coronary heart disease- surgery

Surgery

Surgery in coronary heart disease is reserved for people whose disease is either severe or is not improved or stabilized by medication and other less invasive therapies.

Coronary artery bypass grafting (CABG): This is the standard operation for blockages of coronary arteries.

• If multiple coronary arteries are blocked, or if the left main artery shows significant blockage, bypass surgery is usually the best treatment choice.
• The blocked parts of the arteries are detoured or bypassed with blood vessels “harvested” from your chest (internal mammary), arm (radial artery), or a leg (saphenous vein).
• During the surgery, the heart is stopped temporarily and you are connected to a machine called a bypass pump that takes over the functions of the heart.
• These operations are very successful and have a low rate of complications.

Off-pump bypass surgery: Sometimes surgeons can perform open heart surgery without using a bypass pump and while the heart is beating. The procedure causes fewer side effects than the standard procedure, but it is not feasible in all situations.

Minimally invasive coronary bypass (MINI-CABS): If just your front or right coronary arteries need bypass, a surgeon may replace the blocked artery with an artery from the chest via a small keyhole incision, without opening your chest, to detour the blockage

Transmyocardial laser revascularization (TMR): TMR offers an alternative for people who are not good candidates for either angioplasty or bypass surgery.

• A surgeon uses a laser catheter to create multiple pinholes in your heart muscle.
• The holes encourage growth of new vessels into the diseased heart muscle.
• This procedure can be done by itself or in conjunction with coronary bypass surgery.

Next Steps

Follow-up

Regular follow-up visits with your health care provider are essential. Coronary heart disease is a chronic (long-term, ongoing), relentlessly progressive disease.

• Reducing risk factors may only slow its pace.
• Even angioplasty or bypass surgery only reduces the severity of the disease. It does not cure the disease.
• It often comes back and gets worse, requiring further treatment for people with previous heart attacks or bypass, especially if the patient has not corrected the abnormal risk factors.

Your health care provider will usually monitor you for the following conditions:

• New symptoms or signs of disease progression (periodic physical exams and ECGs or stress tests)
• Silent ischemia (periodic treadmill or radionuclide stress tests or stress echocardiography)

Your health care provider will also monitor your progress in risk reduction and how well treatment is working. Keep track of your own numbers. This is your life.

• Checking weight and activity levels
• Checking blood lipid levels, including the bad LDL, the good HDL, and triglycerides, another fat frequently elevated in overweight patients, especially if diabetic - LDL should be less than 100
• Checking blood pressure, which should be less than 130/80 mm Hg
• If diabetic, checking blood sugar and A1C (should be less than 7.0%)
• Checking progress with quitting smoking

He or she will monitor how well your medications, making adjustments as necessary. Side effects of medications will also be monitored and treated if necessary.

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