coronary_artery_bypass_surgery [Neurosurgery Wiki]

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Coronary artery bypass surgery, also known as coronary artery bypass grafting (CABG), is a surgical procedure to improve blood flow to the heart. This surgery is performed on patients with significant coronary artery disease (CAD), where one or more coronary arteries become narrowed or blocked due to a buildup of plaque (atherosclerosis), which restricts blood flow to the heart muscle. CABG is often recommended when lifestyle changes, medications, or less invasive treatments like angioplasty are insufficient.

### Procedure Overview

1. **Preparation and Anesthesia**:
   - The surgery is typically performed under general anesthesia.
   - The patient’s chest is opened via a midline incision through the sternum (sternotomy) to access the heart.

2. **Harvesting the Graft**:
   - A healthy blood vessel is taken from another part of the body to use as a graft.
   - Commonly used vessels include:
     - **Internal mammary artery**: Often the preferred graft due to its long-term durability.
     - **Saphenous vein**: Taken from the leg, commonly used for multiple grafts.
     - **Radial artery**: Taken from the arm, used when additional grafts are needed.

3. **Creating the Bypass**:
   - The graft is connected above and below the blocked section of the coronary artery, creating a new pathway for blood to flow to the heart muscle.
   - This bypass improves oxygen supply to the heart, reducing symptoms and lowering the risk of heart attack.

4. **On-Pump vs. Off-Pump Surgery**:
   - **On-Pump (traditional CABG)**: The heart is temporarily stopped, and a heart-lung machine takes over blood circulation.
   - **Off-Pump (beating heart surgery)**: The heart continues to beat during surgery, reducing the risks associated with the heart-lung machine. 

5. **Types of Bypasses**:
   - The number of bypasses (single, double, triple, or quadruple) refers to the number of arteries that are bypassed. Each bypass improves blood flow to a different area of the heart.

### Indications for CABG

CABG is recommended for:
- Severe blockage in multiple coronary arteries, especially the left main coronary artery.
- Significant blockage in the coronary arteries with accompanying symptoms such as angina or breathlessness.
- Failure of other treatments, such as angioplasty or stenting.

### Benefits and Risks

#### Benefits:
- Relieves chest pain and other symptoms of coronary artery disease.
- Reduces the risk of heart attack and improves survival in certain high-risk patients.
- Enhances quality of life by allowing increased activity levels and better heart function.

#### Risks:
- As with any major surgery, CABG carries risks, including infection, bleeding, blood clots, stroke, or even heart attack during or after the surgery.
- Cognitive changes or memory issues are a known side effect, though they typically improve over time.

### Recovery

1. **Hospital Stay**: Typically, patients spend a few days in the hospital to monitor heart function and prevent complications.
2. **Physical Recovery**: It may take several weeks to a few months for full recovery. Patients are advised to avoid heavy lifting and gradually increase activity.
3. **Lifestyle Modifications**: Adopting a heart-healthy lifestyle, including regular exercise, a balanced diet, smoking cessation, and management of risk factors (e.g., high blood pressure, cholesterol, diabetes), is essential for long-term success.
4. **Cardiac Rehabilitation**: Many patients benefit from a structured cardiac rehab program, which provides exercise guidance, nutrition counseling, and emotional support to aid recovery.

### Long-Term Outlook

With adherence to a healthy lifestyle and consistent follow-up, CABG patients can experience significant improvements in heart function and quality of life. The success and longevity of the grafts can be enhanced through lifestyle changes and proper management of cardiovascular risk factors.