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Coronary Artery Disease-EVH
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Coronary Artery Disease-EVH


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  • 1. Coronary Artery Disease, Beating Heart Bypass Surgery andEndoscopic Vessel HarvestingYour physician has recommended bypass surgery for you because there is a blockage in one ormore of your coronary arteries. This prevents adequate blood flow to your heart. Each year, over600,000 bypass surgeries are performed worldwide. Now you may have an alternative optionto “traditional” bypass surgery with two new techniques called “beating heart” or “off-pump”coronary artery bypass surgery and minimally invasive vessel harvesting. Thousands of peoplearound the world have been successfully treated for coronary artery disease with this new type ofsurgery. You will naturally have some questions about your surgery.The goal of any bypass surgery is to increase coronary artery blood flow to your heart andimprove your life. Many patients are surprised to learn that a bypass operation may actuallyinclude two surgical procedures. The first operation is where the surgeon will use healthy bloodvessels to “bypass” the blocked arteries in the heart. The second procedure is the removal (or“harvesting”) of a healthy blood vessel, usually from the leg, to construct the bypass grafts.Recent advances in medical technology make it possible to perform the second procedure in adifferent way, through very small incisions using an “endoscopic” technique.Combined with the advances in medical device technology, the skilled hands of the surgeon, andthe cardiac surgery team, you now have new options to discuss with your physician about bypasssurgery and vein removal.This copy is intended to provide you and your family a better understanding of coronary arterydisease, beating heart bypass surgery and endoscopic vessel harvesting. It is not intended as asubstitute for an informed discussion with your physician. If you have questions after readingthis booklet, please write them down so your physician or other healthcare professionals cananswer them for you. Not everyone may be a candidate for these alternative approaches tocardiac surgery however we hope you will discuss these options with your physician.New Patient Info Booklet Page 1 1/21/04
  • 2. Overview of Coronary Artery DiseaseCoronary arteries bring blood and oxygen to nourish the heart. The heart pumps unoxygenatedblood to the lungs, where it receives oxygen. The heart then pumps the oxygen-rich blood to thewhole body. Because the heart is a muscle, it needs a continuous source of oxygenated blood tofunction. Aorta Circumflex Right Coronary Artery Artery Left Anterior Descending ArteryCoronary artery disease (CAD) is caused by atherosclerosis, commonly known as “hardening ofthe arteries.” Atherosclerosis is characterized by a buildup of fatty deposits on the walls of thearteries. These deposits are called plaque. These fatty collections make the lining of the arterythick and rough. If left untreated, the blockage reduces or stops blood flow to the heart muscle,which increases the patient’s risk for angina (chest pain) and heart attack (myocardial infarction).To help the heart function more normally and to increase blood flow to the heart, a bypassprocedure is often recommended.Healthy Arterywith NormalBlood Flow Blockage InfarctPlaque Deposits SiteRestricting BloodFlowNew Patient Info Booklet Page 2 1/21/04
  • 3. What is Bypass Surgery?Bypass surgery is a procedure performed for most types of coronary artery blockages. Theprocedure allows the surgeon to access the heart and the diseased arteries through an incisionin the middle of the chest. The purpose of bypass surgery is to increase the circulation andnourishment to the heart muscle.Most often, healthy arteries or veins are “harvested” to create “bypass grafts” that channel theneeded blood flow around the blocked portions of the coronary arteries. The arteries or veins areconnected from the aorta to the surface of the heart beyond the blockages forming a graft. Thisallows the blood to flow through them and “bypass” the narrowed or closed points. Bypass GraftWhat is “Traditional” Bypass Surgery?Coronary artery bypass surgery became routine in the late 1950s with the invention of the heart-lung machine. With “traditional” bypass surgery, surgeons use the assistance of the heart-lungmachine along with medications to stop the heart so the bypass can be performed on a motionlessfield. The heart-lung machine is referred to as a “pump” because it continues to mechanicallypump oxygen and nutrients to the body during surgery.While the heart-lung machine allows doctors to perform surgery on the heart, it can be invasiveand a potentially traumatic procedure. Complications from the heart-lung machine may includeincreased need for blood transfusion, kidney and lung complications, stroke and longer hospitalstay.New Patient Info Booklet Page 3 1/21/04
  • 4. What is Beating Heart Bypass Surgery?Recent advances in surgery and medical devices allow doctors to have less invasive options inthe treatment of coronary artery disease, such as beating heart bypass surgery. Individuals whohave medical conditions such as diabetes, history of stroke or poor physical health, can nowundergo cardiac surgery with a decreased risk for developing complications related to the heart-lung machine. You will want to talk with your doctor to see if beating heart bypass surgery is anoption for you.Beating heart bypass surgery is different from traditional bypass surgery because it is performedwhile your heart is still beating. Your surgeon does not use the heart-lung machine to stopyour heart during the procedure. In some cases, the surgeon may still need to use the heart-lung machine during the operation. A perfusionist (a specialist trained to operate the heart-lungmachine) may remain on standby during your operation.Your physician may have chosen the beating heart bypass procedure for you because of benefitssuch as: • Quicker recovery • Decreased length of hospital stay • Less trauma due to the elimination of the heart-lung machine • Fewer cognitive and neurological consequences, such as strokeNew Patient Info Booklet Page 4
