bypass heart surgery

Gbex says: Coronary artery bypass surgery, also coronary artery bypass graft (CABG) surgery, and colloquially heart bypass or bypass surgery is a surgical procedure performed to relieve angina and reduce the risk of death from coronary artery disease. Arteries or veins from elsewhere in the patient's body are grafted to the coronary arteries to bypass atherosclerotic narrowings and improve the blood supply to the coronary circulation supplying the myocardium (heart muscle). This surgery is usually performed with the heart stopped, necessitating the usage of cardiopulmonary bypass; techniques are available to perform CABG on a beating heart, so-called "off-pump" surgery.

Procedure:
1.The patient is brought to the operating room and moved on to the operating table.

2.An anaesthetist places a variety of intravenous lines and injects an induction agent (usually propofol) to render the patient unconscious.

3.An endotracheal tube is inserted and secured by the anaesthetist or assistant (e.g. respiratory therapist or nurse anaesthetist) and mechanical ventilation is started.

4.The chest is opened via a median sternotomy and the heart is examined by the surgeon.

5.The bypass grafts are harvested - frequent conduits are the internal thoracic arteries, radial arteries and saphenous veins. When harvesting is done, the patient is given heparin to prevent the blood from clotting.

6.In the case of "off-pump" surgery, the surgeon places devices to stabilize the heart.

7.If the case is "on-pump", the surgeon sutures cannulae into the heart and instructs the perfusionist to start cardiopulmonary bypass (CPB). Once CPB is established, the surgeon places the aortic cross-clamp across the aorta and instructs the perfusionist to deliver cardioplegia to stop the heart.

8.One end of each graft is sewn on to the coronary arteries beyond the blockages and the other end is attached to the aorta.

9.The heart is restarted; or in "off-pump" surgery, the stabilizing devices are removed. In some cases, the aorta is partially occluded by a C-shaped clamp, the heart is restarted and suturing of the grafts to the aorta is done in this partially occluded section of the aorta while the heart is beating.

10.Protamine is given to reverse the effects of heparin.

11.The sternum is wired together and the incisions are sutured closed.

12.The patient is moved to the intensive care unit (ICU) to recover. After awakening and stabilizing in the ICU (approximately 1 day), the person is transferred to the cardiac surgery ward until ready to go home (approximately 4 days).