The coronary by-pass
Heart bypass - or coronary artery bypass graft (CABG) - is a radical
procedure that has become the most frequently performed of all surgical
operations, with around 500,000 carried out every year in the US alone.
Around 10 per cent of all heart patients will undergo a cardiac bypass,
especially if they have one or more coronary arteries that are either
blocked or severely narrowed.
In an operation that can last from two to six hours, the surgeon
removes (or ‘harvests’) veins from the patient’s leg, forearm or chest.
These are then attached or grafted to a part of the artery that is not
blocked, so bypassing the blocked section. Three or more bypasses may
be created, depending on the number of blocked arteries.
The traditional approach is known as ‘on-pump’, where the heart is
stopped for several hours to allow the surgeon to perform the graft.
The patient is attached to a heart-lung machine, or pump, so that the
blood supply can be diverted from the heart and sent through the pump,
where it is oxygenated and then pumped back to the vital organs.
But a newer technique, which some surgeons believe is safer and less
traumatic, is known as ‘off-pump’ or ‘beating-heart bypass surgery’.
While the grafting procedure for both approaches is the same,
‘off-pump’ is performed with a heart that continues to beat, stabilised
by special equipment.
Angioplasty
This procedure is for patients whose arteries are either not
entirely blocked, or who have just one main artery blocked. It is a
relatively simple procedure that involves threading a ‘balloon’ type
device through the artery, so unblocking it, and pushing the plaque
back against the artery walls. A stent is also used to keep open the
artery while the procedure takes place.
While it was once considered to be a safer technique than a full
by-pass, newer evidence recognizes that angioplasty has its own
problems. The most common is that the artery will slowly close up
again, and the patient has to have a full by-pass.
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