Coronary bypass surgery is the main procedure of coronary surgery.
Coronary bypass surgery is a surgical procedure that treats the coronary arteries, those that supply the heart, when they are blocked: this is called coronary stenosis.
They can be blocked for several often associated reasons such as excess cholesterol, smoking, obesity, migration of a blood clot, and limit the supply of oxygen to the heart muscle which leads to cell suffering.
Coronary bypass surgery involves removing a healthy vessel fragment from the patient or using a synthetic tube to graft it into the blocked vessel, bypass the obstacle and restore blood supply to the cells.
This prevents myocardial infarction and its cardiac complications after the discovery of localized stenosis by coronary angiography.
It is possible to replace several arteries in the heart in a single operation.
Coronary bypass surgery is performed in patients with severe coronary artery disease, i. e., whose arteries that supply the heart muscle are blocked by fatty deposits in their inner walls. This procedure is also recommended for people with severe angina. Angina pectoris is usually caused by coronary artery disease, the leading cause of heart disease in North America.
Coronary arteries are located on the surface of the heart. They provide the heart muscle (myocardium) with oxygen-rich blood. For the heart to pump blood normally, the heart muscle must receive a constant supply of oxygen-rich blood from the coronary arteries. When one or more arteries are blocked, the oxygen supply to the heart is reduced.
There are two forms of blocking. In the first form, the blockage appears slowly and only partially obstructs the arteries. This usually results in chest pain or angina, as the heart does not receive enough oxygen. In the second form, a complete blockage appears quickly. When it is complete, part of the heart muscle does not receive oxygen and cells begin to die. This is called a myocardial infarction, or heart attack.
The cause of partial blockages is the deposition of cholesterol and fat in the inner wall of coronary arteries. The gradual accumulation of these substances can lead to the formation of fatty deposits called plaques, during a process called atherosclerosis (hardening of the arteries). Plaque accumulates in the large branches of the two main coronary arteries and reduces blood flow in these arteries. An artery eventually gets blocked, and blood can no longer flow through it. Plaques also contribute to the formation of blood clots. Blood clots, whose volume increases slowly, can further narrow the affected artery, while those that form quickly can suddenly close the artery.
Duration of hospital stay
1 to 2 weeks.
In general, one trip is sufficient.
Average length of stay
4 to 6 weeks.
The cardiologist will ensure that the patient is stable before travelling.
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Before surgery, the doctor will perform several tests to determine the number of transplants needed and the most appropriate location to collect them.
The doctor will perform a physical examination and request blood tests to clarify the diagnosis. He or she may also recommend an exercise test, cardiac scintigraphy, and cardiac catheterization. Catheterization reveals the severity of the disease and allows the affected arteries to be detected.
Conventional coronary bypass surgery is an open-heart procedure and is performed under general anesthesia. It requires the opening of the sternum (median sternotomy) to access the heart and internal mammary arteries and an incision on the leg if it is decided to remove a saphenous vein.
Once the samples have been taken, the extracorporeal circulation is set up, i.e. the heart is put at rest and replaced by a "heart-lung" machine. This allows the collected vessels to be connected to the coronary arteries by making a very small opening in the coronary artery after narrowing.
The waterproofness is ensured by a suture with extremely fine polypropylene suture.
The operation lasts on average between 3 and 5 hours and depends on the number of bypasses and grafts chosen.
The patient will stay between one and three days in intensive care for optimal monitoring. You will then be transferred to a room in the surgical department where your family can visit you. The average stay at the clinic lasts 6 to 10 days.
After the procedure, antiplatelet aggregation therapy will be prescribed to extend the life of the venous bypass surgery. For one month you will be recommended to join an effort rehabilitation program in a specialized centre. This significantly speeds up recovery. You will see your cardiologist again between one and two months after your operation and he/she will agree with you on the modalities for resuming your work or physical activity.
This procedure is performed to increase your life expectancy but does not cure the cause of your coronary artery disease. It is therefore imperative that you take care to reduce the risk of recurrence as much as possible by adopting a diet low in saturated fats, that you take care of your diabetes, your cholesterol level or your hypertension and finally, to quit smoking permanently: all these factors promote atherosclerosis.
• Irregular heart rate
• Heart attack
• Blood clots
Coronary bypass surgery has a success rate of more than 90%.
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