Coronary Bypass

What is coronary artery bypass surgery?

Coronary surgery, also known as coronary revascularization surgery or coronary bypass is a surgical intervention used to divert blood and avoid the obstruction of the coronary arteries. This obstruction consists mainly in the partial or total obstruction (stenosis) of one or some of the arteries that carry blood to the heart.

When the coronary arteries are obstructed, either partially or totally, the blood flowing through them does not have the oxygen necessary for the heart to function as it should, and the first symptoms appear. The main mission of this surgery is to give blood to those areas of the heart that suffer the lack of irrigation, as a consequence of coronary lesions. The procedure is performed under general anesthesia and lasts between four and seven hours.

Why is coronary surgery performed?

This surgery is indicated when a person has a blockage in one or more coronary arteries that jeopardize the supply of oxygenated blood to the heart.

When one or more coronary arteries are blocked, the myocardium does not receive enough blood, causing ischemic heart disease, coronary artery disease, which can also cause angina pectoris.

It is especially indicated in patients who have several vessels of the coronary environment affected after a myocardial infarction in which percutaneous revascularization was not achieved.

Snapshot of coronary surgery.

What does coronary surgery consist of?

As such, the surgery consists of bypassing the interrupted blood flow of a blocked coronary artery using the patient’s own blood vessel grafts. It is also possible to proceed through the leg via the saphenous vein or through the thorax.

Before the surgery begins, the patient will be sedated with general anesthesia, so he or she will not be conscious during the operation. In most operations of this style, the patient is connected to a circulatory pump that performs the work of the heart and lungs for the duration of the intervention.

When creating a shunt, the physician chooses a vein from the body and grafts it around the blocked area.

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As a rule, the saphenous vein is used for the procedure. An incision is made on the inside of the leg and one end of the graft is placed in the coronary artery and the other in the aorta.

Preparation for coronary surgery

When preparing for coronary surgery, the patient will have to be in permanent contact with his physician and anesthesiologist whenever he does not comply with the guidelines they have previously established.

If the patient is a smoker, the specialist will ask him to stop smoking at least two weeks before the operation, since smoking is related to breathing and blood clotting problems.

The patient will come to the hospital clean, where the area will be disinfected with antiseptics and the chest may even be shaved, if necessary to facilitate the operation.

Care after coronary surgery

After undergoing surgery, the patient must remain in the hospital for about a week. On the same day as the operation, the patient will be transferred to the Intensive Care Unit (ICU) where special attention will be paid to his or her heart rate and function.

Once the week of hospitalization is over, the patient will gradually begin to regain normality in his life. The doctor will recommend walking or swimming to regain strength, although the most important thing is to change some lifestyle habits, such as limiting fat intake, quitting smoking, a physical exercise plan…

If the patient’s job does not require a demanding physical effort, he can return to his daily activities five or six weeks after the operation, although if the job requires a great physical effort, he will have to wait longer.

Alternatives to coronary surgery

Apart from pharmacological treatment, the main alternative to coronary revascularization surgery is coronary angioplasty.

This procedure involves the insertion of a catheter through a blood vessel -through the wrist or groin- which is used to open arteries that have suffered stenosis so that blood can flow more easily to the heart. A stent – a small tube made of metal – may be used to keep the artery clear.