Coronary artery bypass surgery
Minimally invasive coronary surgery
Port access surgery
Transmyocardial laser surgery
Other types of cardiac surgery
CORONARY ARTERY BYPASS SURGERY
What is coronary artery bypass surgery?
A coronary artery
bypass graft operation is a type of heart surgery. It is sometimes referred to as CABG. The surgery is done to reroute, or "bypass," blood around clogged arteries and improve the supply of blood and oxygen to the heart. These arteries are often clogged by the buildup over time of fat, cholesterol and other substances.
The narrowing of these arteries is called atherosclerosis.
It slows or stops the flow of blood through the heart’s blood vessels and can lead to a heart attack.
How is coronary bypass done?
During bypass surgery, your doctor may "borrow" blood vessels from other places in your body:
·
A piece from a long vein in your leg may be removed and one end is sewn onto the large artery leaving your heart — the aorta. The other end of the vein is attached or "grafted" to the coronary artery below the blocked area.
·
An artery may be detached from your chest wall and the open end attached to the coronary artery below the blocked area.
·
Either way, blood can then use this new path to once again flow freely to the heart muscle.
Cardiopulmonary bypass with a pump oxygenator
(heart-lung machine) is used for nearly all coronary bypass graft operations. This means that besides the surgeon, cardiac anaesthetist
and surgical nurse, a competent perfusionist (blood flow specialist) is required.
What happens after a bypass operation?
After a bypass operation, patients are often advised to modify their diets to reduce their consumption of fat and cholesterol. They may also be advised to walk or perform other physical activity to help them regain their strength. Doctors also often recommend following a home routine of increasing activity — doing light housework, going out, visiting friends, climbing stairs. The goal is to help a patient return to a normal, active lifestyle.
Most people who have sedentary office jobs can return to work in four to six weeks; those who have physically demanding jobs will have to wait longer and in some cases may have to find other employment.
MINIMALLY INVASIVE HEART
SURGERY
What is minimally invasive
heart surgery?
Minimally invasive coronary artery
surgery is also called limited access coronary artery surgery. It is being
evaluated in several medical centers as an alternative to the
standard methods for coronary artery bypass graft surgery (CABG). Like CABG,
the surgery is done to reroute, or "bypass," blood around clogged
arteries and improve the supply of blood and oxygen to the heart.
These arteries are often clogged by atherosclerosis
.
There are two approaches commonly
used:
- Port-access coronary artery bypass (also referred to as PACAB or
PortCAB)
- Minimally invasive coronary artery bypass (also called MIDCAB)
What is port-access
coronary artery bypass (PACAB or PortCAB)?
In PACAB, your heart is stopped and your blood
is pumped through an oxygenator
or "heart-lung" machine to receive oxygen
during the surgery. This is called "cardiopulmonary
bypass." Then several
small holes or "ports" are made in your chest. Chest arteries or
veins from your leg (femoral vessels) are attached to
the heart to "bypass" the clogged coronary artery(ies). The surgical
team passes instruments through the ports to perform the bypasses,
with or without another small chest incision. The cardiac surgeon
views these operations on video monitors rather than directly.
Procedures are also being developed to replace damaged
valves
through limited access ports.
What is minimally
invasive coronary artery bypass (MIDCAB)?
The goal of MIDCAB is to avoid using the
heart-lung machine. It's performed while your heart is still beating
and is intended for use when only one or
two arteries are to be bypassed. MIDCAB
uses a combination of small holes or "ports" in your chest and a
small incision made directly over the coronary artery to be bypassed.
The cardiac surgeon usually detaches an artery from inside the chest
wall and re-attaches it to the clogged coronary artery. The surgeon
views and performs the attachment directly, so the artery to be
bypassed must be right under the incision.
TRANSMYOCARDIAL
REVASCULARIZATION (TMR)
What is transmyocardial
revascularization? How is it done?
In TMR, a laser cuts a series of channels in
the heart muscle of a sick heart to increase blood flow to the organ.
It is also called laser revascularization.
To do this procedure, a surgeon makes an
incision on the left side of the chest and inserts a laser into the
chest cavity. With the laser, the surgeon shoots holes through the
heart's left ventricle in between heartbeats. (The
laser is fired when the chamber is full of blood so the blood can
protect the inside of the heart.)
From 15 to 30 channels, each a millimeter in
diameter, are opened. Then the surgeon presses a finger on the holes
on the outside of the heart. This seals the outer openings but lets
the inner channels stay open, allowing oxygen-rich blood to flow
through the heart muscle.
How does it compare to other
treatments?
Transmyocardial revascularization has produced
promising results. Eighty to 90 percent of patients who have had this
procedure have improved from Class IV (the most severe chest pain) to
Class I or II, enabling them to live relatively normal lives.
TMR is less invasive, less expensive and
requires less recovery time than coronary artery bypass surgery. Because it doesn't require stopping the heart (and a
heart-lung machine to support circulation), there is less risk of
damage to the kidneys, brain and other organs.
Transmyocardial revascularization probably
won't replace coronary artery bypass or angioplasty
as the most common method of treating
coronary artery disease, however. These alternatives have been proven
over time to be safe, effective ways to restore blood flow to the
heart muscle. But TMR may be used for
- people who are high-risk
candidates for a second bypass or angioplasty.
- people whose blockages are too
diffuse to be treated with bypass alone.
- some patients with heart
transplants who develop atherosclerosis on the
graft.
Email: eps@stvincents.com.au
