Because better educated patients have better outcomes.

Basics of coronary artery bypass graft surgery: What is it?Words to rememberPictures worth seeing

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Coronary artery bypass graft surgery is an operation where a heart surgeon takes blood vessels from somewhere other than your heart, such as your arm or leg, and uses those vessels to create a new route for blood to flow around, or "bypass", the blocked arteries in your heart.

Every year there are about 500,000 people in the United States who have a coronary artery bypass graft surgery (National Center for Health Statistics).

Watch this video animation to see what bypass surgery looks like

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  • Angina

    Angina is severe chest pain, mainly due to coronary artery disease.

    There is pain because the heart is not getting the blood flow and oxygen it needs.

  • Arteriosclerosis

    Arteriosclerosis is when your heart’s arteries thicken and stiffen up, making it difficult for blood to flow through them. The heart’s arteries can stiffen up because of a person’s age, high blood pressure, or the build up of fatty materials like cholesterol.

    Arteriosclerosis is also the most common reason why patients need to have bypass surgery.

  • Cardiac stent

    A cardiac stent is a small metal wire that is placed in a blocked artery to keep it open during a percutaneous coronary intervention (PCI), also known as an “angioplasty” procedure.

  • Cardiopulmonary bypass

    Cardiopulmonary bypass (CPB) is a surgical technique where a “heart-lung machine” temporarily takes over the function of your heart and lungs during bypass surgery, so that blood and oxygen can continue to circulate throughout your body.

  • Coronary

    Something that is related to the arteries of the heart.

  • Coronary Catheterization

    A coronary catheterization is a minimally invasive procedure to investigate how well blood is flowing through the arteries of the heart.

    A physician will use a tube, or catheter, to insert dye into a patient’s arm, groin, or neck. As the dye flows through the body and into the arteries of the heart, the physician takes X-rays to see how well the dye flows through the heart, which helps the physician to determine what kind of treatment might be best for the patient.

  • EKG

    EKG, formally known as an “electrocardiograph”, is a quick and easy test that records the electrical activity of your heart. EKGs help to measure whether or not the heart is beating at a normal rhythm.

  • Graft

    A graft is tissue taken from one part of the body and used in another for surgery. For example, in bypass surgery, the graft is a blood vessel taken from the patient’s chest, arm, or leg and then used to repair arteries in the heart.

  • Ischemia

    Ischemia means no blood flow into tissue.

  • Myocardial Infarction (MI)

    Myocardial infarction, commonly known as a “heart attack”, is when a blockage in the heart’s arteries interrupts blood flow and oxygen to the heart. As a result, the restriction of blood supply, or ischemia, and oxygen shortage can severely damage the heart.

  • Optimism

    Optimism is a tendency to see the more positive side of things and to remain confident about a successful outcome in the future.

  • Percutaneous Coronary Intervention (PCI)

    Percutaneous coronary intervention, commonly known as “angioplasty”, is a procedure that can treat coronary artery disease by widening a blocked or narrowed blood vessel in the heart.

    In this procedure,a “balloon catheter” is threaded into the narrowed vessel, inflated to break up the fatty materials that were blocking blood flow, and then deflated before being removed from the body. PCI is an alternative to heart surgery.

  • Trust

    Trust is the reliance on the integrity, strength, and ability of a person or thing.

  • Unstable Angina

    Unstable angina is a type of chest pain, or angina, that occurs even when a person is at rest, begins to occur more frequently for longer periods of time than previous pains. This is more severe than traditional angina.

Angina

Angina is severe chest pain, mainly due to coronary artery disease.

There is pain because the heart is not getting the blood flow and oxygen it needs.

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  • There are four chambers of the human heart -- the right atrium, right ventricle, left atrium, and left ventricle.
  • There are four valves of the human heart -- the tricuspid, pulmonary, mitral, and aortic valves. These valves direct the flow of blood through the chambers of the heart and the main arteries that deliver blood to the rest of the body.
  • The coronary arteries are a network of blood vessels that deliver blood to the heart. These blood vessels are located on top of the heart itself and if blocked, then it can cause damage to the heart. While there are many different blood vessel branches and arteries, the most important is the left anterior descending artery which is most commonly bypassed in heart surgery.

