Coronary artery bypass surgery

heart bypassbypass surgeryheart bypass surgerycoronary artery bypass graftquadruple bypass surgerycoronary artery bypasscoronary artery bypass graftingcoronary bypasscoronary bypass surgeryquadruple bypass
Coronary artery bypass surgery, also known as coronary artery bypass graft (CABG, pronounced "cabbage") surgery, and colloquially heart bypass or bypass surgery, is a surgical procedure to restore normal blood flow to an obstructed coronary artery.wikipedia
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Myocardial infarction

heart attackheart attacksacute myocardial infarction
CABG does not prevent myocardial infarction (heart attack).
In people with blockages of multiple coronary arteries and diabetes, coronary artery bypass surgery (CABG) may be recommended rather than angioplasty.

Atherosclerosis

atheroscleroticatherogenesisatherosclerotic plaques
The obstruction being bypassed is typically due to arteriosclerosis, atherosclerosis, or both.
A number of procedures may also be carried out such as percutaneous coronary intervention, coronary artery bypass graft, or carotid endarterectomy.

External support

External support may be placed on the vein prior to grafting into the coronary circulation of the patient.
In cardiac surgery and vascular surgery, external support (or external stent) is a type of scaffold made of metal or plastic material that is inserted over the outside of the vein graft in order to decrease the intermediate and late vein graft failure after bypass surgery (e.g. CABG).

Off-pump coronary artery bypass

beating heartoff-pump bypass surgery
Postperfusion syndrome (pumphead), a transient neurocognitive impairment associated with cardiopulmonary bypass. Some research shows the incidence is initially decreased by off-pump coronary artery bypass, but with no difference beyond three months after surgery. A neurocognitive decline over time has been demonstrated in people with coronary artery disease regardless of treatment (OPCAB, conventional CABG or medical management). However, a 2009 research study suggests that longer term (over 5 years) cognitive decline is not caused by CABG but is rather a consequence of vascular disease. Loss of mental function is a complication of bypass surgery in elderly people, and might influence procedure cost benefit considerations. Several factors may contribute to immediate cognitive decline. The heart-lung blood circulation system and the surgery itself release a variety of debris, including bits of blood cells, tubing, and plaques. For example, when surgeons clamp and connect the aorta to tubing, resulting emboli block blood flow and cause mini strokes. Other heart surgery factors related to mental damage may be events of hypoxia, high or low body temperature, abnormal blood pressure, irregular heart rhythms, and fever after surgery.
Off-pump coronary artery bypass or "beating heart" surgery is a form of coronary artery bypass graft (CABG) surgery performed without cardiopulmonary bypass (heart-lung machine) as a treatment for coronary heart disease.

Circulatory system

cardiovascularcirculationcardiovascular system
A normal coronary artery transports blood to and from the heart muscle itself, not through the main circulatory system.
Coronary artery bypass surgery

Vein graft failure

chronic graft occlusionGraft failurevein graft disease
Graft failure: grafts last 8–15 years, and then need to be replaced.
In medicine, vein graft failure (VGF) is a condition in which vein grafts, which are used as alternative conduits in bypass surgeries (e.g. CABG), get occluded.

Great saphenous vein

saphenous veinsaphenous veinsgreater saphenous vein
In the other, a great saphenous vein is removed from a leg; one end is attached to the aorta or one of its major branches, and the other end is attached to the obstructed artery immediately after the obstruction to restore blood flow.
The vein is often removed by cardiac surgeons and used for autotransplantation in coronary artery bypass operations, when arterial grafts are not available or many grafts are required, such as in a triple bypass or quadruple bypass.

Coronary artery disease

coronary heart diseaseischemic heart diseaseischaemic heart disease
A study comparing the outcomes of all patients in New York state treated with CABG or percutaneous coronary intervention (PCI) demonstrated CABG was superior to PCI with DES in multivessel (more than one diseased artery) coronary artery disease (CAD). Patients treated with CABG had lower rates of death and of death or myocardial infarction than treatment with a coronary stent. Patients undergoing CABG also had lower rates of repeat revascularization. The New York State registry included all patients undergoing revascularization for coronary artery disease, but was not a randomized trial, and so may have reflected other factors besides the method of coronary revascularization.
Procedures such as percutaneous coronary intervention (PCI) or coronary artery bypass surgery (CABG) may be used in severe disease.

