WHEN SURGERY IS NEEDED IN ANGINA: BYPASS

Apr
02
2009

Bypass surgery

When bypass surgery was first started, it was usual to take a vein from the leg (we have plenty to spare!) and insert it around the narrowed site in the coronary artery. The blood then flows through the vein, around the stenosis, to reach the myocardium beyond it. The immediate result is a much better flow of blood to the heart muscle, carrying much more oxygen and glucose to the starved area.

There has been a more recent trend to use a small segment of artery from inside the chest wall—the internal mammary artery—instead of the vein. Among the reasons for the change is that the artery is more readily available than a leg vein, and that an arterial graft is probably more appropriate than a vein graft for what, after all, is another artery. There have been reports that the internal mammary graft is more effective in the long term, but other comparisons between the two seem to suggest that there is little difference in the merits of the two types of graft.

Bypass grafts are, of course, done under general anaesthetic, and patients must stay in the hospital for several days afterwards. I was astonished to be called to a patient’s home on a Friday to see him, to be told that he had had his bypass just four days before, on the Monday! The pressure to remove patients from hospital care in today’s fast-paced health care climate is surely immense!

Bypass surgery appears to work best for those who have left-main or severe three-vessel blockages.