There are four chambers of the human heart -- the right atrium, right ventricle, left atrium, and left ventricle.

"What to know before surgery"

What's the difference between angioplasty, or "stenting", and bypass surgery?

submitted over 2 years ago by Open Clinic

Watch Dr. Doty's answer Read Dr. Doty's answer About Dr. Doty

There is common confusion between the terms angioplasty or stenting and coronary bypass surgery. Angioplasty is a procedure where a small catheter is placed inside the arteries of the heart that are blocked and balloon is blown up to try to crack open or expand the area of narrowing. Bypass surgery involves open heart surgery. The chest is opened, the patient is placed on a heart-lung machine, and then actual bypass grafts are placed using veins or arteries to route the blood stream around the blocked arteries in the heart. Angioplasty is a less invasive procedure usually done by an interventional cardiologist and the patient can go home the same day or the next day. Coronary bypass surgery is performed by a cardiac surgeon and generally requires several days in the hospital to recover.

John is a cardiovascular and thoracic surgeon at Intermountain Medical Center in Salt Lake City, Utah. His education and training as a surgeon include:

  • Johns Hopkins Hospital Cardiothoracic Surgery Fellowship (2000-2003)
  • Johns Hopkins Hospital General Surgery Residency (1994-2000)
  • Georgetown University School of Medicine (Medical Degree, 1994)
  • Brigham Young University (Bachelor of Science, 1990)

What are the risks of bypass surgery?

submitted almost 3 years ago by Open Clinic

Watch Dr. Doty's answer Read Dr. Doty's answer About Dr. Doty

So there are essentially about five major risks of bypass surgery and those five risks are: death, stroke, heart attack, bleeding, and infection. The risk of any of those complications goes up if you are older, if your heart is sick, you need an emergency operation, or you have other organs in your body that do not work well. In general, if you are reasonably healthy and the operation is done in an elective manner, so it is scheduled, the risk of any of those complications is probably only about 2 or 3%. Many of these risks can be estimated through a risk calculator through the Society of Thoracic Surgery and each individual patient will have a different risk profile. There are also many other very unlikely complications but those are the major risks of bypass surgery.

John is a cardiovascular and thoracic surgeon at Intermountain Medical Center in Salt Lake City, Utah. His education and training as a surgeon include:

  • Johns Hopkins Hospital Cardiothoracic Surgery Fellowship (2000-2003)
  • Johns Hopkins Hospital General Surgery Residency (1994-2000)
  • Georgetown University School of Medicine (Medical Degree, 1994)
  • Brigham Young University (Bachelor of Science, 1990)

How should I prepare myself the night before bypass surgery?

submitted over 2 years ago by Open Clinic

Watch Dr. Malaisrie's answer Read Dr. Malaisrie's answer About Dr. Malaisrie

There are several things you need to do the night before your cardiac surgery. The most important thing is not to have anything to eat or drink after midnight. It is okay to have a regular dinner but we would recommend avoiding anything spicy that can upset your stomach. It is okay to have something bland to eat and it is also okay to have an alcoholic beverage. We also recommend that you have an anti-bacterial bath washing both the hair on your head and your entire body. This is to avoid the risk of infection during the operation. For our men, we recommend that if you have any facial hair that beards and mustaches be shaven beforehand. For our women, all nail polish should be removed as this can interfere with sensors that we use during the operation. In addition, for our women we recommend to avoid placing any make-up lotion or powders during the morning of the operation.

