Comparison of Surgical Treatments for Blocked

Arteries

By-Pass Surgery with Heart-Lung Machine

By-Pass Surgery using Off-Pump Technique

Angioplasty with Stent

Coronary Circulation

http://www.heartpoint.com/cathtell.html

Blockages In Arteries

http://www.brucemindich.com/Overview_of_cad.htm

The By-Pass: using another vessel to by-pass the blockage and restore flow.

• Anastomosis: “An anastomosis is a surgical connection between two structures. It most commonly refers to a connection which is created between tubular structures, such as blood vessels or loops of intestine.”

• http://www.nlm.nih.gov/medlineplus/ency/article/002231.htm

What vessels are used for the by-pass?1. Saphenous Vein from the

Leg•   Relatively easy to locate and remove•  Long segments can be divided to provide multiple

grafts.•  Long segments can be used to reach blockages on

the back of the heart.•  Endoscopic technology can be used to remove the

vein with small incisions.•  Can usually be sewn to the coronary artery without

difficulty.• Good size match for coronary arteries.• May not be usable in patients with severe vascular

disease

http://www.ctsa.com/html/cabg_2002.html Last update - 9/04/02.   Page by kas@ctsa.

What vessels are used for the by-pass?2. Internal Mammary Arteries

•   Two different mammary arteries (left and right chest); both can be used.

• Stay open longer than most saphenous vein grafts. Do not develop atherosclerotic disease.

• So durable that surgeons try to use one on every patient, if possible.

•  Too short to reach some blockages on the back of the heart.

http://www.ctsa.com/html/cabg_2002.html Last update - 9/04/02.   Page by kas@ctsa.

What vessels are used for the by-pass?3. Radial Arteries

• Radial Artery from the lower arm.

• Longer and wider than the mammary arteries.

• Thicker than the mammary artery - easier to sew.

• Taken from the non-dominant arm (ie, from the left arm if you are  right-handed.)

• 93% of these grafts are still open after 1 year.

• Longer term results      are under study.

http://www.ctsa.com/html/cabg_2002.html Last update - 9/04/02.   Page by kas@ctsa.

By-Pass Surgery (heart-lung)1. Anesthesia

2. Harvest graft vessel

3. Open Sternum

4. Retract Ribcage

5. Cut Open Pericardial Sac

6. Attach to Heart Lung Machine

7. Attach Graft to Blocked Artery

8. Attach Graft to Aorta or Branch of Aorta

9. Restore Flow of Blood to Heart

10.Remove Heart Lung Machine

11.Stabilize Heart

12.Close.

“The heart-lung bypass machine takes over the work of the heart and lungs during bypass and other open-heart procedures so the heart can be still while the surgeon works. It also is frequently used to cool the patient’s body temperature, reducing oxygen requirements and protecting the heart and other organs.

During total cardiopulmonary bypass, all blood is diverted from the heart by inserting big cannulas, or tubes, in the right atrium, the collecting chamber of the heart, and the aorta, a major artery, that moves blood out of the heart into the body. This enables a bloodless field that’s important for surgeries such as replacing the mitral valve that lets blood into the left ventricle, the ejection chamber of the heart.”

Dr. Kwabena Mawulawde, cardiothoracic surgeon at the Medical College of Georgia

http://www.mcg.edu/news/2002NewsRel/mawulawde.html

By-Pass Surgery, Off-Pump1. Anesthesia

2. Harvest graft vessel

3. Open Sternum

4. Retract Ribcage

5. Cut Open Pericardial Sac

6. Stabilize Heart with Apparatus

7. Attach Graft to Blocked Artery

8. Attach Graft to Aorta or Branch of Aorta

9. Remove Stabilizer

10. Close.

Angioplasty with Stent1. The person is awake during the

procedure.2. Stent implantation :• The stent is introduced into the blood

vessel on a balloon catheter.   • The doctor maneuvers the balloon

catheter to the blocked area of the artery and inflates the balloon.

• The inflation of the balloon causes the stent to expand, pressing it against the vessel wall.

• The balloon is deflated and withdrawn.• The stent stays in place permanently,

holding the vessel open and improving the flow of blood.

• The doctor may choose to further expand the stent with a balloon catheter similar to that used in an angioplasty procedure.

• The stent will hold the artery open, allowing blood to flow freely as in a healthy vessel.

• New cells and tissue will slowly grow over the stent eventually covering the inner surface.

• © 2004, Guidant Corporation. All rights reserved

Where is the catheter inserted?

1. Groin/Femoral ApproachCatheter introduction into the groin requires a small incision to be made on the inside of your upper thigh so an introducer sheath (short tube) can be inserted into your femoral artery. Next, your doctor will insert a guiding catheter (long, flexible tube) into the introducer sheath and advance it through the aorta to where the coronary arteries branch off to the heart.

2. Arm/Brachial ApproachCatheter introduction into the arm requires that a small incision be made on the inside of your elbow after local anesthesia has been given. The guiding catheter is then inserted directly into the artery through the small incision and advanced to where the coronary arteries branch off to the heart.

3. Transradial ApproachCatheter introduction into the wrist requires that a small incision be made on the inside of your wrist after local anesthesia has been given. The guiding catheter is then inserted directly into the artery through the small incision and advanced to where the coronary arteries branch off to the heart

© 2004, Guidant Corporation. All rights reserved