Triple Bypass Surgery

Thanks to modern technology, coronary artery bypass graft surgery is more common than ever before. It is just one of many innovative treatments that have proven effective in managing cardiovascular disease which has long been one of the most prevalent reasons for death in the United States. Often simplified as "bypass surgery", coronary artery bypass graft is also known by its acronym, CABG (pronounced as "cabbage").

What Is Triple Bypass Surgery?

Coronary arteries are the blood vessels that supply blood to the heart, which are vastly different than the rest of the blood vessels in the rest of the body. Sometimes, those become blocked and this is called "coronary artery disease". When the blockage is very severe, it may stop the flow of blood to that particular region of the heart.

Coronary artery bypass surgery is done to help restore the blood flow to the heart by bypassing the blocked or diseased area. Generally, the surgeon will take the vessel from the leg or sometimes from the arm. The vessel will then be grafted to the existing heart vessel before the blockage and after the blockage. It's not a quick easy detour that would be taken on a drive. The blood is being rerouted around blocked vessels to get it to the heart.

The number of grafts will be dependent upon how many vessels require repair. If there are three vessels requiring repair, then the surgery is titled "triple bypass surgery". Three grafts would then be done to reroute the three vessels that were affected.

When Is It Done?

The doctor and the patient will work closely together to determine if a bypass surgery should be done or if there should be another procedure such as an angioplasty or a stent done.

Coronary bypass surgery may be an option if:

  • The patient is having severe chest pain that is caused by narrowed arteries which supply the heart with blood. If the patient is short of blood to the heart upon light exercise or even at rest. Occasionally, an angioplasty and stenting can resolve this; however, for other patients the bypass is the only option.
  • If one or more of the coronary arteries as well as the heart's main pumping chamber isn't working well.
  • If the left main artery is blocked or severely narrowed. This is the artery that supplies the most blood to the left ventricle of the heart.
  • If the blockage can't be resolved by an angioplasty, or if the patient has had a previous stent placed or a previous angioplasty and the arteries are narrowed.

Triple bypass surgery may also be done in an emergency. If the patient has a heart attack or if the doctor determines that the patient isn't responding to other types of treatments. The surgery doesn't cure the condition. However, it does allow for opening the blockage. Patients must still make the conscious decision to change their lifestyles accordingly. Even if a patient has the surgery, he/she must remember to have routine checkups and maintain their weight. The patient must also lower their blood cholesterol and lower the risk of blood clots.

What Happens During Bypass Surgery?

After the anesthesiologist gives the anesthesia, the surgeon will begin. He or she will remove the veins from either the leg or the arm in preparation for grafting them into the heart blood vessel that will be grafted.

The surgeon will determine which veins to use dependent upon where the blockage is and how large the arteries are that need to be grafted.

Common Blood Vessels Used for Bypass Surgery

There are four options when it comes to grafting. They can use the following arteries for grafting:

Internal mammary artery: This is also referred to as the IMA or an internal thoracic artery. This is the most used type of bypass graft. It has long been known to show the best long term results. Because it has its own oxygen blood supply, it can be easily kept intact. It is sewn to the coronary artery just below the area that is blocked. Approximately 90 percent of all patients have received at least one of this type of graft.

Radial artery: This is the next most common kind of graft. The two arteries that are in the arm called the ulnar and the radial arteries are used. Most of us receive the blood in our arms from the ulnar artery. However, there are no side effects if the radial artery is where we receive our blood. The doctors and surgeon will run an intraoperative test to ensure that the radial artery can be used. If they are using the radial artery, patients may be required to ingest calcium channel blockers for a few months after having surgery. This will ensure that the artery remains open. Occasionally, patients will report numbness in their wrist after the procedure is done. However, long term numbness isn't common.

Other grafts that are less commonly used are the Saphenous vein near the knee and the gastroepiploic artery in the stomach.

Here's a video on the anatomy of a triple bypass surgery to help you better understand what it would be like: 

What Are the Possible Risks?

It's great that risks are quite low today; over 95% patients undergoing the surgery will not have serious side effects. Possible risks from the graft are as follows:

  • Bleeding from the site of the graft or the attached graft.
  • Heart rhythm issues such as atrial fibrillation.
  • Blood clots, which may result in other conditions such as stroke, heart attack or even lung problems.
  • Infections at either the graft removal site or the incision site for the graft.
  • Stroke.
  • Post pericardiotomy syndrome (symptoms of fever and chest pain) influences about 30 patients.
  • Kidney or renal failure (usually temporary).
  • Memory loss due to fluids built up or bits of fats traveling to the brain.
  • Anesthesia reactions.
  • Death although this is extremely rare after triple bypass surgery. Death is generally due to a stroke or a heart attack.
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