Why does coronary heart disease require aggressive treatment? Coronary atherosclerotic heart disease, or coronary heart disease, is a disease in which the blood supply to the heart muscle is inadequate due to narrowing of the coronary arteries that nourish the heart. Just like a person going hungry without eating, myocardial ischemia can have three outcomes. One is like a person who does not eat for a meal will have stomach pain, acute myocardial transient ischemia will cause chest tightness, chest pain, which lasts for a few minutes and can be relieved by resting or taking nitroglycerin tablets, this is called angina, which will make the patient less and less active. Another kind is like a person who will die of starvation if he or she does not eat for a few days, while a complete blockage of the coronary artery will cause a myocardial infarction and complete death of the local heart, causing life-threatening conditions. Another kind is like a person who is starving for a long time causing malnutrition, continuous myocardial ischemia will cause chronic malnutrition of the heart, called ischemic cardiomyopathy, and the patient will eventually go into chronic heart failure and may need a heart transplant. Because the results of coronary heart disease are so serious, patients need aggressive and timely treatment. What is the best thing about total arterialized bypass? There are currently three main types of treatment for coronary artery disease. One is drug therapy, which can slow down the progression of coronary heart disease and improve the symptoms of angina, and is generally used to prevent coronary heart disease or as an adjunctive treatment. The other is medical interventional therapy, which is a method of unblocking the pipeline, that is, putting a stent in the stenotic segment to open up the narrowed blood vessel, suitable for the case of limited lesions. There is another kind of surgical coronary artery bypass grafting, also called coronary artery bypass grafting, which is to connect another pipeline to the distal end of the stenosis, which can simplify the process and is suitable for diffuse lesions. The additional tube connected during the bypass surgery is the bridge vessel. After decades of statistics, it has been found that there is a huge difference in the usual rates after 10 years. The usual rate of using a vein as a bridge vessel is only about 50%, while the in situ left internal mammary artery is up to 95%, the dissected right mammary artery is about 90%, and the radial artery is about 80%. Therefore, “arterial bridging” is much more effective than “venous bridging”. Why is the internal mammary artery “skeletonized”? Skeletonization comes from the English word skeletonize, which in this case means to trim the artery cleanly without surrounding tissue, as opposed to pedicle with surrounding tissue. Advantages: I. The artery is taken down longer and can be bypassed for more narrow vessels. Second, because the internal mammary artery is located behind the sternum, “skeletonization” preserves the tissue behind the sternum, which can improve the blood supply behind the sternum and reduce the incidence of poor sternal healing (once it occurs, the mortality rate is as high as 50%). Diabetic patients have poor healing ability, and the skeletonization technique is especially beneficial to them. Third, because the skeletonized internal mammary artery graft can eliminate the need to clamp the aorta as in general bypass surgery, reducing the risk of cerebral infarction in patients after surgery. What are the difficulties of skeletonized internal mammary artery? Coronary artery bypass grafting with skeletonized internal mammary arteries is very demanding for cardiac surgeons. First, because the internal mammary artery is very thin, only about 2 mm in diameter, it is important to prevent damage during vessel extraction in order to maintain long-term patency. While the method of vessel extraction with surrounding tissue is relatively easy, the skeletonization method is more difficult and requires a very skilled surgeon to ensure the success of the procedure. Second, it is even more difficult to keep the rice-sized anastomosis open while not directly clamping it during the vessel anastomosis. In conclusion, skeletonizing the internal mammary artery is an excellent option for patients waiting for bypass, and this procedure can be pursued whenever available to reduce the risk of postoperative angina recurrence or myocardial infarction and to help these patients achieve the best possible outcome.