Medical Health Encyclopedia

Heart bypass surgery

ARTERY AND VEIN GRAFTS

If a vein from the leg, called the saphenous vein, is to be used for the bypass, an incision is made in the leg and the vein removed. The vein is located on the inside of the leg, running from the ankle to the groin. The saphenous vein normally does only about 10% of the work of circulating blood from the leg back to the heart. Therefore, it can be taken out without harming the patient or harming the leg.

It is common for the leg to swell slightly during recovery from the surgery, but this is only temporary and is treated by elevating the leg.

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The internal mammary artery (IMA) can also be used as the graft. This has the advantage of staying open for many more years than the vein grafts, but there are some situations in which it cannot be used.

The left IMA, or LIMA, is an artery that runs next to the sternum on the inside of the chest wall. It can be disconnected from the chest wall without affecting the blood supply to the chest. It is commonly connected to the artery on the heart that supplies most of the muscle, the left anterior descending artery, or LAD.

Other arteries are also now being used in bypass surgery. The most common of these is the radial artery. This is one of the two arteries that supply the hand with blood. It can usually be removed from the arm without any impairment of blood supply to the hand.

TRADITIONAL APPROACH

In the traditional surgery, the patient is connected to the heart-lung machine, or bypass pump, which adds oxygen to the blood and circulates blood to other parts of the body during the surgery. This is necessary because the heart muscle must be stopped before the graft can be done.

One end of the graft is stitched to an opening below the blockage in the coronary artery. If the grafted vessel is the saphenous vein or the radial artery, its other end is stitched to an opening made in the aorta. If the grafted vessel is the mammary artery, its other end is already connected to the aorta.