Percutaneous coronary intervention

coronary angioplastyPCIpercutaneous transluminal coronary angioplasty
A study comparing the outcomes of all patients in New York state treated with CABG or percutaneous coronary intervention (PCI) demonstrated CABG was superior to PCI with DES in multivessel (more than one diseased artery) coronary artery disease (CAD). Patients treated with CABG had lower rates of death and of death or myocardial infarction than treatment with a coronary stent. Patients undergoing CABG also had lower rates of repeat revascularization. The New York State registry included all patients undergoing revascularization for coronary artery disease, but was not a randomized trial, and so may have reflected other factors besides the method of coronary revascularization.
PCI is an alternative to coronary artery bypass grafting (CABG, often referred to as "bypass surgery"), which bypasses stenotic arteries by grafting vessels from elsewhere in the body.

Reperfusion therapy

reperfusioneperfusionreperfused
Coronary artery bypass surgery, also known as coronary artery bypass graft (CABG, pronounced "cabbage") surgery, and colloquially heart bypass or bypass surgery, is a surgical procedure to restore normal blood flow to an obstructed coronary artery.
From 1995 to 2004, the percentage of people with cardiogenic shock treated with primary PCI rose from 27.4% to 54.4%, while the increase in coronary artery bypass graft surgery (CABG) was only from 2.1% to 3.2%.

Angina

angina pectorischest painstable angina
CABG is performed to relieve angina unsatisfactorily controlled by maximum tolerated anti-ischemic medication, prevent or relieve left ventricular dysfunction, and/or reduce the risk of death. Bypass surgery can provide relief of angina when the location of partial obstructions precludes improving blood flow with stents.
In patients in whom such noninvasive testing is diagnostic, a coronary angiogram is typically performed to identify the nature of the coronary lesion, and whether this would be a candidate for angioplasty, coronary artery bypass graft (CABG), treatment only with medication, or other treatments.

Internal thoracic artery

internal mammary arteryinternal mammaryinternal mammary branch
In one, the left internal thoracic artery, LITA (also called left internal mammary artery, LIMA) is diverted to the left anterior descending branch of the left coronary artery.
The internal thoracic artery is the cardiac surgeon's blood vessel of choice for coronary artery bypass grafting.

Heart failure

congestive heart failurecardiac failurechronic heart failure
CABG is performed to relieve angina unsatisfactorily controlled by maximum tolerated anti-ischemic medication, prevent or relieve left ventricular dysfunction, and/or reduce the risk of death.
As a result, coronary catheterization may be used to identify possibilities for revascularisation through percutaneous coronary intervention or bypass surgery.

Postperfusion syndrome

pumphead syndrome
Postperfusion syndrome (pumphead), a transient neurocognitive impairment associated with cardiopulmonary bypass. Some research shows the incidence is initially decreased by off-pump coronary artery bypass, but with no difference beyond three months after surgery. A neurocognitive decline over time has been demonstrated in people with coronary artery disease regardless of treatment (OPCAB, conventional CABG or medical management). However, a 2009 research study suggests that longer term (over 5 years) cognitive decline is not caused by CABG but is rather a consequence of vascular disease. Loss of mental function is a complication of bypass surgery in elderly people, and might influence procedure cost benefit considerations. Several factors may contribute to immediate cognitive decline. The heart-lung blood circulation system and the surgery itself release a variety of debris, including bits of blood cells, tubing, and plaques. For example, when surgeons clamp and connect the aorta to tubing, resulting emboli block blood flow and cause mini strokes. Other heart surgery factors related to mental damage may be events of hypoxia, high or low body temperature, abnormal blood pressure, irregular heart rhythms, and fever after surgery.
A study by Newman et al. at Duke University Medical Center published in the New England Journal of Medicine (NEJM) showed an increased incidence of cognitive decline after coronary artery bypass surgery (CABG), both immediately (53 percent at discharge from hospital) and over time (36 percent six weeks, 24 percent at six months, and 42 percent at five years).

Cardiac muscle

myocardiumheart musclemyocardial
A normal coronary artery transports blood to and from the heart muscle itself, not through the main circulatory system.
If the blockage is not relieved promptly by medication, percutaneous coronary intervention, or surgery, then a region of heart muscle may become permanently scarred and damaged.

