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  • Welcome to our healthcare knowledge. Here you can find healthcare reliable information from the hospital to help educate yourself
   
 
         
         
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Coronary Artery Disease Surgery

Welcome to the Center for Information of Coronary Artery Disease Surgery

Below is the basic knowledge of Coronary Artery Disease Surgery:

Coronary Artery Disease Surgery

 

What does it mean: coronary artery blockage?

Coronary Artery Disease SurgeryCoronary Artery Disease SurgeryCoronary Artery Disease Surgery

If we think about heavy traffic at some intersection in any major city, we may imagine a traffic cop at the center of intersection doing their duty. Also, it is normal to see some police directing traffic over the congested main road. However, when the traffic is chronically congested, several express ways across major city areas are developed to relieve this "blockage" of traffic "flow".

Get back to what we about to discuss in detail further, that is, the coronary bypass surgery. When we consider major blood flow blockage long in the length of the coronary artery, we need to put the "expressways" to transfer blood flow across the major coronary arterial narrowing and relieve the jeopardized heart muscles from lack of enough blood supply.

That means we would see the most benefit from this so called "revascularization procedures" whenever there are certain inadequacy in blood supply to the heart muscle. The "expressway" will not provide much benefit when the traffic on the main road below does not being heavily jammed.

What about getting over the coronary artery obstructive disease?

Coronary Artery Disease Surgery

For the case of coronary artery revascularization, we can see the very strong benefit in patients who have already been affected with acute heart attack, or in a more specific term: acute coronary syndrome. This syndrome includes a spectrum of severity from unstable blood flow to the heart muscle -- may or may not produce any damage to the heart muscle -- to the total blockage of blood supply to the entire thickness of its wall, jeopardizing the pumping force of that part of "ischemic" wall of heart chamber.

The sudden blockage of blood supply to heart muscle occurs when, in the most cases, the plaque coverage has broken apart or gradually eroded, the so called "the plaque rupture" or "plaque erosion", respectively. It is this mechanism of plaque instability that bring some difference between the treatment’s choice of coronary artery disease; percutaneous coronary intervention and coronary artery bypass graft surgery.

When you have a balloon angioplasty with coronary stent placement, the impediment at that particular location in the coronary artery is being cleared away. Although the initial blockage in the artery may be resolved, it is the subsequent rupture on the farther non-occlusive plaque -- coating the inner surface of the coronary artery and not detectable from coronary angiogram – that bring the emergency problems again. However, when you have coronary artery bypass surgery, the new "expressway" will get across the length of any possible lipid deposition areas. The atheromatous plaque is mostly confined near the origin of the coronary artery. The bypass way will direct the blood traffic from its source (the aorta) onto the terminal areas on the surface of the heart, and in effect, bypassing the problematic areas in the early part of the coronary artery.

Therefore, we can obviously see the first benefit of coronary bypass surgery over balloon angioplasty with stent placement; deterring the development of future heart attack by bypassing all the diseased area all and direct blood flow onto the "better" runoff sites. That means many patients who have more disease burden at several areas along the same or the difference coronary arteries, the benefit tip toward the surgery as compared to the percutaneous intervention.

This is why coronary bypass operation claims better benefit over the balloon angioplasty with stent (percutaneous coronary intervention) when there are multiple areas of coronary artery occlusive disease, particularly the artery supplying the most important area of heart pump – wall of left ventricle. From this we can also deduct another strong indication for coronary artery bypass – multiple coronary occlusions with decline in left ventricular function.

What kind of conduit used in coronary bypass surgery and how does it affect the long term outcome?

Coronary Artery Disease Surgery

For the patients who received bilateral internal mammary artery graft, they will have a better long term survival with 20 year patency rate of the mammary artery grafts more than 90%. Therefore, any patient who is a possible candidate for bilateral internal mammary artery coronary bypass surgery, the operation should be done with bilateral internal mammary graft.

How long does it take for me to stay in the hospital?

Coronary Artery Disease Surgery

That depends on the nature of operation and patient’s general conditions before undergo open heart surgery (in fact, any kind of surgery). In a straightforward case, the patient would be encouraged to walk around the bed on the first day after the operation. Within five or six days, if no complication happen (97% of the cases), the patient can choose to get back home and doing some light works – a kind of works that need not much physical exertion. The main hindrance for rapid recovery is their breastbone pain after the operation.

What should I expect after leaving the hospital?

Coronary Artery Disease Surgery

Most patients are allowed to drive within 3-6 weeks. Normally, there is no flying limitation after heart operations. Within one month, the patient can have sexual activity after thorough postoperative re-evaluation. Again, due to the divided breastbone -- with stainless steel wire close the bone together – the patient should not carry a too heavy weight or have any physical exertion in the first three months after the surgery.

Does the coronary artery bypass surgery deter occurrence of future emergency events?

Coronary Artery Disease Surgery

Someone might think they can eat any fatty diet as much as they want for now and when the coronary artery disease happen, they will have a good surgeon to cure their conditions. This cannot be any farther from the truth. The fact is coronary artery “revascularization procedures” – coronary artery intervention with balloon angioplasty or coronary artery bypass grafting – cannot completely stop the future heart attack. It is like when you construct the expensive expressway across the city, it does not mean that there would be no traffic jam over the expressway. This is also the same for the coronary bypass grafting. The most commonly used conduits – literally the expressway – the saphenous vein graft, can become clogged after only 4-5 years after the operation. At 10 years period, nearly half of all vein grafts will be totally occluded. If the patients do not well address their hypertension, diabetes mellitus, abnormal lipid profiles and so on, then they will not be in a good shape about 10 years after the operation.

What should I do after I leave the hospital?

Coronary Artery Disease Surgery

The coronary artery bypass surgery can significantly provide better long term survival, particularly in the patients with evidences inadequate blood supply to the heart muscle. However, as stated before that having an expressway in the major city does not guarantee there would be no traffic jam on the expressway, performing coronary artery bypass also does not completely deter future heart attack. When abnormal lipid in circulation can deposit the coronary arterial wall, how could it be possible that this very same mechanism will not do their job on the newly placed coronary graft? All you need to do is to make sure that you have all of your atherosclerotic risk factors under well checked, otherwise you may not be in a good shape ten years after the operation.


Remark:

  • This information should not be used as a substitute to consultation from a physician. Always talk with your doctor about diagnosis and treatment information.
  • The service center is Heart Center of Bangkok Hospital Phuket.
  • For more information about our medical services! Please contact us at info@phukethospital.com
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Keywords: heart center, cardiac center, the heart and heart disease, heart disease, heart attack, heart failure, cardiologist, cardiology, cardiovascular disease, heart cardiovascular, heart problems, the heart diseases, heart diseases, coronary heart disease, heart surgery, bypass surgery, cardiovascular problems, coronary artery disease, cardiac surgery, heart & vascular, heart vascular, centre heart, heart conditions, center of the heart, center heart, heart and vascular disease, heart hospital, the heart center, heart treatment, cardiac disease

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