For more information, please click: Coronary Artery Bypass Grafting Professional Network http://www.cabg120.com]Shaanxi Provincial People’s Hospital Cardiovascular Surgery Department Shi Jian
Coronary artery bypass grafting (CABG, mostly known as coronary artery bypass grafting in China) is undoubtedly one of the major advances in the history of human medicine in the 20th century. Today it has become one of the most common and effective methods for the treatment of coronary artery disease, and there are two main types of surgery.
Bypass surgery with the assistance of extracorporeal circulation, referred to as stop-and-go bypass.
Bypass surgery without extracorporeal circulation, referred to as non-stop bypass
The vast majority of bypass surgeries performed worldwide, especially in developed countries such as Europe and the United States, are still performed under cardiac arrest, and non-stop bypass surgery accounts for about 1/3 of the annual bypass surgery volume.
Here we make a brief introduction.
Non-stop bypass surgery, with the help of special equipment, allows the heart to reduce the number and amplitude of beats, and the doctor anastomoses the coronary artery with a diameter of only 1 or 2 mm, which has many benefits because it does not use extracorporeal circulation: it avoids reperfusion damage caused by myocardial ischemia, and it also avoids damage to lung function and liver and kidney function caused by extracorporeal circulation, and reduces the amount of blood transfusion. But performing a fine vascular anastomosis on a beating heart to achieve a perfect state is a challenging task. Just as with fine embroidery work, it is impossible to achieve the same satisfactory work even if the same embroiderer is in both quiet and active states. For nonstop bypass, the number of anastomosed vessels is lower than for surgery under arrest, and the poor long-term patency rate of revascularization is also a challenge that cannot be universalized at this time. OPCAB should be considered the first choice for those patients with contraindications or high-risk risk factors for extracorporeal circulation, which include advanced age, renal insufficiency, presence of chronic obstructive pulmonary disease, aortic calcification, diffuse cerebrovascular or peripheral vascular disease, history of cerebrovascular disease, and those with bleeding and coagulation disorders.
The classical coronary artery bypass grafting procedure, in which the heart is stopped with the assistance of extracorporeal circulation, usually takes about one hour. The surgeon completes the procedure on a quiet and immobile heart and can handle each vessel that needs to be treated with ease, and the quality of the anastomosis of the procedure is very satisfactory, so the long-term patency rate and the degree of complete revascularization are higher than those of non-stop surgery. Although the efficacy of this procedure has been confirmed, the necessity of extracorporeal circulation prevents some patients, especially those with combined other organ failure, from being treated because they cannot tolerate the extracorporeal blow. Although coronary artery bypass surgery in cardiac arrest involves a series of risks associated with extracorporeal circulation, the risks associated with it have been reduced to a very low level with the improvement of medical technology, and the fact that more than 600,000 people undergo cardiac surgery each year with the help of extracorporeal circulation machines also indicates that most patients can tolerate extracorporeal circulation well.
“Tailoring” is critical. Stopping and not stopping are just two techniques for bypass, and both methods should be used wisely to provide the greatest benefit to the patient. The decision to stop or not to stop must be made on a patient-by-patient basis, telling the patient which method has the best long-term outcome, rather than simplistically saying that stopping is better or not stopping is better.