Arteriosclerosis

cerebral arteriosclerosishardening of the arteriesarteriosclerotic
The obstruction being bypassed is typically due to arteriosclerosis, atherosclerosis, or both.
Coronary artery bypass surgery: This surgery creates a new pathway for blood to flow to the heart. The surgeon attaches a healthy piece of vein to the coronary artery, just above and below the blockage to allow bypass.

Left anterior descending artery

anterior interventricularleft anterior descendingleft anterior descending coronary artery
In one, the left internal thoracic artery, LITA (also called left internal mammary artery, LIMA) is diverted to the left anterior descending branch of the left coronary artery.
Even a small amount of plaque in this area can (for a variety of poorly understood reasons) rupture and cause death; bypassing chronic blockages or trying to open them up with angioplasty does not prevent heart attack but it can restore blood flow in case of a sudden blockage or heart attack and if performed within a rapid time period can minimize the damage done.

Stroke

strokesischemic strokecerebrovascular accident
Stroke, secondary to embolism or hypoperfusion.
High risk: atrial fibrillation and paroxysmal atrial fibrillation, rheumatic disease of the mitral or aortic valve disease, artificial heart valves, known cardiac thrombus of the atrium or ventricle, sick sinus syndrome, sustained atrial flutter, recent myocardial infarction, chronic myocardial infarction together with ejection fraction

Revascularization

revascularisationre-vascularisationrevascularized
The SYNTAX trial was a randomized controlled trial of 1800 patients with multivessel coronary disease, comparing CABG versus PCI using drug-eluting stents (DES). The study found that rates of major adverse cardiac or cerebrovascular events at 12 months were significantly higher in the DES group (17.8% versus 12.4% for CABG; P=0.002). This was primarily driven by higher need for repeat revascularization procedures in the PCI group with no difference in repeat infarctions or survival. Higher rates of strokes were seen in the CABG group.
For coronary artery disease (ischemic heart disease), coronary artery bypass surgery and percutaneous coronary intervention (coronary balloon angioplasty) are the two primary means of revascularization.

Vasoplegic syndrome

Vasoplegic syndrome, secondary to cardiopulmonary bypass and hypothermia
VPS occurs more frequently after on pump CABG surgery versus off pump CABG surgery.

Endoscopic vessel harvesting

endoscopic vein harvesting
The right internal thoracic (mammary) artery (RITA or RIMA) and the radial artery from the forearm are frequently used as well; in the U.S., these vessels are usually harvested either endoscopically, using a technique known as endoscopic vessel harvesting (EVH), or with the open-bridging technique, employing two or three small incisions.
Endoscopic vessel harvesting (EVH) is a surgical technique that may be used in conjunction with coronary artery bypass surgery (commonly called a "bypass").

Minimally invasive direct coronary artery bypass surgery

MIDCABMinimally Invasive Coronary Artery Bypass Surgery
Further refinements to OPCAB have resulted in minimally invasive direct coronary artery bypass surgery (MIDCAB), a technique of performing bypass surgery through a 5 to 10 cm incision.
Minimally Invasive Direct Coronary Artery Bypass (MIDCAB) is a surgical treatment for coronary heart disease that is a less invasive method of coronary artery bypass surgery (CABG).

Median sternotomy

sternotomy
Delayed healing or refracture of sternum - the sternum is bifurcated logitudinally (a median sternotomy) and retracted to access the heart. Failure to follow "sternal precautions" following surgery could result in delayed healing or refracture of the sternum which was sutured at the closure of the chest wound:
This procedure provides access to the heart and lungs for surgical procedures such as heart transplant, corrective surgery for congenital heart defects, or coronary artery bypass surgery.

Pleural effusion

pleuraleffusionpleural effusions
Pleural effusion: Fluid in the space around the lungs. This can lead to hypoxia which can slow recovery.
Pleural effusions may also occur through medical or surgical interventions, including the use of medications (pleural fluid is usually eosinophilic), coronary artery bypass surgery, abdominal surgery, endoscopic variceal sclerotherapy, radiation therapy, liver or lung transplantation, and intra- or extravascular insertion of central lines.

Coronary stent

coronary artery stentheart stentstent
Bypass surgery can provide relief of angina when the location of partial obstructions precludes improving blood flow with stents.
The MASS-II trial compared PCI, CABG and optimum medical therapy for the treatment of multi-vessel coronary artery disease. The MASS-II trial showed no difference in cardiac death or acute MI among patients in the CABG, PCI, or MT group. However, it did show a significantly greater need for additional revascularization procedures in patients who underwent PCI.