypass, an incision is made in the leg and the vein removed. The vein is located on the inside of the leg, running from the ankle to the groin. The saphenous vein normally does only about 10% of the work of circulating blood from the leg back to the heart. Therefore, it can be taken out without harming the patient or harming the leg.
It is common for the leg to swell slightly during recovery from the surgery, but this is only temporary and is treated by elevating the leg.
The internal mammary artery (IMA) can also be used as the graft. This has the advantage of staying open for many more years than the vein grafts, but there are some situations in which it cannot be used.
The left IMA, or LIMA, is an artery that runs next to the sternum
on the inside of the chest wall. It can be disconnected from the chest wall without affecting the blood supply to the chest. It is commonly connected to the artery on the heart that supplies most of the muscle, the left anterior descending artery, or LAD.
Other arteries are also now being used in bypass surgery. The most common of these is the radial artery
. This is one of the two arteries that supply the hand with blood. It can usually be removed from the arm without any impairment of blood supply to the hand.
Angioplasty is a medical procedure in which a balloon is used to open narrowed or blocked blood vessels of the heart (coronary arteries). It is not considered to be a type of surgery. See also cardiac catheterization
Arteries can become narrowed or blocked by deposits called plaque. Plaque is made up of fat and cholesterol
that builds up on the inside of the artery walls. This condition is called atherosclerosis
If the blockage is not too severe, an angioplasty procedure can be used to open the artery. Traditional angioplasty involves the use of a balloon catheter -- a small, hollow, flexible tube that has a balloon near the end of it.
Before the balloon angioplasty
procedure begins, you will be given some pain medicine. Occasionally, blood thinning medicines are also given to prevent formation of a blood clot.
You will lay down on a padded table. The health care provider will make a small cut on your body, usually near the groin, and insert the catheter into an artery. You will be awake during the procedure.
The health care provider will use x-rays to look at your heart and arteries. Dye will be injected into your body to highlight blood flow through the arteries. This helps reveal any blockages in the vessels leading to the heart. The balloon catheter is moved into or near the blockage, and the balloon on the end is blown up (inflated). This opens the blocked vessel and restores proper blood flow to the heart.
In almost all cases, a device called a stent is also placed at the site of narrowing or blockage in order to keep the artery open. A common type of stent is made of self-expanding, stainless steel mesh.
In a small number of cases, a special catheter with a small, diamond tip is used to drill thru hard plaque and calcium that is causeing the blockage. This is called rotational atherectomy.