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Dr Diana R Holdright

Consultant Cardiologist

Dr Diana Holdright

Treatments - Bypass Surgery

Furring up and narrowing of the coronary arteries impairs blood supply to the heart muscle and causes symptoms, typically chest discomfort, which can affect quality of life and, in some situations, prognosis. Treatment always involves medicines and in many cases patients are offered either angioplasty or bypass surgery (coronary artery bypass grafting or CABG – pronounced “cabbage”) to improve the blood supply to the heart. The choice of treatment depends in part on the clinical situation, i.e. whether a patient has a stable pattern of symptoms, or if it is an emergency situation such as a heart attack, the extent and location of the narrowing in the coronary arteries, and patient preference; there will be situations where both bypass surgery and angioplasty are suitable options and these should be explored carefully.

Conventional bypass surgery involves the placement of lengths of vein (typically the saphenous vein taken from the leg) or artery (using the internal mammary artery, which lies on the undersurface of the chest wall, or the radial artery, which is located in the forearm) to bypass the blockage in the coronary artery. One end of the length of vein is attached to the main blood vessel from the heart, the aorta, and the other end is attached to the coronary artery beyond the blocked segment; in the case of the internal mammary artery, which arises from a large blood vessel from the aorta, it is attached directly to the coronary artery. Because of the significantly higher long term patency rate of the internal mammary artery, every effort is made to use this as a bypass graft, with additional vein bypass grafts as necessary. The traditional operation, which has been refined over more than 60 years, involves making an incision through the breast bone at the front of the chest, known as a median sternotomy, to gain access to the heart. During the procedure the heart is “put on bypass” using a heart-lung machine to support the circulation and oxygenate the blood whilst the heart is stopped for the surgery to be performed.

More recent advances include the use of “off-pump” surgery (Off Pump Coronary Artery Bypass, OPCAB) which avoids the need for a bypass machine, as the heart does not need to be stopped for the surgery to be performed; instead it is undertaken on a beating heart. The role of minimally invasive robotic surgery for cardiac conditions is currently being investigated.

Coronary artery bypass surgery is a major operation and most patients should expect to be in hospital for 7 to 10 days, with full recovery taking an average of three months. Driving of private motor vehicles should cease for at least four weeks post-surgery, but the DVLA does not need to be notified. Drivers with vocational Group 2 licences are subject to different restrictions, and full guidance can be found on the DVLA website.

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Treatments - Bypass SurgeryTreatments - Bypass Surgery