Coronary artery bypass surgery: what it is and when to use it

By Cristiano Antonino On Mar 3, 2023

The purpose of coronary artery bypass surgery is to bypass narrowings (stenosis), i.e. occlusions resulting from atherosclerosis, of the coronary arteries, which are the vessels responsible for maintaining a constant blood supply to the heart muscle, essential for maintaining effective cardiac activity

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The reduced supply of oxygen and nutrients to the heart muscle can cause serious cardiovascular events that can be

transient, such as angina pectoris
irreversible due to prolonged coronary obstruction, such as heart attack.

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What does coronary bypass surgery consist of?

The cardiac bypass technique most often consists of a longitudinal incision in the middle of the anterior chest wall through the sternum (median sternotomy).

The patient is connected with cannulas to the extracorporeal circulation circuit, the venous blood is drained, oxygenated and pumped back into the aorta: this circuit keeps the patient alive.

The coronary artery bypass bypass allows the narrowing of the coronary vessel to be bypassed by inserting a vascular conduit upstream and downstream of the narrowing point to restore good flow downstream of the stenosis.

The conduits used for the graft are either vein segments taken from the patient’s own leg (thus not subject to rejection), or an artery, the internal mammary artery, which runs inside the chest.

The proximal end of the saphenous vein is sutured to a section of the aorta so that the blood from it, through the vein, reaches the coronary artery at the site of the obstruction.

If the mammary artery is used, there is no need to connect it proximally, as it originates physiologically from an arterial system (to the subclavian artery).

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Is cardiac bypass risky?

In general, the mortality rate of coronary artery bypass surgery is about 1% in elective cases, which is considerably lower than the risk of myocardial infarction that patients who are not candidates for the operation would face, with an average hospital stay most often of 7-8 days.

Bypass surgery of the heart has now become a routine technique with precise and rational indications.

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