Chris is a cardiovascular and thoracic surgeon at Northwestern Memorial Hospital in Chicago, Illinois. His education and training as a surgeon include:

  • Stanford University Cardiopulmonary Transplant Fellowship (2006-2007)
  • Baylor College of Medicine Cardiothoracic Surgery Residency (2004-2006)
  • Loyola University Chicago General Surgery Residency (1999-2004)
  • University of Maryland (Medical Degree, 1998)
  • Williams College (Bachelor of Arts, 1994)

Will bypass surgery relieve my chest pain?

submitted over 2 years ago by Open Clinic

Watch Dr. Morris's answer Read Dr. Morris's answer About Dr. Morris

The short answer is yes, it should relieve chest pain. Coronary bypass surgery is performed for two reasons. The first is for survival benefit. Successful coronary bypass surgery will help you live longer than you otherwise normally would. The second main reason that bypass surgery is performed is for symptom relief and the most common symptom relieved by coronary bypass surgery is angina or chest pain. It does this by restoring robust blood flow to the myocardium or the heart muscle to give it oxygen that the heart needs. So yes, bypass surgery should relieve your chest pain if your chest pain is attributable to ischemic coronary disease or ischemic heart disease. It should relieve it for a long time to come. Thank you for your question.

Cullen is a cardiovascular and thoracic surgeon at The Emory Clinic in Athens, Georgia. His education and training as a surgeon include:

  • Texas Heart Institute Cardiopulmonary Transplant Fellowship (2006)
  • Emory University Cardiothoracic Surgery Residency (2002-2006)
  • Emory University Cardiothoracic Surgery Research (1999-2001)
  • Emory University General Surgery Residency (1996-2002)
  • Emory University (Medical Degree, 1996)
  • University of North Carolina, Chapel Hill (Bachelor of Arts, 1992)

Can I undergo bypass surgery if I already have cardiac stents in place?

submitted about 2 years ago by Open Clinic

Watch Dr. Esmailian's answer Read Dr. Esmailian's answer About Dr. Esmailian

With respect to have bypass surgery after stenting or angioplasty, that is definitely doable. There are many patients who have had a stent placed or some sort of angioplasty done in the past that the diseases in the arteries progressed and then they have to have bypass surgery in order to be able to restore the blood flow to the heart. However, there are some patients who may not be able to have bypass surgery based on the fact that the angioplasty has very much blocked up all the artery and there is not much artery left to be bypassed. Those are very rare cases but make sure your patients are candidates for bypass surgery. One other thing one needs to also remember is the fact that after stenting in patients who have had drug _________ around them, if those stents are used, those kind of patients will be on a medication called Plavix, which is a blood thinner, and they have to stay on that for a long time, indefinitely for some patients. Those kind of patients will be at high risk for having bleeding problems since the medication cannot be stopped. But in summary, patients who have had previous angioplasty of any shape, including stenting, could be a candidate for bypass. I hope I answered your question. Thank you.

Fardad is a cardiac surgeon at Cedars-Sinai Heart Institute in Los Angeles, California. His education and training as a surgeon include:

  • UCLA Medical Center, Professor of Surgery (1994-2010)
  • UCLA Medical Center Cardiothoracic Surgery Residency (1992-1994)
  • UC San Diego General Surgery Residency (1987-1992)
  • George Washington University (Medical Degree, 1987)
  • UCLA (Bachelor of Science, 1983)

How should I go about choosing a surgeon for my bypass surgery?

submitted about 2 years ago by Open Clinic

Watch Dr. Lee's answer About Dr. Lee

Rick is a cardiac surgeon at Northwestern Memorial Hospital in Chicago, Illinois. His education and training as a surgeon include:

  • Cleveland Clinic, Heart Transplant Fellowship (2002-2003)
  • Washington University Cardiothoracic Surgery Fellowship (2000-2002)
  • Rush University General Surgery Residency (1999-2002)
  • Washington University (Master of Business Administration, 1995-1997)
  • Washington University Arrhythmia Surgery Research Fellowship (1995-1997)
  • Medical College of Wisconsin Internship (1993-1995)
  • University of Illinois at Chicago (Medical Degree, 1993)
  • Northwestern University (Bachelor of Arts, 1988)

“It occurred to me that there was no difference between men, in intelligence or race, so profound as
the difference between the sick and the well.” Nick Carraway, narrator of The Great Gatsby by F. Scott Fitzgerald