Basics Of A Coronary Artery Bypass Graft
Your heart muscle receives oxygenated blood through the coronary arteries and their branches
. As long as these arteries remain unblocked, blood can easily flow through them to the muscle. Over time, however, the passages can become obstructed. This usually happens when plaque accumulates along the inside walls, a condition called arteriosclerosis. The opening through which blood normally flows becomes narrowed, which prevents it from reaching your heart. Depending on how narrow the arteries have become, a heart attack (myocardial infarction) may be imminent.
A coronary artery bypass graft (CABG) can be done in order to restore blood flow to your heart when one or more arteries become narrowed. This is accomplished by removing a vein or artery from another part of your body, and using it to circumvent the blockage. Below, we'll explain how this blood vessel is chosen, and describe how CABG is performed. You'll also learn about the risks involved, and what to expect following the procedure.
How The Substitute Blood Vessel Is Chosen
The sites from which substitute vessels are taken include the arms, legs, and chest. The radial artery may be removed from the arms, though doing so is less common than taking a vein or artery from other areas. The saphenous vein is the most common vessel used. It is a superficial vein located in the legs; it begins near the large toe and ascends to the femoral vein. The internal thoracic arteries found along the chest wall are also used.
The decision of which vessel is appropriate depends on the circumstances surrounding the disease. Grafts using internal thoracic arteries tend to last longer than those using the saphenous vein. The downside is that their length limits their use to bypassing blockages near the start of the coronary arteries. Also, it takes longer to withdraw them from the chest than withdrawing the saphenous vein from the legs. Consequently, they are rarely used for emergencies.
How A Coronary Artery Bypass Is Performed
Traditionally, the sternum was separated during CABG surgery to provide the surgeon with access to the aorta and the blocked blood vessel. This required the use of a heart-lung machine that maintained the heart's pumping activity while the organ was arrested. Today, even though a sternotomy is still done, many coronary artery bypasses are performed without arresting the heart, or using the pump.
One end of the substitute blood vessel used for the bypass graft is stitched into the aorta. The other end is stitched to the blocked coronary artery beyond the obstruction. This allows oxygenated blood to flow from the aorta past the blockage further along the artery, thus restoring blood flow to your heart muscle.
What Are The Risks?
A coronary artery bypass graft can lead to complications. For example, a small percentage of patients experience a myocardial infarction after surgery has been completed. A much smaller percentage experience a stroke. In some cases, bleeding may occur. This requires the surgical team to explore the area closely prior to resetting the sternum and closing the chest. If both have already been done, the chest must be reopened.
The likelihood of complications increases with the patient's age and the existence of one or more risk factors.
Recovering From The Procedure
Immediately following surgery, you'll be transferred to an intensive care unit (ICU). This gives your doctor an opportunity to closely monitor your vital signs, and if necessary, respond to complications. After one or two days, you'll be moved to a normal recovery ward. You can expect to stay there for three to seven days, depending on how well your body responds to the graft. Once your physician is confident regarding your condition, you'll be released to your home.
If your surgeon performs a traditional CABG with a heart-lung machine, a full recovery may require up to twelve weeks (though most patients recover more quickly). If an off-pump bypass graft is done, you might make a full recovery in as little as five or six weeks. During this time, your doctor will likely recommend cardiac rehabilitation to strengthen your heart. You will also be encouraged to make follow up visits so your doctor can monitor your progress.
Consult your physician to find out whether you need a coronary artery bypass. In many cases, the procedure is necessary to avoid life-threatening heart problems in the future.
by: Donald Massey
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