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Coronary Artery Bypass Graft (CABG)

Coronary artery bypass surgery, also coronary artery bypass graft (CABG pronounced cabbage) surgery, and colloquially heart bypass or bypass surgery is a surgical procedure performed to relieve angina and reduce the risk of death from coronary artery disease. Arteries or veins from elsewhere in the patient’s body are grafted to the coronary arteries to bypass atherosclerotic narrowings and improve the blood supply to the coronary circulation supplying the myocardium (heart muscle). This surgery is usually performed with the heart stopped, necessitating the usage of cardiopulmonary bypass; techniques are available to perform CABG on a beating heart, so-called “off-pump” surgery.

Indications for CABG

Several alternative treatments for coronary artery disease exist. They include:

  • Medical management (anti-anginal medications plus statins, antihypertensives, smoking cessation, tight blood sugar control in diabetics)
  • Percutaneous coronary intervention (PCI)

Both PCI and CABG are more effective than medical management at relieving symptoms

Loss of mental function is a common complication of bypass surgery, and should influence procedure cost benefit considerations. One published study using MRI imaging just after coronary bypass surgery found significant brain damage in 51% of patients.

Several factors may contribute to immediate cognitive decline. The heart-lung blood circulation system and the surgery itself release a variety of debris, including bits of blood cells, tubing, and plaques. For example, when surgeons clamp and connect the aorta to tubing, resulting emboli block blood flow and cause mini strokes. Other heart surgery factors related to mental damage may be events of hypoxia, high or low body temperature, abnormal blood pressure, irregular heart rhythms, and fever after surgery.

A safer and more permanent and successful way to prevent heart attacks in patients at high risk is to exercise, give up smoking, take “drugs to get blood pressure under control and drive cholesterol levels down to prevent blood clotting”.Longer term, behavioral and medication treatment may be the only way to avoid vascular related loss of mental function.

Sources:

Wikipedia

Medscape

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