Coronary Bypass Surgery

Prior to coronary angioplasty and stenting, the only way to increase the blood flow to the heart muscle was to undergo a coronary bypass operation. This “does exactly what it says on the tin”! The heart Surgeon would take a piece of vein, usually from the lower leg, and stitch one end to the main artery that comes out of the heart which is known as the aorta and the other end to the coronary artery beyond the blockage. It is in fact a surgical plumbing procedure! Bypass surgery was originally used for patients with bad anginal pain that could not be controlled on tablets, but we now know from 30 years of careful research that certain patients have their life expectancy prolonged by undergoing bypass surgery. Unfortunately veins from the leg don’t last forever, but with careful control of risk factors and careful attention to lifestyle, many patients will experience longer than 10 years and in some cases up to 20 years “trouble free motoring” after their heart surgery. Coronary bypass surgery has become much safer over the last 25 years. Factors that increase the risk for heart surgery are advancing age, damage to the left ventricle or pump of the heart, diabetes, previous stroke, and lung or kidney disease. Fortunately many patients who are at high risk from heart surgery can be treated with stenting as above.

Very good results have been obtained by using the left internal mammary artery in the chest to bypass narrowings in the left anterior descending artery down the front of the heart. As it is an artery and not a vein, it is not being asked to perform an unusual function and it is a fairly simple job for the heart surgeon to isolate the mammary artery and move it over to the heart. People often ask if this is detrimental to the tissues in the chest that the mammary artery was supplying but the answer is no. Patients who have had their mammary artery used can expect it to last at least 20 years in most cases and all they will notice is some slight numbness over the left chest wall.

It is possible to have a second or even third bypass operation although where feasible we would now prefer to treat patients by stenting and postpone the need for a second bypass operation if possible.

Recent advances in coronary surgery include the ability to operate on certain patients without putting the patient onto the heart lung bypass machine and this has lessened complications and shortened hospital stay. This is called off pump coronary artery bypass or OPCAB.