Conventional Coronary Artery Bypass Grafts (CABG) may be used to bypass
any blocked coronary artery, and is most often used when you have more
than one blocked artery. The procedure is performed using general
anesthesia, and usually takes three to five hours. The surgeon utilizes a
long breastbone incision (median sternotomy),which provides maximum access
to the heart and connecting blood vessels.
The heart is stopped, the aorta (the large artery leaving the heart) is
clamped, and a heart-lung machine (also called a pump oxygenator or
cardiopulmonary bypass pump) is used to circulate blood through the rest
of the body. This is known as "on-pump" surgery.
Healthy veins and arteries taken from several areas of your body may be
used to construct your new coronary artery bypass(es). Blood vessels
typically used include the long saphenous leg vein, radial artery from the
forearm and internal mammary artery.
Your surgeon will explain which of these is most appropriate for you.
If a saphenous leg vein is recommended, a new procedure for removing the
vein may be used. Rather than the traditional groin-to-ankle incision, the
new method uses several small (approximately 1") cuts on the inside of the
leg. The benefits of this new procedure include faster healing and return
to normal activities, with less pain, chance of infection and scarring.
When the bypass is fashioned from a leg vein or radial artery, one end
is attached or grafted to the aorta and the other to a point on the
diseased coronary artery below the blocked area. In most cases, an
internal mammary artery (IMA) is used.
These arteries run parallel to the sternum on either side. An IMA may
be detached from the chest wall and the open end attached to the diseased
coronary artery below the blockage. If more than one coronary artery
blocked, a bypass is performed on each diseased artery. Once the new veins
and/or arteries are in place, the heart is restarted, the heart-lung
machine is removed, and blood is allowed to flow.
Some patients may be eligible for minimally-invasive direct coronary
artery bypass surgery. This off-pump procedure uses the right or left
internal mammary artery to bypass a blockage of the right coronary artery
or the left anterior descending artery.
The surgeon makes a 3" horizontal incision (called a limited anterior
thoracotomy) between the ribs on the right or left side, rather than the
traditional breastbone incision. In addition to the previously listed
benefits of off-pump surgery, MIDCAB offers these potential advantages:
fewer problems with postsurgical fluid retention and puffiness
faster healing of incision, with less chance of infection
faster overall recovery/postoperative activities less limited.
Some patients, including those with multiple risk factors, are eligible
for MIDCAB procedures. Your surgeon will explain if you are a candidate
for this procedure.
An increasing percentage of coronary artery bypass surgeries are now
performed "off-pump." Unlike the conventional method, in which the heart
is stopped, the aorta clamped and circulation maintained by a heart-lung
machine - new technologies allow the surgeon to graft bypass vessels while
the heart is beating.
"Beating-heart" surgery offers a safe alternative for many patients.
When appropriate, off-pump procedures may provide a number of advantages,
including: less time in surgery, shorter intubation time, faster
stabilization; shorter ICU and overall hospital stay, less trauma to all
body systems, such as reduced risk of lung and kidney complications,
myocardial infarction, stroke, thromboembolism, and neuro-cognitive
problems such as short-term memory loss, confusion and depression.
Other benefits include less blood loss and need for transfusions, less
use of heparin (a blood thinning drug) and vasodilators (drugs that widen
blood vessels), faster recovery and improved outcomes in high-risk groups,
including the elderly and ultimately, lower overall costs.
Irregularities of the heartbeat (cardiac arrhythmias) are one of the most
common maladies affecting the heart. Because the heart does not pump blood
as efficiently when it has an irregular heartbeat, patients with cardiac
arrhythmias usually complain of tiredness and shortness of breath,
especially with exertion.
Fortunately, many cardiac arrhythmias can be successfully treated with
medicines or catheters. However, when arrhythmias are not responsive to
drug therapy and cannot be treated with catheters, heart surgery may be
required if the symptoms are particularly severe or life threatening.
The MAZE procedure is a surgical intervention that cures atrial
fibrillation (AF) by interrupting the circular electrical patterns that
are responsible for this arrhythmia.
Strategic placement of incisions in both atria stops the formation and
the conduction of errant electrical impulses and channels the normal
electrical impulse in one direction from the top of the heart to the
bottom. Scar tissue generated by the incisions permanently blocks the
travel routes of the electrical impulses that cause AF, thus eradicating
the arrhythmia.
The standard approach used for open heart surgical procedures
(including the MAZE) is to divide the breastbone (sternum) with an
incision. This gives the heart surgeon direct access to the heart which
lies angled to the left just under the sternum.
Once the surgery is completed, the sternum is wired back together and
the skin is closed with absorbable suture. The sternum will knit back
together in 6-8 weeks and will be just as strong once the healing process
is complete.
The MAZE procedure does require that the heart be stopped and
necessitates the use of the "heart-lung machine" or cardiopulmonary
bypass. In order to make the incisions and to close them with sutures, the
surgeon needs to work on a non-beating heart. To protect the other organs
while the heart is stopped, cardiopulmonary bypass supplies blood flow and
oxygen to all of the body's organ systems.
The MAZE procedure is frequently performed with other cardiac surgical
procedures such as coronary artery bypass grafting, mitral valve repair
and/or valve replacement