Before It Becomes Fatal

Bypass Surgery and Stents Explained Simply

Fingers showing model human heart on white

Bypass heart surgery is exactly what it sounds like. If you think about a highway bypass, which offers an alternative route to congested city driving, you get the general idea. In this case, it is blood, which needs to be rerouted due to clogged coronary arteries which normally supply oxygen-rich blood to the heart muscles. Blockages are generally caused by a buildup of plaque on the walls of the blood vessel.  If the plaque ruptures, a blood clot will form around the plaque.  This can significantly block blood flow through the artery, and the heart muscle supplied by this artery begins to die due to lack of oxygen and nutrients. This is called a heart attack or myocardial infarction.

In order to reroute the blood around the blockage, a strong, healthy, clear vein must be grafted to the existing coronary arteries before and after the block. If there is more than one blocked artery, multiple grafts may be needed – hence the terms “bypass” (one), double bypass (two), triple bypass (three) and quadruple bypass (four). It is very rare for a quintuple bypass to be performed, but it does occasionally happen.

In traditional, open-chest bypass surgery, a vein is harvested from the patient’s leg or wrist for the graft (the more bypasses which need to be made, the longer the vein must be). The patient’s sternum is cut open with a saw and the ribs spread. Blood is re-routed through a heart/lung machine to keep oxygenated blood flowing to the patient’s brain and vital organs, and the heart is stopped. The surgeon goes to work sewing the re-routed vein to the arteries before and after the blockages, opening up the pathways for blood to flow freely again. Recovery for this kind of surgery averages around two months, depending on the general health of the patient.

A new kind of bypass surgery, called Totally Endoscopic Coronary Artery Bypass (TECAB) Surgery is now being performed at some hospitals. This breakthrough surgery utilizes the Da Vinci Surgical System robot which accesses the heart through five finger-tip sized slits in the chest. There is no need to saw through the sternum or spread the ribs. According to the University of Chicago hospital website, with the Da Vinci Surgical System, “The surgeon sits in a console equipped with controls that direct robotic arms to perform the surgery. The robotic arms are very agile and work as an extension of the surgeon’s hands. A tiny camera attached to the robotic arms gives the surgeon a very detailed, three-dimensional view of the operating space inside the chest.” Advantages to this type of surgery include a much shorter recovery time, (according to the same website, “Most patients are back to work and/or other activities within a week, compared to four to eight weeks with open-chest bypass.”), shorter hospital stay, less chance for infection, minimal blood loss, minimal scarring, and sometimes, it can be performed without stopping the heart.

Dr. Vincent Gaudiani, a cardiologist at the California Pacific Medical Center, in his 3-part video series showing a live open-chest bypass, described surgery as “controlled injury that has a therapeutic aim.” TECAB would appear to minimize this injury to a significant degree.

Angioplasty & Stents

Sometimes bypass surgery is not necessary, and balloon angioplasty to open blocked arteries can be performed. With this procedure, a catheter is threaded through the patient’s groin or wrist arteries, the end of which is capped with a tiny balloon. When the constricted area is reached, the balloon is inflated and deflated in succession, inflating a little more each time to increase the cleared area. Sometimes a stent is inserted at the same time to hold the artery walls open. To install the stent, it is placed over the deflated balloon prior to insertion and, when the balloon is in place and inflated, the inflated balloon expands the stent, which locks in place. The balloon is deflated and removed, but the stent remains within the artery, hopefully keeping the artery clear indefinitely. Some stents are even coated with medications to prevent further clotting.

The procedure is minimally invasive and usually only requires a night or two in the hospital. The majority of experienced pain will be at the insertion site, and recovery is relatively quick.

If you suspect you may have heart-related issues, please take the time to visit your doctor. There are many options available, from surgical and medicinal, to relatively simple lifestyle changes, which can treat life-threatening heart problems before they become fatal.

S. Joanne Dames - MD, MPH

Updated: 7/15/2020

One Response to “Before It Becomes Fatal”

December 07, 2020 at 12:58 pm, Stress Tests, Cardiac Cath & Stents: The “Unnecessary” Triad | PrevMed Health said:

[…] Stent. Source: Dames SJ. Before It Becomes Fatal: Bypass Surgery and Stents Explained Simply. […]


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