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VERIFIED CONTENTAuthor: lek. Katarzyna Banaszczyk

One of the methods of treating ischemic heart disease is an invasive procedure, commonly known as bypass surgery, or more medically - aorto-coronary bypass surgery. This operation is the most frequently performed procedure in cardiac surgery. What is bypass implantation?

By-passes - what is this procedure?

By-passes is a cardiac surgery procedure, otherwise known as coronary artery bypass grafting (CABG - short for coronary artery bypass grafting). Such an operation allows the aorta to connect with the coronary vessels in such a way that it avoids the sections of the coronary vessels narrowed by atherosclerotic plaques. Coronary vessels supply the heart muscle with oxygen-rich blood.

The aim of this procedure is therefore to improve arterial blood supply to the heart, thanks to which the heart is better supplied with oxygen and substances necessary for its proper functioning. The blood supply to the heart muscle improves, thanks to which it is possible to reduce the symptoms of the disease resulting from the narrowing of the coronary vessels of the heart.

Vascular bypass grafts are most often obtained from the superficial vein of the lower limb (typically the lower leg). If a fragment of a venous vessel cannot be removed from the lower limb (for example, due to varicose veins), the radial artery (located in the upper limb) or the right internal thoracic artery (chest) can be used. Typically, a cardiac surgeon will need about 10 centimeters of vessel to perform a bypass.

Coronary artery disease - what is it?

At this point, it is worth taking a closer look at the condition, which in some situations requires bypassing. The essence of ischemic heart disease is the insufficient supply of oxygen-rich blood to the heart muscle, in the vast majority (>80-90% of cases) it is caused by atherosclerosis of the coronary arteries - that is, the formation of atherosclerotic plaques in these arteries, which leads to them strictures. Coronary atherosclerosis can even lead to a myocardial infarction if the stenosis is significantly severe or the plaque ruptures and the blood flow in the arterial vessel is suddenly restricted.

It's good to know that when talking about arteriesCoronary arteries, we mean here two arteries - and more precisely the right coronary artery, which supplies blood to the right atrium and the ventricle, the posterior part of the interventricular septum, and a certain part of the left ventricular wall and the left coronary artery, which supplies blood to the rest of the heart muscle. Depending on the site of the stricture, a different part of the heart will be ischemic.

Coronary heart disease - symptoms

It is worth mentioning here about the symptoms of ischemic heart disease, which in some situations are eliminated by performing cardiosurgical procedures, including by-passes. The most common symptoms reported by patients with ischemic heart disease are:

  • chest pain - typically caused by physical exertion, but also by emotional stress and exposure to cold air, this pain is most often felt retrosternally, it can radiate to the left upper limb, sometimes the jaw, neck. Patients describe this sensation as pressure, a heavy feeling or a burning, burning, or crowding sensation. Moreover, the pain typically lasts a few minutes and resolves with rest. Chest pain is a very important clinical symptom in medicine, because it should be differentiated from myocardial infarction,
  • exercise-induced dyspnea,
  • fatigue, weakness,
  • stomach ache, nausea.

The symptoms described above should definitely make us visit a doctor, preferably at the beginning of the general practitioner, i.e. your family doctor. After examining us, the doctor will decide on the next diagnostic steps and it is possible that he will recommend a visit to a specialist - a cardiologist.

By-passes - indications for aortic-coronary bypass

In most cases, ischemic heart disease is treated with medication and, of course, lifestyle modifications, including diet and appropriately selected physical activity. However, in some cases it is necessary to undergo an invasive procedure to restore patency of the coronary vessels of the heart. Typically, the first-line procedure that doctors decide on is coronary angioplasty (so-called ballooning), which consists in dilating the narrowed vessel using a special "balloon".

Which procedure is selected depends on the vessel affected by the atherosclerosis, the age of the patient, and other factors, such as comorbidities or the patient's life expectancy.

Coronary aortic bypass (i.e. bypass, CABG) is preferred when we are dealing with:

  • with left main coronary artery disease,
  • diseasethree vessel,
  • comorbidities (such as, for example, diabetes, impaired left ventricular function),
  • contraindications to dual antiplatelet therapy - such therapy is necessary after coronary angioplasty,
  • tortuous course of the vessels or significant calcifications in the vessels,
  • recurrent restenosis (i.e. restenosis) in the stent.
  • the presence of indications for another cardiac surgery (then two procedures can be performed during one procedure - for example, surgery of the ascending aortic aneurysm, or replacement of the heart valve).

By-passes - the course of coronary bypass surgery

Patients before the coronary artery bypass surgery are wondering what the whole operation looks like and what exactly happens during its duration. The procedure can be performed with or without extracorporeal circulation. In the first case, the cardiac surgeon first opens the chest by making an incision along the sternum. Then, it is necessary to connect the equipment for cardiopulmonary bypass and cardiac arrest. In this case, the procedure is performed on a non-beaten heart. After the vascular bypass is in place and the vessels are properly connected, the heart rate is restored.

This procedure can also be performed without the use of extracorporeal circulation. Then the heart does not stop beating - the procedure is performed on a beating heart. The cage is opened in the same way as described above. Increasingly, procedures are also performed from an access other than through incision of the sternum - it is also possible to bypass access through left-sided thoracotomy - i.e. opening the cage on the left side, but this method is used only when it is necessary to treat individual strictures.

You should be aware that after coronary artery bypass surgery, appropriate cardiac rehabilitation is necessary, which allows you to return to normal life activity. Appropriate exercises are already implemented in the hospital, immediately after the procedure, and after discharge - the patient should stay in a sanatorium, where doctors will select appropriate exercises for the state after the procedure.

Coronary aortic bypass - contraindications to the procedure

It is not possible to perform a bridging in all cases. The contraindications for bypassing include:

  • disagreement on the part of the patient - this is an absolute contraindication to each operation,
  • stenosis of the coronary artery along its entire course - this makes it impossible to bypass the stenosis because the entire vessel is occupied,
  • significantly impaired heart function when left ventricular ejection fraction is below 20-30%,
  • severe bleeding diathesis - which poses a risk of significant bleeding during surgery,
  • unstable, advanced chronic diseases such as kidney failure, lung diseases, severe hypertension, electrolyte disturbances, advanced malignant neoplasms,
  • an active infection that continues throughout the body.

The final decision to perform the procedure is of course made by the patient together with specialists - in the case of coronary artery bypass grafting, a special qualification is required, in which a cardiologist, cardiac surgeon, invasive cardiologist, anesthesiologist and specialist neurologist participate. Sometimes it is also necessary to consult another specialist, depending on the other chronic diseases present in a particular patient.

By-passes - complications after the procedure

Like all procedures, including the coronary artery bypass surgery, may be associated with the occurrence of certain complications, the more so as it is a major surgery, usually performed in patients with chronic diseases. The complications of this operation include:

  • myocardial infarction,
  • stroke,
  • death during surgery,
  • bypass bleeding,
  • need to re-operate,
  • operating wound infection,
  • pneumonia,
  • acute renal failure,
  • pulmonary embolism.

In case of any doubts, it is not worth giving up the procedure - ask your doctor about the issues that interest you. Coronary aortic bypass surgery reduces the risk of myocardial infarction and improves the quality of life of patients suffering from ischemic heart disease. Although rehabilitation after surgery takes about 6 weeks, it is possible to return to normal activity, including work.

About the authorbow. Katarzyna BanaszczykA graduate of the medical faculty of Collegium Medicum in Bydgoszcz, UMK in Toruń. Currently, he is carrying out a postgraduate medical internship. Author of scientific articles and many educational articles aimed at disseminating medical knowledge.

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Cardiology