Heart bypass surgery

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.

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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.

TRADITIONAL APPROACH

In the traditional surgery, the patient is connected to the heart-lung machine, or bypass pump, which adds oxygen to the blood and circulates blood to other parts of the body during the surgery. This is necessary because the heart muscle must be stopped before the graft can be done.

One end of the graft is stitched to an opening below the blockage in the coronary artery. If the grafted vessel is the saphenous vein or the radial artery, its other end is stitched to an opening made in the aorta. If the grafted vessel is the mammary artery, its other end is already connected to the aorta.

The entire surgery can take 4-6 hours. After the surgery, the patient is taken to the Intensive Care Unit. For a few days after the surgery, the patient is connected to monitors and tubes.

OTHER TECHNIQUES

Other surgical techniques for this procedure are being used more frequently. One popular method is to avoid the use of the heart-lung machine. This is called off-pump coronary artery bypass or OPCAB. This operation allows the bypass to be created while the heart is still beating.

The advantage here is that use of the heart-lung machine can lead to some loss of memory and mental clarity, while with OPCAB, that risk is reduced because the heart isn't stopped, and the blood isn't oxygenated externally.

Another alternative is the use of smaller incisions that avoid splitting the breastbone. This is referred to as Minimally Invasive Direct Coronary Artery Bypass or MIDCAB.

Coronary bypass surgery can now be performed with the aid of a robot, which allows the surgeon to perform the operation without even being in the same room as the patient.

Indications:

Coronary artery bypass surgery is a treatment option for ischemic heart disease (too little blood reaching the heart muscle). Coronary surgery is recommended when there is disease of the left main coronary artery, disease of three or more vessels (triple vessel disease), or nonsurgical management hasn't worked. Nonsurgical management includes medication and/or angioplasty.