Coronary Artery Bypass Grafting

Coronary Artery Bypass Surgery

(i) 2% of patients may have a heart attack during ring teaching.
(ii) Excessive bleeding may occur during operation.
(iii) The balloon may burst.
(iv) Circumcision of the ring may cause complete cessation of blood flow.
(v) Blood clots may occur at the site of stent placement.
(vi) Patient may be re-booked.
(vii) Sometimes blood clots form in the area where the ring is applied and the clot enters the blood vessels of the brain causing a stroke.
(viii) Many may be allergic.
(ix) It is an expensive medical procedure.

(i) Removal of the arterial occlusion by angioplasty relieves the patient’s chest pain.
(ii) Chances of heart attack are eliminated.
(iii) The patient can do light activities within a few days.
(iv) Prolonged precautions are not required.
(v) Patient recovers within one month.

1. Before starting laser angioplasty, the patient’s heart rate, blood pressure and diabetes are controlled.
2. The patient is sedated by applying local anesthesia to the skin of the groin or arm to prevent pain.
3. A puncture is made in a major blood vessel in the groin or arm with a thick needle.
4. A guide catheter (narrow, flexible and long tube) is inserted through the hole.
5. The tip of the guide catheter is inserted into the atheroma segment of the coronary artery.
6. A laser catheter is passed through the guide catheter.
7. Dye is injected into the catheter to mark areas of arterial plaque. This method is called fluoroscopy. The dye helps monitor whether the catheter has reached the precise location. It is monitored by X-ray monitor.
8. After reaching the plaque-laden part of the artery, the laser beam destroys the plaque layer by layer. Destroyed plaque evaporates.
9. As a result, blood circulation becomes normal.

1. Surgery is done after confirmation by angiogram.
2. Before starting angioplasty, the patient’s heart rate, blood pressure and diabetes are controlled.
3. The patient is sedated by applying local anesthesia to the skin of the groin or arm to prevent pain.
4. A puncture is made in a major blood vessel in the groin or arm with a thick needle.
5. A guide catheter (narrow, flexible and long tube) is inserted through the hole.
6. The tip of the guide catheter is inserted into the atheroma segment of the coronary artery.
7. A balloon catheter covered by a stent is passed through the guide catheter.
8. Dye is injected into the catheter to mark areas of arterial plaque. This method is called fluoroscopy. The dye helps monitor whether the catheter has reached a specific location. It is observed with the help of monitor.
9. Within 30-60 seconds of delivering the balloon and stent to the atheroma, the balloon is inflated. This compresses the fat in the atheroma and dilates the narrowing of the artery.
10. A metal stent or ring is placed over the part of the artery dilated by the balloon. After placing the ring, the catheter with the balloon is taken out.
11. The ring contains a drug coating that is always released into the artery. The free drug dissolves arterial fat and inhibits re-bulking.
12. A single angioplasty takes 30-40 minutes and the patient has to stay under a doctor’s observation for a day.
Sometimes balloon pressure does not dilate narrowed arteries. As a result angioplasty was not possible and the patient underwent CABG surgery.

1. Balloon angioplasty
2. Stenting angioplasty
3 . Laser angioplasty
4 . Coronary atherectomy

The word Angioplasty is composed of Angio meaning blood vessel and plasty meaning reconstruction. When cholesterol or fat accumulates in the artery, or the blood flow is blocked, the blood flow is normalized by widening it by mechanical means is called angioplasty. This is called percutaneous coronary intervention (PCI). Cholesterol accumulates in the coronary arteries for a long time and forms plaque. The plaque thickens to form an atheroma called a coronary artery. Coronary arteries account for 70%-80%. Dr. Andres Groenzig of Switzerland first applied this method in 1977.

Coronary bypass patients have to follow certain restrictions. Not smoking, controlling high blood pressure, controlling diabetes, treating cholesterol, exercising regularly, maintaining a healthy body weight, not being under stress, taking medicines as prescribed by the doctor.

Coronary bypass can be done with the heart beating. It is called OPCAB. Coronary bypass is now done by making a short cut on the left side of the chest by stopping the heart. It is called MIDCAB.
1. Before starting coronary bypass, the patient’s heart rate, blood pressure and diabetes are controlled.
2. The patient is rendered unconscious by applying anesthesia to prevent pain.
3. The patient’s blood circulation is kept normal by heart-lung machine.
4. The patient’s chest was cut and the heart was removed.
5. An artery in the arm or leg is cut and connected to the heart. As a result, blood in the heart alternates
moving
6. In this case it takes 3-5 hours. The patient is kept under close observation in the hospital for 2-3 days. The patient recovered within two months.