Coronary Artery Bypass Surgery

What is coronary artery bypass surgery?

Coronary artery bypass surgery, also referred to as heart bypass surgery and coronary artery bypass grafting, is a commonly performed procedure which restores blood flow to areas of the heart that aren’t getting as much blood as they need.

If there is a blockage in an artery, it can cut off blood flow, and cause a heart attack and even cardiac arrest. Heart bypass surgery restores blood flow and improves the heart’s function, by using blood vessels from another part of the body to reroute the blood around the blockage.

A coronary artery bypass is major surgery but Cleveland Clinic Abu Dhabi’s Heart, Vascular & Thoracic Institute offer many advanced, minimally invasive surgical options for eligible patients, which allow for quicker recovery, shorter hospital stays, and a reduced risk of complications.

Why is coronary artery bypass surgery performed?

The heart pumps blood around the body, but it also needs its own supply to ensure it can do its job properly. Blood is delivered to the heart via a network of blood vessels called arteries. If tissues don’t get enough blood, it leads to a condition called ischemia.

The muscle cells in your heart are especially sensitive to ischemia, and in severe cases, heart muscle cells begin to die when there isn’t a sufficient blood supply. Heart bypass surgery treats ischemia by restoring the flow of blood to affected heart muscle.

This improves the function of the heart and helps people which have had a heart attack, or are at risk of having one, to feel better.

Coronary artery bypass grafting is usually performed on people with coronary heart disease, which includes conditions that cause a narrowing of the arteries in the heart due to a build up fatty plaques. A buildup of plaques inside the arteries can cause them to stiffen and narrow. If a plaque area breaks open, a blood clot can form and lead to a blockage. This causes ischemia in areas of the heart and can cause a heart attack.

Coronary heart diseases also include coronary artery disease, angina pectoris, silent myocardial ischemia (heart ischemia with no symptoms).

What happens before coronary artery bypass surgery?

Coronary artery bypass grafting is major surgery, and a number of tests are performed ahead of the procedure. These include a number of imaging and lab tests which determine suitability for the procedure, such as:

• Blood test
• Cardiac catheterization
• Cardiac MRI
• Cardiac CT scan
• Echocardiogram
• Electrocardiogram (ECG or EKG)
• Exercise stress test
• Nuclear cardiac stress test
• Urine test
• X-ray or CT angiography

Your doctor will discuss any medications you are taking and advise which ones you can and can’t take ahead of surgery.

They will also discuss the procedure with you in detail, helping you to prepare and to make sure you understand what will happen afterwards. This will include things like support at home, recovery, and diet.

Traditional coronary artery bypass surgery

Traditional, open bypass surgery is a complex procedure that can take several hours to perform. Under general anesthesia, you may be put on several types of life support.

Intubation and ventilation involves inserting a tube into the windpipe which is attached to a ventilator. This machine moves the air in and out of the lungs for you.

Intravenous (IV) lines will be inserted into veins so that fluids and medications can be delivered. A urinary catheter will be inserted to allow urine to leave the body under anesthesia.

Sometimes, a heart-lung bypass machine is used, which does the job of both these organs. The machine pumps blood out of the body and into a machine, where it adds oxygen and removes carbon dioxide. It then pumps blood back into the body. A heart-lung bypass allows medical teams to stop the heart temporarily, so it is easier for them to perform surgery.

A cardiothoracic surgeon then makes an incision in the middle of the chest, splits the sternum (breastbone) and lifts the rib cage so they can access the heart. A harvested blood vessel, which is usually taken from the leg, chest or arm, is then used to create the bypass. The bypass is attached to the aorta at one end, and to the blocked artery, just after the blockage, at the other end. More than one harvested blood vessel may be needed for double, triple or quadruple bypasses.

The heart is then restarted (if it was stopped) and the blood starts to flow again. The rib cage is put back into place and wired so that it can heal. Staples and stitches then close the incision.

Advanced coronary artery bypass surgery techniques

Minimally invasive coronary artery bypass surgery

During this procedure the surgeon doesn’t make a large incision in the chest and doesn’t split the sternum or lift the rib cage. Instead, they make very small incisions between the gaps in the ribs to access the heart. The procedure sometimes uses the off-pump technique, which means that a heart-lung bypass machine isn’t used as the heart isn’t stopped.

For certain candidates, including some high-risk patients, minimally invasive bypass surgery offers many advantages, such as:

• Faster recovery
• Less blood loss
• Less pain
• Lower risk of infection and complications
• Lower risk of stroke and arrhythmia
• Shorter surgery time, less time under general anesthesia
• Shorter hospital stay
• Smaller scars.

Hybrid coronary artery bypass surgery

These procedures use a mixture of different types of coronary artery bypass surgery. For example, robot-assisted surgery may be performed on one artery, but other techniques, such as stenting, may be performed on other diseased blood vessels.

Total arterial grafting

A number of specialized approaches have emerged which improve the success rates of revascularization in coronary artery bypass surgery in certain patients. Total arterial revascularization involves harvesting an artery to create the bypass vessel instead of a vein. Arteries can be more suitable bypass vessels and patients are less likely to experience complications that are often associated with vein bypass grafts.

Life after coronary artery bypass surgery

Recovery from surgery will depend on the type of surgery you have had, and many other factors such as your age and overall health. After a hospital stay, most patients will begin a cardiac rehabilitation program. Led by a range of professionals, including nurses, nutritionists and dietitians, exercise physiologists, and counselors, the program aims to aid recovery and rebuild strength.