Coronary artery bypass surgery is as the name suggests
when you get a blockage in your coronary vessel.
To treat that, you have two possible ways.
One is to put a stent
and push that narrowing or stenosis open.
Another option is actually bypass it
and in coronary artery bypass surgery
what we do is we bypass that blockage.
We leave that blockage in place, but we go
beyond that blockage and feed that vessel with a new inlet.
For a fresh blood supply
There are three major blood vessels to supply blood
to the heart, the left coronary artery, which divides
into two major branches, and then the right coronary artery
and patients can develop blockages in those arteries
that lead to heart disease.
Coronary bypass surgery is utilizing either a vein
or an artery to bypass the blockages, and the bypasses are
usually placed in a location that is far
beyond the blockage.
Thereby not only treating the blockage that's occurring
at present, but also treating future blockages
for most patients.
You do as many bypasses as necessary to
achieve what's called a complete revascularization, meaning
that you have bypassed every single significant
or sizable vessel to all major territories of the heart.
Cleveland Clinic, for the most part
invented coronary bypass surgery.
Back in the 1960s
Mason Stones was a cardiologist who happened
upon coronary angiography
and developed really the the first coronary angiogram.
And together with his surgical colleague, Brene Favaro
they worked and were able to do the first coronary bypass
and coronary bypass surgery.
Had a tremendous history here
at the Cleveland Clinic from the early 1970s.
We did far more coronary bypass surgeries here
than anywhere else in the world.
Coronary artery bypass surgery is certainly
the most common operation that heart surgeons perform
and it's actually the most common operation
among heart surgery programs in the country.
But that doesn't mean
that it's the same operation for every patient.
Every patient needs a tailored approach
to coronary revascularization.
So there are multiple approaches
for coronary artery bypass surgery.
The standard approach is utilizing a full sternotomy
which is full splitting of the sternum
and the surgery can be performed
either utilizing the heart lung machine
or what's called off pump technique.
And thereby we use stabilizers to stabilize portions
of the heart to do the bypasses we need to do.
We can also perform minimally invasive coronary
bypass surgery.
A lot of those can be performed
through a very small incision between the ribs.
We never wanna compromise quality
for cosmetics because our objective is not to
have a perfect immediate outcome.
Our objective is to have long-term success.
When we look at performing bypass surgery
we use either the mammary artery, a radial artery
from the arm
or a portion of the saphenous vein from the leg.
Now, each of these bypasses lasts certain length of time.
They don't last forever.
The mammary artery by far lasts the longest.
It's one of the only arteries
in the body that really does not develop atherosclerosis.
So multi arterial grafting is by far the best strategy
for performing coronary artery bypasses for patients
because it gives the most long lasting effect.
Not only do we have high volume cardiac surgery practice
but the patients we get here are very high risk patients.
We accept patients from all over the country, in fact
from all over the world.
Many of them have seen one
two or more surgeons that have declined to
offer those patients surgery because of their high risk.
And the surgeons here are very comfortable dealing
with those patients.
The Cleveland Clinic has long been a leader in reoperative
coronary artery bypass surgery that is new coronary bypasses
in someone who's had bypass surgery before.
We do the largest number
of those cases yearly than any other center.
What we do to achieve excellent results is
having a great team approach.
We have excellent surgeons, we have excellent support
and we use grafts and techniques that ensure that
the patient will have not only excellent short-term outcomes
and very low complication rate
but also excellent long-term results.
I think a lot of patients before heart surgery
don't actually fully understand how poorly they feel
and what's rewarding is seeing them return
to what they were seeing them really be able to
enjoy life again.
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