With a success rate of 100%, coronary bypass surgery reduces heart damage and improves patients’ quality of life.

With a success rate of 100%, coronary bypass surgery reduces heart damage and improves patients' quality of life. (h2)

Coronary artery disease is present in 16 million Americans and is characterized by cholesterol-filled plaques that block arteries and can cause chest pain (angina) or myocardial infarction (heart attacks).

The development of coronary artery disease depends upon the presence of predisposing conditions or behaviors, i.e., RISK FACTORS.

The usual risk factors (high level of evidence) are:

• Family history
• Advanced age
• High blood pressure
• Diabetes
• Cholesterol/Lipid abnormalities
• Smoking
• Obesity

More recently identified risk factors with moderate evidence include inflammatory diseases (rheumatoid arthritis, psoriasis, lupus…), sleep apnea, periodontal disease, air pollution and emotional stress, amongst others

Regardless of the source of injury, when the endothelium of the coronary arteries is damaged, LDL cholesterol enters the artery wall and the macrophages respond with an inflammatory reaction and more damage. The cycle continues, and over time, these elements form a large plaque in the artery walls.

Many of the most common risk factors for coronary artery disease are modifiable and up to 90% of CAD could be prevented by addressing these treatable risk factors (medication, quitting smoking, regular physical activity, etc.).

If you have coronary artery disease, the therapy should be tailor-made for you by addressing your personal medical history and based on your medical condition.

The three treatments options for coronary heart disease are:

1. Medical therapy.
2. Revascularization with stenting (balloon angioplasty + stent)
3. Bypass surgery (coronary artery bypass grafting)

Coronary Artery Bypass Grafting (CABG)

When compared to stenting, coronary artery bypass grafting is associated with best results and longer life spans in people with the most severe and complex coronary artery disease. This includes blockages in all three of the heart´s major arteries, and people with a blockage of the left main coronary artery. In addition, surgery is the best option for patients with diabetes and patients with heart dysfunction.

Coronary artery bypass grafts (CABG) deliver a new source of blood to regions of the heart impaired by blocked arteries. The surgeon uses arteries and veins from a different part of the body to reroute the flow of blood around the blockage. Because most people having CABG surgery require three or more bypasses, the heart surgeon uses your internal mammary artery (located on the inside of the chest wall and extremely durable) or other arteries (radial) and veins (saphenous veins in the leg).

Bypass surgery is highly invasive as it usually requires a median sternotomy incision and intensive care for a few days. There are two types of CABG operations:

1. On pump.On-pump surgery procedures place the patient on a heart-lung machine and stop the heart temporarily. This machine takes over the function of the heart and lungs while the bypasses are performed.

2. Off-pump. The off-pump method eliminates the need for the surgeon to stop the heart and to place the patient on cardiopulmonary bypass. This is called off-pump coronary artery bypass (OPCABG) grafting. Using this approach, special devices are used to expose and stabilize the coronary arteries while the surgeon works on the beating heart.
The choice of an on- or off-pump procedure is up to the individual and depends on each case. One would assume that avoiding the heart-lung machine would improve the safety of CABG surgery, but recent large studies have demonstrated that it offers no additional benefits to most patients.

Multiple Heart Bypass Surgery

The number of coronary arteries that do not work properly determines the number of grafts that must be performed. Thus, a triple bypass surgery procedure is the procedure performed in order to make diversions around three of the coronary blood vessels. During this surgery, three separate grafts will be carried out on three different blood vessels in the heart. If only two of the coronary arteries were being operated on, this surgery would be called a double bypass instead of a triple bypass.
Following the surgery, the patient is normally discharged from the hospital after around five to seven days when surgery has been successful. Apart from the substantial triple bypass surgery survival rates, patients who have gone through this surgical operation will be able to take care of their condition with just a few medicines. A lot of them will see their symptoms reduced after only a few weeks, be able to go home just a week after surgery and may also return to work after a few months.