When one or more of the coronary arteries becomes partially or totally blocked, the heart does not get an adequate blood supply.  This is called ischemic heart disease or coronary artery disease (CAD). It can cause heart pain (angina). Sometimes it does not cause pain until the blood supply to the heart becomes critically low, and the muscle begins to die. This is a heart attack (myocardial infarction).

Heart bypass surgery creates a detour or "bypass" around the blocked part of a coronary artery to restore the blood supply to the heart muscle. The surgery is commonly called Coronary Artery Bypass Graft, or CABG (pronounced "cabbage").

Description

After the patient is anesthetized, the heart surgeon makes an incision in the middle of the chest and separates the breastbone. Through this incision the surgeon can see the heart and aorta (the main blood vessel leading from the heart to the rest of the body). After surgery, the breastbone will be rejoined and the incision will be sewn closed.

If a vein from the leg is used, an incision is made in the leg and the vein removed. The vein is located on the inside of the leg running from the ankle to the groin. It normally does only about 10% of the work of circulating blood from the leg back to the heart. Therefore, it can be taken out without harming the patient or adversely affecting the leg. It is common for the leg from which the vein is taken to swell slightly during recovery from the surgery.

If the internal mammary artery is used as the graft, there is no additional incision because it is already located close to the heart.

In the traditional surgery, the patient is connected to the heart-lung machine, which adds oxygen to the blood and circulates blood to other parts of the body during the surgery. This is necessary because the heart muscle must be stopped before the graft can be done.

One end of the graft is stitched to an opening below the blockage in the coronary artery. If the grafted vein is from the leg, its other end is stitched to an opening made in the aorta. If the grafted vessel is the mammary artery, its other end is already connected to the aorta.

The entire surgery can take four to six hours. After the surgery, the patient is taken to the Intensive Care Unit. For a few days after the surgery the patient is connected to monitors and tubes.

Other techniques to do this surgery are being developed. Some involve using only grafts taken from arteries, nota leg vein. Another technique does not stop the heart during the surgery. And yet another uses smaller incisions to perform the grafts.

The costs of any surgery vary significantly between surgeons, medical facilities, and regions of the country. Patients who are younger, sicker, or need more extensive surgery will require more intensive and expensive treatment. Patients should be sure to check with their health insurance to determine type of coverage.

Surgery charges can be separated into five parts: 1) the surgeon's fee, 2) the anesthesiologist's fee, 3) the hospital charges, which includes nursing care and the operating room, 4) the medications, and 5) additional charges.

Indications

Coronary artery bypass surgery is recommended whenother therapy has not relieved ishcemic heart disease (too little blood reaching the heart muscle).The symptoms of ischemic heart disease include angina (chest pain)and shortness of breath, and these may be the earliest signs.

A person may have no symptoms at all, some have mild, intermittent chest pain, and some have more pronounced and steady pain. Still others have CAD that is severe enough to make normal everyday activities difficult.Symptoms that usually bring a person to a doctor are a feeling of heaviness, tightness, pain, burning, pressure, or squeezing, usually behind the breastbone but sometimes also in the arms, neck, or jaw. Nevertheless, some people have heart attacks without ever having any of these symptoms.

In cases where there are no symptoms, a doctor might still suspect CAD and do tests to determine if it is present. CAD is sometimes suspected if there is a family history of heart disease and a combination of other factors, including high blood cholesterol, diabetes mellitus, high blood pressure, cigarette smoking and being a male.

Because CAD varies so much from one person to another, the way it is diagnosed and treated will also vary. Heart bypass surgery is one treatment.

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