Coronary artery atherosclerotic heart disease, or coronary heart disease, has become the number one killer in Western countries, and the incidence of coronary heart disease is also quite high in China, with a trend of gradual increase. Coronary artery bypass grafting, commonly known as coronary artery bypass grafting, is the most effective treatment for coronary heart disease internationally, and has a history of more than 30 years. Our Anzhen Hospital and many other hospitals in China have carried out coronary artery bypass surgery extensively in recent years, and have accumulated rich clinical experience and achieved very good results, but at present most people do not know much about this surgery and are more or less afraid of it. What is coronary heart disease all about? As we all know, every organ in our body needs adequate blood circulation, and the heart is the power pump that supplies blood to the whole body. The heart itself also needs an adequate supply of blood. In fact, the first blood pumped by the heart is the one that supplies itself. The arteries supplying the heart are the left and right coronary arteries, and the left coronary artery is divided into two branches, the anterior descending branch and the gyrus branch. The body’s lipid metabolism disorders and other reasons make lipid deposits in the arterial lining and lead to atherosclerosis, narrowing the lumen and reducing the amount of blood flowing through it. Coronary heart disease is a condition in which the blood supply to the heart is reduced due to coronary artery sclerosis, and therefore, coronary heart disease is also called ischemic heart disease. In severe cases, even minor activities such as eating and dressing are restricted, and myocardial infarction and sudden death can occur. Angina pectoris usually lasts for a few minutes and can be relieved immediately by rest or nitroglycerin. Which patients need coronary artery bypass surgery? In general, coronary artery stenosis below 50% has little effect on blood flow, while stenosis up to 75% can significantly affect blood flow and produce angina symptoms. Therefore, any single coronary artery with a stenosis of 75% or two or more stenoses greater than 50% needs to undergo coronary artery bypass surgery, and many patients who have undergone coronary angioplasty and have stents installed in the coronary arteries (commonly known as PTCA) also need to undergo bypass surgery in a timely manner once angina occurs again. This will not only eliminate angina and enable the patient to live and work normally, but also prevent myocardial infarction and sudden death. Ventricular wall tumors formed after myocardial infarction must be surgically removed because they can seriously affect cardiac function and produce serious heart rate arrhythmias or thromboembolism. What is bypass surgery? Coronary artery stenosis in coronary artery disease is mostly segmental and mainly located in the proximal and middle segments of the coronary artery, while the distal segments are mostly normal. Coronary artery bypass surgery is to create a channel between the proximal and distal coronary artery stenosis so that the blood bypasses the stenosis and reaches the distal end, just as a bridge makes a highway cross a mountain valley or river unobstructed. However, the materials used are not steel and concrete, but its own saphenous vein, internal mammary artery, right gastroretinal artery, radial artery, and inferior abdominal wall artery. With saphenous vein bypass, the saphenous vein is removed from the upper leg or thigh and anastomosed to the distal end of the narrowed coronary artery at one end and to the ascending aorta at the other end, or several lateral holes can be made in one vein at the same time to anastomose to several coronary arteries side-by-side, which is called sequential bypass or serpentine bridge. With saphenous vein bypass, the operation is less damaged and simpler, but the long-term effect is worse than arterial bypass, therefore, it is suitable for older patients, while with arterial bypass the damage is high, the technique is demanding and the operation is difficult, but the long-term effect is better than saphenous vein, which is suitable for younger patients. In general, the saphenous vein bypass can be used alone for the elderly over 80 years old, and all arterial bypass can be considered for the elderly over 55 years old, while one internal mammary artery plus the saphenous vein can be used for other ages. The procedure is usually performed under general anesthesia with hypothermia, extracorporeal circulation, and cardiac arrest. It usually takes 2-3 hours. In simple cases, coronary artery bypass surgery can also be performed without extracorporeal circulation and with the heart beating. What should I do before coronary artery bypass surgery? Coronary artery bypass surgery is a very complex and technically demanding procedure with high patient injury. Coronary artery, left ventricle and internal mammary artery angiography must be done before the surgery to clarify the location and degree of coronary artery stenosis and to determine the number and exact location of bypasses accordingly. Echocardiogram, electrocardiogram, blood biochemistry; lung, liver, kidney function and routine urine and stool tests are also required to understand the functional status of all organs of the body. Infection should be strictly controlled before surgery. Patients should practice abdominal breathing, stop using aspirin and other drugs, be optimistic and cheerful, feel comfortable, and avoid excessive mental tension, because too much mental tension can easily cause coronary artery spasm and produce myocardial infarction and increase the risk of surgery. Immediate effect Thirty years of coronary artery bypass grafting history has confirmed its effectiveness in relieving the symptoms of angina pectoris. The word “immediate” is the most appropriate way to describe the postoperative results. Many patients are able to walk up and down stairs within a few days of coronary artery bypass grafting. If they recover well, they can be out on the street in a week. Some patients describe that the chest pain and tightness disappeared after surgery, just like a window suddenly opened in a stuffy house in winter, and even the air they sucked in was extra fresh. After 1-2 months after surgery, they can generally perform light work, and after 3-4 months, they can basically resume their original work. A 68-year-old retired cadre needed intravenous nitroglycerin injection before surgery and still had chest pain when he turned over. After the surgery, he was able to walk around in a week after 5 bridges were built for him. He was able to take care of himself completely. However, not all patients recover as well. An important factor that affects the recovery is the preoperative cardiac function status. Patients with coronary artery disease should go to the hospital as soon as they have angina symptoms to avoid difficulties in recovery after surgery due to extensive myocardial infarction and necrosis of too many heart muscle cells. How many years can a bridge over the heart last? This is a question that many patients are concerned about. It is generally believed that the ten-year patency rate is about 60-70% when a vein is used as the bypass material. The long term patency rate is better with arterial bridges. However, not all patients are suitable for arterial bridges because of the limited amount of arterial material available in the body, the tendency of some arterial materials to spasm, or the thinness of the lumen, or even the lesion or stenosis of the artery itself. ”If you do not pay attention to the improvement of diet, lifestyle and long-term medication after coronary artery bypass surgery, the bridge will always be at risk of re-clogging. The early postoperative period and the subsequent recovery period should be adapted to activity. Activity is beneficial for the recovery of the whole body and the opening of the bridge. Cholesterol and lipid intake should be reduced in the diet. Long-term medication is essential to ensure the patency of the “bridge”. A stable blood pressure should be maintained after surgery. A high blood pressure increases the burden on the heart, while a low blood pressure does not allow the blood to flow through the bridge. If anticoagulation is not contraindicated, aspirin and pentoxifylline should be taken for as long as possible. It is generally believed that at least one year should be taken to prevent the formation of blood clots in the “bridge” to varying degrees, thus preventing the blockage of the “bridge”. ”The patency of the bridge needs to be monitored. Regular postoperative follow-ups, such as electrocardiograms, isotopes and even coronary angiograms, should be performed in order to detect possible problems as early as possible. In conclusion, the patency of the “bridge” is inseparable from the patient’s own care and attention and the doctor’s concern.