  • 5. Obtaining the Healthy Vein or ArteryThe removal (“harvesting”) of the vein is a separate surgical procedure that is done during yourbypass surgery. The most common vein used for the bypass graft, the Greater Saphenous Vein,is taken from the leg. Once the vein is removed, other veins in your leg will take over for thesaphenous vein and, after healing, your leg’s blood supply should return to normal.Traditionally, the vein is removed from your leg through a long incision that may stretchfrom ankle to groin. Often, patients who have this method of vein removal experience morepostoperative pain from the leg incision than from the chest incision. Rehabilitation may bedelayed because the longer leg incision may make it more difficult for the patient to stand orwalk after surgery.A minimally invasive procedure offers patients an alternative to the traditional vein harvesting.Using special instruments, the vein removal can now be performed through one to three smallerleg incisions, each approximately one inch in length. An endoscope is connected to a videocamera and inserted through these small openings. The endoscope is used to view the saphenousvein and remove the vein with minimal stress to the leg. This procedure reduces the surgicaltrauma to the patient and decreases the incidence of wound healing complications.TraditionalIncision Endoscopic IncisionNew Patient Info Booklet Page 5 1/21/04
  • 6. In most cases, the small incision approach can be used successfully. However, every surgicalpatient is unique, and your surgical team will recommend the best procedure for you.Your surgeon may choose to use one or more of your healthy arteries as a conduit for the bypassgraft. The most common artery used is the internal mammary artery (IMA), located in the chest.Harvesting this artery is performed through the same incision used to access your heart. Theradial artery, located in the arm, is another vessel often used. Removing the radial artery requiresa separate incision.It is important to remember that the goal of any bypass surgery is to increase coronary arteryblood flow. Increased blood flow may: • Provide relief of angina (pain or tightness in the chest) • Improve the pumping ability of the heart muscle • Reduce the risk of heart attacksMost importantly, the quality of your life should improve.What can I expect? • You will be asleep during the surgery. Your anesthesiologist will meet with you prior to surgery to discuss any allergies, concerns about medication and pain management following surgery. Bring a list of all your current medications, as this will help the anesthesiologist in planning your care. • The length of the operation varies. It can take anywhere from 2 to 6 hours. Your surgeon will be able to provide you with a better estimate based on your selected treatment.After beating heart bypass surgery • You may go into a cardiac surgery recovery room, or Intensive Care Unit (ICU), where you will be closely monitored. Your family can visit you for short periods of time. • A breathing tube is placed during surgery. It will be removed as soon as you are able to breathe on your own. In some cases, the tube may be removed in the operating room. • After the breathing tube is removed, you will be asked to cough and do deep breathing exercises. • You will be connected to monitoring devices that will assist the medical team in evaluating your progress. Tests will be performed during your stay, such as an ECG, blood pressure monitoring and blood sampling. • Once you are able to swallow liquids, you will progress to solid foods as tolerated by your digestive system.New Patient Info Booklet Page 6 1/21/04
  • 7. • You may experience some discomfort from the incisions. If you are uncomfortable, remember to ask for pain medication before the pain becomes extreme. • You may feel very tired. Fatigue is to be expected after a surgical procedure. • If your saphenous vein was harvested, swelling may occur in the leg. You may notice some bruising and fluid collection in the lower portion of your leg. Your healthcare professional may recommend you wear the elastic support stockings provided by the hospital for a period of time. • You will be instructed about activity and exercise. Assistance will be provided to help you increase your activities. • Typically, your complete hospital stay after beating heart bypass surgery may range from 3 to 7 days, depending on the procedure performed and the necessary treatments required following your surgery.Returning HomeYour doctor will discuss with you the importance of a cardiovascular rehabilitation program.Cardiac rehabilitation can help your recovery and reduce your chances of having more heartproblems.Your doctor or healthcare professional will provide you with postoperative instructions to follow.These instructions may include: • Contact your physician if you experience any chest pain. • Observe your incisions daily. Notify your doctor of any redness, swelling or drainage with your incisions. • Take a rest period at least once a day. Resting helps your body to heal.Your doctor will also provide you with specific instructions regarding lifting heavy objects, whento resume driving and when to begin your exercise program.You have had coronary artery bypass surgery and begun your cardiac rehabilitation program.What’s next? You can control and improve your chances of living a longer, healthier life bychanging your lifestyle and reducing the risk factors associated with coronary artery disease.Certain risk factors increase your chance of atherosclerosis (hardening of the arteries): • Smoking • High blood pressure • High cholesterol • Sedentary lifestyle (lack of exercise) • Obesity (being overweight) • Diabetes • Stress • Family history of coronary artery diseaseNew Patient Info Booklet Page 7 1/21/04
  • 8. Information contained in this booklet is intended to provide you and your family with a betterunderstanding of coronary artery disease, beating heart bypass surgery and endoscopicvessel harvesting. This booklet is designed to use in conjunction with a consultation with yourphysician. This is not intended as a substitute for medical advice. If you still have questionsafter reading this booklet, please write them down so that your doctor or other health careprofessional can answer them for you.New Patient Info Booklet Page 8 1/21/04