According to an article published in the January/February 2007 edition of Health Affairs, 152,000 coronary artery bypass graft procedures were done in 2003. The article goes on to state that this is one of the most frequently performed surgeries in the United States. There are several options for performing cardiac bypass surgery.
Standard Procedure
The standard coronary artery bypass procedure is done through a large incision that is made from the top of the breast bone to the bottom of the breast bone. The breast bone, or sternum, is then sawed in half in a lengthwise fashion. When the surgeon has opened the chest, the heart is then cannulated. This means that cannulas or large plastic tubes are placed in the right atrium of the heart and the beginning of the aorta coming from the heart. These tubes are connected to a heart-lung bypass machine. The heart-lung machine takes the blood from the body and oxygenates it, taking the place of the heart. This allows the surgeon to stop the heart and empty the heart of blood. A saphenous vein graft taken from a vein in the leg, the left internal mammary artery or chest wall artery and sometimes a radial artery from the forearm are used to bypass the blockages in the coronary arteries. One end of the graft is sewn onto the aorta, and the other end is sewn onto the blocked coronary artery. Once all grafts have been secured, the heart is decannulated and blood flow is returned to the heart. The breast bone is wired closed and the chest wall is sewn closed with suture. Depending on the number of grafts, this can take four to six hours.
Off Pump
In off-pump coronary artery bypass, the heart is accessed the same way as in the standardized procedure. The difference is that the surgeon does not use the heart-lung machine and the heart remains beating. To sew the bypass grafts to the tiny coronary arteries, the surgeon makes use of specialized equipment that allows the heart to beat but steadies the sewing surface. The advantage of this method is that it eliminates the risk involved when using the heart-lung machine.
Minimally Invasive Procedure
Minimally invasive techniques may or may not use the heart-lung machine. Some centers use robots to assist in performing minimally invasive surgery. Patients who have arteries on the front of the heart that are blocked are candidates for minimally invasive surgery. Minimally invasive techniques do not require the large chest incision and do not typically saw the sternum apart. Small incisions are made that access the area of blockages, and the internal mammary artery is used to bypass the blockages. Patients usually go home two to three days after minimally invasive surgery.
