Coronary
artery bypass
surgery
Raj diwedi
1b
What is this?
• Coronary artery bypass surgery, also known as coronary
artery bypass graft (CABG, pronounced “cabbage”), is a
surgical procedure to treat coronary artery disease
(CAD), the buildup of plaques in the arteries of the
heart. It can relieve chest pain caused by CAD, slow the
progression of CAD, and increase life expectancy. It
aims to bypass narrowings in heart arteries by using
arteries or veins harvested from other parts of the
body, thus restoring adequate blood supply to the
previously ischemic (deprived of blood) heart.
• There are two main approaches. The first uses a
cardiopulmonary bypass machine, a machine which
takes over the functions of the heart and lungs
during surgery by circulating blood and oxygen.
With the heart in cardioplegic arrest, harvested
arteries and veins are used to connect across
problematic regions—a construction known as
surgical anastomosis. In the second approach,
called the off-pump coronary artery bypass
(OPCAB), these anastomoses are constructed while
the heart is still beating. The anastomosis
supplying the left anterior descending branch is the
most significant one and usually, the left internal
mammary artery is harvested for use.
Purpose
• Coronary artery bypass surgery aims to prevent
death from coronary artery disease and improve
quality of life by relieving angina, the associated
feeling of chest pain. The decision to perform
surgery is informed by studies of CABG’s efficacy in
different patient subgroups, based on the lesions’
anatomy or how well the heart is functioning. These
results are compared with that of other strategies,
most importantly percutaneous coronary
intervention (PCI).
Percutaneous coronary
intervention?
• Percutaneous coronary intervention (PCI) is a minimally invasive
non-surgical procedure used to treat narrowing of the coronary
arteries of the heart found in coronary artery disease. The
procedure is used to place and deploy coronary stents, a
permanent wire-meshed tube, to open narrowed coronary arteries.
PCI is considered ‘non-surgical’ as it uses a small hole in a
peripheral artery (leg/arm) to gain access to the arterial system, an
equivalent surgical procedure would involve the opening of the
chest wall to gain access to the heart area. The term ‘coronary
angioplasty with stent’ is synonymous with PCI. The procedure
visualises the blood vessels via fluoroscopic imaging and contrast
dyes. PCI is performed by an interventional cardiologists in a
catheterization laboratory setting.
• Patients who undergo PCI broadly fall into two
patient groups. Those who are suffering from a
heart attack and are in a critical care emergency
room setting and patients who are clinically at a
high-risk of suffering a heart attack at some future
point. PCI is an alternative to the invasive surgery
coronary artery bypass grafting (CABG, often
referred to as “bypass surgery”), which bypasses
narrowed arteries by grafting vessels from other
locations in the body.
• PCI is used to open a blocked coronary
artery/arteries and to restore arterial blood flow to
heart muscle, without requiring open-heart
surgery. In patients with acute coronary
syndromes, PCI may be appropriate; guidelines
and best practices are constantly evolving. Heart
attack ‘onset to treatment time’ is important and
significantly influences clinical outcomes of PCI
procedures.
Procedure?
• The term balloon angioplasty is used to describe
the inflation of a balloon (often part of an
integrated medical device combining a balloon,
guidewire, and stent) within the coronary artery to
‘crush’ the plaque causing the occlusion into the
walls of the artery. Balloon angioplasty is still often
performed as a part of PCI procedure,
• PCI consists of preparation of the
skin area to be accessed (groin or
arm), by shaving and swabbing the
area with a bacteriostatic agent,
usually a chlorhexidine based
product. An introducer needle is
inserted into the target artery.
Comparison with CABG?????
Conflicting data exists relating to clinical outcomes comparing PCI/Stenting and
CABG surgery. The preponderance of studies do suggest that CABG offers
advantages in reducing death and myocardial infarction in people with multivessel
blockages compared with PCI.The assessments are complicated by considerations
such as the fact that PCI is a minimally invasive procedure and CABG is significant
surgery.Different modeling studies have come to opposing conclusions on the
relative cost-effectiveness of PCI and CABG in people with myocardial ischemia that
does not improve with medical treatment.
