Heart Bypass Surgery (CABG)
Bypass surgery can be performed on any artery in the body, but most often involves the coronary arteries (the arteries that supply blood to the heart muscle itself). During bypass surgery, a graft vein or artery is taken from a healthy blood vessel in the body. The graft is then surgically attached above and below an obstructed or poorly functioning artery.
After surgery, the blood will flow through the graft vessel, avoiding or “bypassing” the blocked vessel, and provide oxygen and nutrients necessary for survival to the area of tissue beyond the blockage.
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What is the difference between on-pump and off-pump bypass?
During on-pump bypass, the pumping and oxygenation function of the heart is taken over by a heart-lung machine during the surgery, and medications are given that briefly paralyze the heart (cardioplegia). This way, the heart is completely at rest while the surgeon performs the bypass surgery.
Off Pump/Beating Heart is also known as “beating heart bypass surgery.” A heart-lung machine is not used, and the heart is not stopped with medications. Instead, the heart continues to perform its pumping and oxygenation functions while the surgeon works. The surgeon stabilizes just the portion of the heart where the bypass is needed, while the remainder of the heart continues to function normally. There are four sources used during bypass surgery for the healthy graft blood vessel.
What vessels do surgeons use as grafts?
The saphenous vein in the leg is the most common vein used as a bypass graft. Traditionally, the saphenous vein was obtained via a long and painful incision in the leg, from groin to ankle. This new endoscopic technique requires only two or three 1-inch long incisions in the leg. An endoscope connected to a video camera is then inserted into the smaller incisions and the saphenous vein is removed with far less scarring and trauma.
There are several arteries that can be used as grafts for bypass surgery, but the most common is the left internal mammary artery (LIMA). The right internal mammary artery (RIMA) may also be used as a graft. These arteries are accessed thru the same chest incision used to access the heart. Occasionally, the radial (in the arm) or the gastroepiploic (near the stomach) arteries may be used, each accessed through separate incisions.
Your surgeon may use a sutureless device for the part of a vein graft that is attached to the aorta. The saphenous vein is loaded onto a device that is inserted into a small hole the surgeon has cut in the patient's aorta. He or she then pushes a button, releasing a tiny web of wires, which unfold to form a star-shaped rivet. Your doctor can determine if this is an option for you.
This is a vein that has been cryopreserved and stored in a tissue bank. It is blood type specific for the patient.