What is meant by coronary artery bypass grafting

Question 1: Surgical Introduction to Coronary Artery Bypass Grafting Coronary artery bypass grafting, or coronary artery bypass grafting, or coronary artery bypass grafting, or Coronary Artery Bypass Grafting abbreviated CABG, is internationally recognized as the most effective treatment for coronary heart disease. Coronary artery bypass grafting, which began in 1964, is a surgical procedure used to replace obstructed coronary arteries in order to improve the blood supply to the heart muscle, relieve angina pectoris, improve the quality of life, and reduce the risk of death from coronary artery disease. The method is to use a transplanted blood vessel, i.e., a bridge vessel (often the saphenous vein and the internal mammary artery with a stump, but also the radial artery, the gastroretinal artery with a stump, and other arteries and veins of the limb) to establish a vascular access at the root of the ascending aorta to the coronary arteries farther away from the diseased coronary arteries and the obstruction, so that the blood pulsing out of the heart from the aorta passes through the bridge and bypasses the diseased coronary arteries, flowing to the distal end of the stenotic coronary arteries or the blocked coronary arteries, and reaches the This improves coronary perfusion and increases myocardial oxygen supply, and the artery does not have to be connected to the root of the ascending aorta. The procedure can be performed in cardiac arrest, which requires the use of extracorporeal circulation, i.e., traditional coronary artery bypass grafting (CABG); it can also be performed on a beating heart, i.e., "off-pump CABG" (OPCAB or OPCABG). Currently, the number of off-pump CABGs in China exceeds the number of extracorporeal bypass grafts.

Question 2: Number of bypass grafts for coronary artery bypass grafting The surgeon evaluates the results of the coronary angiogram to determine the location of the coronary artery lesion and estimates the number of bypass grafts prior to surgery, but the final number of bypass grafts is determined by examining the coronary arteries intraoperatively.　　The number of bypasses is generally defined as the number of anastomoses between the bridging vessel and the diseased coronary artery. In order to economize on bridging vessels, except for important coronary arteries, such as the anterior descending branch, which are anastomosed with a single vessel, the same bridging vessel is used for all other diseased vessels, up to a maximum of two bridging vessels, with different vessels anastomosed at different parts of the bridging vessel. Such as the use of internal mammary artery, saphenous vein with four bridges, can be internal mammary artery - anterior descending branch, aorta - saphenous vein - diagonal branch - obtuse marginal branch - posterior descending branch **** 4 anastomoses; there are also operators using the program: the internal mammary artery There are also operators who use the scheme: internal mammary artery - anterior descending branch, aorta - saphenous vein - diagonal branch - obtuse marginal branch, aorta - saphenous vein - posterior descending branch.　　A higher number of bypasses does not equate to a more critically ill patient, and similarly, a lower number of bypasses does not equate to a healthier patient. A patient with more coronary artery disease may receive relatively fewer bypasses due to a lack of suitable "target vessels". A coronary artery that is too thin (internal diameter) Question 3: When should bypass grafting be done? The treatment of coronary artery disease has two goals: to prolong the patient's life expectancy and to improve the patient's quality of life. Currently, there are three methods of treatment for coronary heart disease. The first is medication, i.e. taking medication to control the symptoms. The main points are to dilate the coronary arteries, reduce the heart load and inhibit platelet aggregation. The second is percutaneous coronary intervention, which is often referred to as stenting. The third type is coronary artery bypass grafting, i.e. coronary artery bridging. Human experience has demonstrated that the immediate and long-term effects of drug therapy alone are significantly inferior to those of stenting and coronary artery bridging. Coronary artery bridging and interventional stenting have their own advantages and disadvantages and are adapted to different situations. In general, coronary artery bridging has adequate revascularization, complete relief of myocardial ischemia, and good postoperative results, but with slightly higher risks. The advantages of stenting are that it is less invasive and can be performed multiple times. However, its indications are narrow (especially not for lesions at the left main bifurcation, uncontrolled diabetics, and patients with comorbidities of other intracardiac pathologies requiring surgical intervention), and the probability of needing postoperative reintervention (i.e., bridging surgery or re-stenting) is seven times higher than that of bridging surgery. Cost-wise, if multiple stents are placed, they may be more expensive than surgery. In the United States, the ratio of stented to operated patients is about two to three to one, in Japan and South Korea the ratio is about five to one, and in China the ratio is estimated to be at least ten to one. Fu Wai Hospital had 6,771 percutaneous coronary interventions and 2,104 coronary bypass surgeries in 2009 (3.22:1). It is not the case that all Chinese patients have conditions more suitable for stenting, nor is it the case that Chinese internists are more skillful at stenting than those in foreign countries. The only explanation is that due to the high technical requirements of coronary artery surgery, many hospitals in China cannot meet the requirements of surgical treatment and have to put stents in. There are a large number of stent patients who have stents placed when they should not have. Not according to the condition of the scientific choice of treatment, the patient caused the greatest loss.

