Treatment and Prevention
Coronary artery bypass surgery is an open-heart procedure. The patient
is placed under general anesthetic. The surgeon will begin the operation by
making an incision in the chest and then dividing and separating the breastbone.
Ice water will be placed on your heart to cool it down. Tubes are then attached
to the heart and connected to a heart-lung machine that keeps the blood supplied
with oxygen. Blood will travel from the upper chambers of the heart to the machine
and then throughout the body. Blood pressure, temperature, and breathing will
all be closely monitored.
Once the heart-lung machine has taken over for the heart, the surgeon will
clamp the aorta (a major artery taking blood from the heart to the
rest of the body). He or she will then graft or sew a vein or artery taken from
another part of the body onto the blocked coronary artery. The grafted veins
or arteries join the aorta to the coronary artery, bypassing the blocked part
of the coronary artery and bringing oxygen-rich blood to the heart. The vein
used for the graft is usually taken from the leg (the saphenous vein).
Most surgeons also use at least one artery as a graft. This is often an internal
mammary artery taken from the chest wall beneath the breastbone (sternum).
The mammary artery is already connected to the aorta so, unlike the transplanted
leg vein, it only has to be sewn onto the blocked coronary artery. In some cases,
another thoracic or chest artery is used. Both the transplanted veins and arteries
were nonessential in their original location, and their removal does not affect
blood flow.
Once the grafting is finished, the patient will be taken off the heart-lung
machine. The patient's own heart and lungs will take over again, and the surgeon
will rejoin the breastbone with stainless steel wires. Sometimes as many as
four arteries are bypassed in a single operation called quadruple bypass surgery.
An average operation lasts from three to six hours. Afterwards, some
people are initially disoriented and suffer from a fever
for three or four days. Most patients will be able to eat solid foods after
a day or two and leave the hospital in about five days to a week. The stitches
will be removed about a week after the operation. The doctor will let the patient
know when to return to work. Remember that exercise helps the healing process
and prevents the formation of blood clots.
After surgery, most patients will be prescribed medications, if they are not
already taking them. The medications usually prescribed include cholesterol-lowering
medications, beta-blockers and ACE inhibitors (drugs that control
blood pressure and decrease the work of the heart), and antiplatelet medications
such as ASA (Aspirin®) to prevent blood clots.
Artery grafts rarely go on to develop coronary artery disease. More
than 90% still work ten years after the surgery. Vein grafts do eventually become
obstructed. After five years, one third of any veins may be clogged.