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Introduction to Coronary Artery Bypass Surgery
• Bypass Surgery, Cont. • New Bypass •
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The most common operation that heart surgeons perform is coronary
artery bypass surgery.
It is also the most studied surgical procedure in the history of
surgery. The procedure is incredibly successful, and yet, it still
carries a significant risk and potential morbidity to patients, not to
mention the rising costs of the keeping up with the latest technology.
Below is an article I wrote on new technologies in cardiac surgery.
I discuss a lot of the philosophy behind the reasons for introducing new
techniques which I will share with you here.
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As you can see, we have
introduced a lot of new technologies in cardiac surgery at Lehigh Valley
Hospital...
This actually represents only a partial list, as
new technologies are being introduced every few months!
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Before talking
about Coronary Artery Bypass Surgery, we need to talk about the blood
supply to the heart:
The heart is busy pumping blood out to the rest
of the body and it does so through a very large artery leading out of the heart
known as the aorta (see diagram above). Keep
in mind, though, that even though the heart is pumping blood out to all the
other organs, the heart needs its own blood supply in order to survive.
The blood supply to the heart comes from the coronary
arteries, which are actually the first two branches of the aorta.
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What is
hardening of the arteries?
The fancy word for hardening of the arteries is
atherosclerosis. Basically, the inner lining
of the coronary arteries becomes damaged and as a result plaque (fatty
substances and calcium) begins to build up. As the plaque builds up, the
arteries become narrowed as shown in the picture at the right:
What causes hardening of the
arteries?
There are many common risk factors that leads to hardening of the arteries.
Unfortunately, the most common is
genetics. If your parents had coronary artery
disease, especially at a young age, then your risk for coronary artery disease
is also high. Keep in mind, if your parents did not have coronary artery
disease that does not mean you're free and clear. Our genetics go back
thousands of years and so the bad genes can be hidden for generations.
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After genetics, there is a whole list of other
risk factors. Of course, some might debate that all of the following are
effected by genetics as well. For example, everyone agrees that
high cholesterol is a risk factor for heart
disease. Certainly, our diets have an impact on our cholesterol levels,
but also our genetics determine our baseline cholesterol levels. That's
not to say that you should continue to eat fried foods because your family has a
history of high cholesterol. On the contrary, it's even more important for
you to stop eating high fat foods since your risk for getting heart disease is
even greater. |
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High blood pressure (arterial
hypertension) is one of the most common risk factors for
developing hardening of the arteries. In addition, high blood pressure
causes muscle damage to the heart, leads to aneurysm formation, kidney failure,
and even stroke. The problem with high blood pressure is that most
patients don't realize that they have it. It's truly a silent killer!
That's why you need to have a yearly physical exam. Interestingly, high
blood pressure can often be tricky to treat as patients may exhibit "normal"
blood pressure in their doctor's office, but have an abnormal response in blood
pressure during exercise or stress. |
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Diabetes
causes hardening of the arteries. Indeed, diabetes causes very severe
changes in all of the body's blood vessels, nerves, and tissues. When the
diabetes is severe, the blood vessels can become so narrowed and diseased along
their lengths that we can't even perform a bypass to the vessels because their
is no adequate place to do our sewing.
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Obesity
can lead to diabetes and, of course, can contribute to high cholesterol and high
blood pressure. As you can imagine, it's very common for us to see
patients with multiple risk factors. Additionally, patients with both
diabetes and obesity are at significant risk for developing wound infections and
difficulty healing. |
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Smoking
causes hardening of the arteries. Yes it does! Cigarette smoke is
toxic for many reasons. First, it causes spasm of the the blood vessels.
On top of that, the chemicals in the smoke include chemicals that break down
tissues and destroys the cells throughout the body. That's why smokers are
at risk for a lovely combination of heart disease and cancer. By the way,
not just lung cancer, but many others such as kidney cancer, blood cancer, and
blood cancers. Heavy smokers also do poorly with surgery, often having
pulmonary (lung) complications such as pneumonia, blood clots, and a
significantly increased chance of wound problems. |
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Last Modified
Tuesday, October 11, 2005
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