Triple bypass surgery, a type of coronary artery bypass graft (CABG) , is open heart surgery performed to treat three blocked or partially blocked coronary arteries in the heart. Each of the operative vessels is individually bypassed, so it can carry blood to the heart muscle.
You may need this surgery if you have coronary artery disease (CHD) due to atherosclerosis , which prevents blood from flowing freely.
Triple bypass surgery does not cure or prevent coronary artery disease, but it can prevent symptoms of coronary artery disease, such as chest pain and shortness of breath. In addition, it can improve overall heart function, improve quality of life, and reduce risk of death.
Blood vessels are taken from your leg (saphenous vein), into your sinus (internal sinus artery), or from your arm (radial artery) to replace the affected portions of the coronary arteries. Your surgeon will determine the specific vessel used.
Diagnoses related to triple bypass surgery
IC caused by atherosclerosis is the most common cause of triple bypass surgery. Atherosclerosis, also known as hardening of the arteries, occurs when cholesterol and other lipids begin to build up on the inner walls of damaged blood vessels. This build-up leads to the formation of a waxy thickening in the vessel known as plaque.
Atherosclerosis can develop in any blood vessel in the body, and damage to the arteries of the heart can lead to a heart attack.
The AMA Ethics Journal considers angina , which is chest pain due to decreased blood flow in the coronary arteries, as a possible indication for triple bypass surgery .
The American Heart Association identifies the following benefits of bypass surgery :
- Manage blockage of blood flow to the heart muscles.
- Improve the supply of blood and oxygen to the heart muscles.
- Reduce the risk of heart attack
- Improved ability to maintain physical activity that has been limited by angina or ischemia (insufficient blood supply)
How common is bypass surgery?
Bypass surgery is the most common cardiothoracic surgical procedure. According to a 2020 market report, 340,000 CABGs are performed annually in the United States .
The American Heart Association (AHA) has partnered with the American College of Cardiology to develop guidelines for bypass surgery.
These criteria, last updated in 2011, include several subgroups of patients :
Patients who may require emergency bypass surgery for an acute myocardial infarction (heart attack) include :
- Patients with acute myocardial infarction who have
- 1) Primary PCI failed or cannot be completed
- 2) the coronary anatomy is adequate for CABG, and
- 3) There is persistent ischemia of a significant part of the myocardium (heart muscle) at rest and / or hemodynamic instability, resistant to conservative therapy.
- Patients who have undergone surgical treatment for a post-infarction mechanical complication of myocardial infarction, such as rupture of the interventricular septum, mitral valve insufficiency due to infarction and / or rupture of the papillary muscle or rupture of the free wall.
- Patients with cardiogenic shock are eligible for CABG regardless of the time interval from MI to onset of shock and the time from MI to CABG.
- Patients with life-threatening ventricular arrhythmias (presumably ischemic in origin) with stenosis (narrowing) of the left main artery greater than or equal to 50% and / or three-vessel coronary artery disease (CHD)
- Patients with multivessel coronary artery disease with recurrent angina or myocardial infarction within the first 48 hours after ST-segment elevation myocardial infarction (STEMI) as an alternative to a later strategy
- Patients older than 75 years with ST-segment elevation or left bundle branch block , eligible for revascularization, regardless of the time interval from myocardial infarction to the onset of shock.
The manual also indicates cases where emergency CABG is not indicated :
- Emergency CABG should not be performed in thermodynamically stable patients with persistent angina and a small viable myocardial area.
- Emergency CABG should not be performed in patients without re-blood flow (successful epicardial reperfusion with failed microvessel reperfusion).
Laboratory tests and work
Before triple bypass surgery, you can count on a number of tests and procedures to determine if triple bypass surgery is the best option for you.
These tests can include:
- Stress test : This is a cardiac perfusion scan that measures the amount of blood in the heart muscle at rest and during exercise. For this test, you must walk and / or run on a treadmill.
- Echocardiogram : This test uses ultrasound to create a picture of the heart as it moves and to assess blood flow to and from the heart.
- Electrocardiogram (EKG or EKG): This test measures the electrical activity of the heart.
- Cardiac catheterization : This is an invasive test that examines specific blockages in the coronary blood vessels using a special dye and x-rays to show the inside of the coronary arteries.
- Lung function test – Your face is involved in this test. It measures how well your lungs absorb and release air and how well they move gases like oxygen.
- Blood tests : These labs may include a complete blood count, biochemical tests, and blood clotting tests.
- Chest X-ray – examines the chest, lungs, heart, large arteries, ribs, and diaphragm.
- Cardiac Magnetic Resonance Imaging (MRI) – Provides a detailed view of the heart, including the surrounding chambers and blood vessels.
- Carotid Doppler / Ultrasound : The purpose of a carotid artery ultrasound is to look for blockages or narrowing of the carotid arteries , which can increase the risk of stroke.
- Transesophageal echocardiogram (TEE ) : This is an invasive test that examines the valves and chambers of the heart and how the heart is working.
- Computed tomography (CT) scan : This test assesses the structure of the aorta, lungs, and surrounding organs.
- Ankle Brachial Index : This test determines if there is any blockage or narrowing of the arteries in the arms and legs.
- Vein mapping : This is a non-invasive test that examines the blood vessels in the legs.
Depending on the severity of your heart disease or pain, you may have one or more of the tests listed above. If you have an emergency triple bypass, you won't be able to do a long test, such as a stress test.
Get the word of drug information
Because triple bypass surgery involves three main blood vessels, there are significant risks involved. This operation can be planned, but in some cases it can be done urgently.