Coronary Bypass more commonly known as coronary artery bypass grafting (CABG) is a medical surgery where weak arteries are replaced with blood vessels harvested from various other parts of the body. This surgery becomes essential when the weakened vessels can no longer effectively transport blood to and from the heart. The surgery serves to relieve angina (a painful tightening of the cardiac muscle) and diminish the risk of death associated with coronary artery disease¹.

The image to the left shows how the saphenous vein can be used to bypass the blocked portion of the coronary arterty and connect the artery directly to the aorta.

HISTORY

CABG surgery was developed independently in both Russia and the United States in the 1960s. On the Russian frontier, Vladimir Demikhov and Vasili Kolesov met with success when they experimentally used the internal thoracic artery for CABG on animal subjects. Their work also includes the development of one of the first mechanical cardiac devises needed for CABG². In America, the CABG technique was pioneered by Rene Falvaloro and his colleagues at the Cleveland Clinic. In 1867, Falvaloro became the first surgeon to successfully perform the CABG surgery on a living patient.

COMPLICATIONS

While CABG is more prevalent today, with over 500,000 operations performed annually in the United States, surgeons still face numerous possible complications during surgery. Surgeons must weigh the risks associated with older age, gender, diminished left ventricular function, unstable angina, cardiogenic shock (where blood flow to a section of the heart is dramatically decreased), and multiple obstructions. These risks decrease the rate of success during the surgery and the recovery period. Even with these risks taken into account, the five-year survival rate is 88 percent and the ten-year survival rate is 75 percent for CABG surgeries in the United States³. These survival rates include both men and women, however, women have a higher mortality rate related to CABG surgery as compared to men. This trend is taken into account by surgeons in their risk assessment, although pre-operative treatments are able to minimize the female mortality rate⁴. While this surgery is a voluntary operation, surgeons strongly advise patients with severe blood flow problems to consider the surgery.

FUTURE

There are presently two robotic systems, the ZEUS and the da Vinci System, designed to assist in CABG surgeries. The future of CABG surgeries is expected to rely even more heavily on robotic assistance. There is currently an expanding field, composed of engineers and surgeons, designated to improving upon the precision of the existing systems while developing the new generation of medical robotics technology. This new generation is designed to implement biotechnology and sustainability into their design, thus allowing surgeons to increase operating room efficiency while minimizing the need for ancillary personnel. In addition, such improvements will decrease the need for recurrent surgeries as the arteries can be strengthened⁵.

The future is also moving towards minimally invasive surgery for women as an alternative to the riskier CABG surgery. This type of surgery minimizes the recovery stages associated with the surgery while solely treating the weakest areas of the heart. This method tailors the procedure to fit the patient’s needs and limitations through the use of pre-operative procedures. Such instances include hormonal treatments and differing physical therapy techniques tailored to the female body⁶.

REFERENCES

1. Yusif, S. et al. (2004). Effect of Coronary Artery Bypass Surgery on Survival. Lancet 344, 563-570.

2. Konstantinov, IE. (2004). Complications in Cardiothoracic Surgery: Avoidance and Treatment. Texas Heart Institute Journal 131, 349-58.

3. Doty, John R. (2002) Cardiothoracic Surgery Notes: Coronary Artery Bypass. The Cardiothoracic Surgery Network.

4. Blankstein et al (2005). Female Gender is an Independent Predictor of Operative Mortality after Coronary Arterty Bypass Graft Surgery. Circulation 112, I-323-I-327.

5. Diodato et al. (2004). Robotics in Surgery. Current Problems in Surgery 41, 752-810.

6. Edwards et al (2005). Gender-Specific Practice Guidelines for Coronary Artery Bypass Surgery: Perioperative Management. The Annals of Thoracic Surgery 79, 2189-2194.