By-Pass Surgery: All-Arterial Revascularization

Q: What causes coronary artery disease?
A: Coronary artery disease is caused by atherosclerosis, the buildup of a hard, waxy substance called plaque inside your arteries. Over time, this buildup can cause narrowing inside your arteries, limiting the flow of oxygen-rich blood to your heart. In some cases, pieces of plaque may break off and completely block an artery or cause an artery to clot off.  

Q: How does bypass surgery treat coronary artery disease?
A: Bypass surgery creates a detour around the blocked artery and forms an alternate route for blood to flow to the heart. 

Q: What happens during bypass surgery?
A: A piece of blood vessel is taken from somewhere else in the body and then reattached below the narrowed or blocked section of the diseased coronary artery. The earliest techniques used the saphenous veins found along the inside of the legs. Then, surgeons began using the internal mammary artery behind the left ribcage. The left internal mammary still is used more than 95 percent of the time because the mammary artery already is attached to a large artery on one end, leaving only one end of the artery to be detached and then grafted to a coronary artery. 

Q: What is the latest bypass surgery technique?
A: Over the past five to six years, cardiovascular surgeons also have been using the radial artery found in the forearm. They often start with the radial artery in the patient's nondominant arm and should another artery be needed, they then may use the right internal mammary artery in addition to the left internal mammary artery. This combination has proven to help people live longer. 

Q: How is bypass surgery performed?
A: Simply put, when bypass surgery is performed:

  • The patient is put to sleep with general anesthesia.
  • The surgeon exposes the heart surgically.
  • The surgeon harvests a piece of healthy blood vessel from the chest, arm or leg.
  • Connection to a heart-lung bypass machine allows the surgeon to stop the heartbeat while he or she works on the arteries. Or, the surgeon may use newer stabilizing devices to do the bypass on the beating heart.
  • The surgeon uses the harvested blood vessel to create bypass grafts around the narrowed or blocked parts of the arteries.
  • The surgeon then allows flow through the bypasses and closes the incisions.
  • The patient wakes up once the anesthesia wears off.

Q: What is recovery like after bypass surgery?
A: Bypass surgery is a detailed procedure that varies in length depending on the complexity of each patient's problem. Recovery involves four to seven days in the hospital, and then anywhere from three to 12 weeks of rehabilitation as the patient returns to his or her prior activities. There are no long-term restrictions and exercise, especially in the form of cardiac rehabilitation, is encouraged. 

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