The vascular "bridge" used in coronary artery bridging surgery is known in medicine as a vascular bypass graft. Whether or not a blood vessel can be used as a coronary vascular bypass graft should meet several requirements: adequate length, a wide variety of sources, minimal damage to the patient at the time of acquisition, and a high rate of long-term patency of the vessel. The most widely available sources are artificial vessels or treated xenografts, but these are also the vessels with the lowest long-term patency rates, so they are not used clinically. The best patency rates are achieved when the patient's own blood vessels from other sites are removed and used for coronary vascular bridging. Autologous vessels are no more than autologous veins and autologous arteries. The vessels of greatest origin and length on the body are the superficial veins of the lower extremities, the great and small saphenous veins. The most traumatic for the patient to obtain is the gastro-omental artery (open chest bypass with open abdominal access). The one with the highest long-term patency rate is the internal thoracic artery (also known as the internal mammary artery). Therefore, the greater the number of arterial bridges a patient receives, the longer the efficacy of the procedure in relieving myocardial ischemia lasts. Of course, the type of bridge used depends on the patient's condition. All of the arterial bridges are more invasive to obtain and the procedures are more time-consuming.

As we know from the previous section, coronary artery bridging does not cure coronary artery disease, but only relieves myocardial ischemia due to narrowing of the coronary arteries. The American Heart Association's guidelines state that patients who undergo coronary artery bridging surgery have a 50% chance of dying from coronary artery disease. There are two reasons for this, namely the continued development of atherosclerotic lesions in the coronary arteries themselves and new lesions and their development on the newly constructed vascular bridge. Therefore, how to slow down the progression of atherosclerosis after surgery becomes the main task of postoperative treatment. Lowering blood lipids, controlling blood glucose, controlling blood pressure, quitting smoking, and proper medication, all of these can slow down the progression of the lesions. An important complication of diabetes is atherosclerosis of the small and medium arteries, which is associated with coronary artery disease in many patients. Long-term patency of venous bridges can be significantly improved by starting and continuing oral aspirin for a long period of time, up to 48 hours after surgery. Clopidogrel also has the effect of aspirin, but is more expensive to take long-term. Statin lipid-lowering drugs are the most important advance in the pharmacologic treatment of coronary heart disease in the last 30 years. Like aspirin, statins significantly improve the long-term patency of venous bridges. The American Heart Association guidelines recommend that patients undergoing coronary artery bridging surgery for coronary artery disease need to take statin lipid-lowering drugs if there are no contraindications, regardless of whether or not their blood lipids are normalized after surgery. It is important to note that statins may have the side effect of liver damage, and in order not to interfere with early postoperative recovery, Fu Wai Hospital generally recommends that patients begin taking them one month after surgery (which is significantly different from the requirement for aspirin). Taking medication ...... >>

Question 4: What is heart bypass surgery? Cardiac bypass surgery is a surgical treatment for coronary artery disease, myocardial infarction, and myocardial vessel occlusion that requires open-heart surgery.

When the blood flow is poor after a heart vessel is occluded, bypass surgery is to take another blood vessel and rebuild a blood vessel on both sides of the occluded vessel so that the blood flow can pass through again, just like building a bridge over the occluded blood vessel so that the blood can pass through the bridge from above.