Coronary artery bypass grafting, commonly known as coronary artery bypass grafting, is internationally recognized as the most effective treatment for coronary heart disease, has a history of more than 30 years, the former U.S. President Bill Clinton, the former Russian President Boris Yeltsin chose the operation. However, most people in China do not know much about the procedure and are more or less afraid of it. Who needs coronary artery bypass surgery? Generally speaking, a stenosis of less than 50% of a coronary artery has little effect on blood flow, while a stenosis of 75% significantly affects blood flow and causes angina symptoms. Therefore, where a single coronary artery stenosis of 75%, or two or more stenosis greater than 50%, are required to perform coronary artery bypass surgery, many patients who have undergone coronary angioplasty and stent installation in the coronary arteries, once angina occurs again, but also need to perform bypass surgery in a timely manner. This will not only eliminate angina and enable patients to live and work normally, but also prevent myocardial infarction and sudden death. Ventricular wall tumor formed after myocardial infarction, because it can seriously affect cardiac function, produce serious arrhythmia or thromboembolism, it must be surgically resected, in the resection of ventricular wall tumor at the same time the coronary artery bypass grafting surgery, the effect is better. What is bypass surgery? Coronary artery stenosis in coronary artery disease is mostly segmental distribution and mainly located in the near middle of the coronary artery, the distal segment is mostly normal, coronary artery bypass grafting is in the coronary artery stenosis of the proximal and distal end of the establishment of a channel between the narrowed part of the coronary artery, so that the blood bypasses the narrowed part and reaches the distal end, like a bridge to make the highway over the gullies and rivers unimpeded, as well. The materials used, however, are not steel or concrete, but one’s own saphenous vein, internal mammary artery, right gastric omental 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 at one end to the distal coronary artery stenosis and at the other end to the ascending aorta, or at the same time several side holes are made in one vein for lateral anastomosis with several coronary arteries, which is known as sequential bypass or serpentine bridge. Bypass of the saphenous vein is less damaging and simpler than arterial bypass, but the long-term effect is worse than that of arterial bypass, so it is suitable for older patients, while arterial bypass is more damaging, more technically demanding, and more difficult, but the long-term effect is better than that of the greater saphenous vein, and it is suitable for younger patients. In general, the saphenous vein alone can be used to bypass the vein in the elderly over 80 years of age, all arterial bypass can be considered under 55 years of age, and an internal mammary artery with a large saphenous vein can be used in 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 do I have to do before coronary artery bypass surgery? Coronary artery bypass surgery is a very complex, technically demanding and difficult surgery with high patient injury. Coronary artery, left ventricle and internal mammary artery angiograms must be done before the surgery to determine the location and degree of coronary artery stenosis, and to decide the number and exact location of the bypass grafts accordingly. Echocardiography, electrocardiogram, blood biochemistry; lung, liver, kidney function and routine urinary and fecal examinations are also required to understand the functional status of the organs of the whole body. Infection is strictly controlled before surgery. Patients should practice abdominal breathing, stop using aspirin and other medications, be optimistic and cheerful, be in a good mood, and avoid excessive mental tension, as too much mental tension can easily cause coronary artery spasm, resulting in myocardial infarction and increasing the risk of surgery. Immediate effect Thirty years of history of coronary artery bypass grafting has confirmed its effectiveness in relieving the symptoms of angina pectoris. The word “immediate” is the best way to describe the results of the procedure. Many patients are able to walk up and down stairs within a few days of their coronary artery bypass graft. If they recover well, they can walk down the street a week later. Some patients described that their chest tightness and pain disappeared after the operation, just like a window suddenly opened in a stuffy house in winter, and even the air they sucked in was exceptionally fresh. After 1-2 months after the operation, the patients are generally able to perform light work, and after 3-4 months, they can basically resume their original work. There was a 68-year-old retired cadre who needed intravenous nitroglycerin injection before the operation and still had chest pain when he turned over. After 5 bridges were built for him, he was able to walk around in a week. He was able to take care of himself. However, not all patients’ recoveries are as smooth. An important factor affecting recovery is preoperative cardiac function. Coronary heart disease patients should go to the hospital as early as possible as long as there are symptoms of angina pectoris, so as to avoid extensive myocardial infarction, too many myocardial cell necrosis after the operation to bring difficulties in recovery. 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 of a venous bridge is about 60-70%. The long-term patency rate is better with arterial bridges. However, due to the limited amount of arterial material in the body, and the fact that some arterial material is prone to spasm, or the lumen is too thin, or even the arteries themselves are diseased or narrowed, arterial bridges are not suitable for all patients. The “bridge” needs to be protected at all times After coronary artery bypass grafting, if you do not pay attention to the improvement of dietary structure, adjustment of lifestyle habits, and long-term rational use of medication, then the bridge will always be at risk of re-obstruction. Activities should be adapted to the early postoperative period and the subsequent recovery period. Activity is beneficial for the recovery of the whole body and for the smoothness of the “bridge”. Dietary intake of cholesterol should be reduced. Long-term postoperative medication is essential to keep the “bridge” open. Blood pressure should be kept stable after surgery. High blood pressure increases the burden on the heart, while low blood pressure does not allow blood to flow through the bridge. If anticoagulation is not contraindicated, aspirin and Pansentin should be taken for as long as possible. It is generally believed that at least one year, which can varying degrees to prevent the formation of blood clots within the “bridge”, thus preventing the “bridge” blockage. “The patency of the bridge needs to be monitored. Regular postoperative checkups, such as electrocardiograms, isotopes and even coronary angiograms, are needed to detect possible problems as early as possible. In short, the patency of the “bridge” is inseparable from the patient’s own care and attention and the doctor’s concern. “How safe is bypass grafting? Coronary artery bypass grafting has a role to play in helping patients with coronary artery disease to regain a normal life that is unrivaled by other methods, and its own development has taken more than 30 years. However, it has only taken 6-7 years to make a qualitative leap in our country. This great stride in development comes mainly from the dedication and promotion of a group of young medical experts. In addition to conventional coronary artery bypass grafting, they can also perform special and difficult surgeries such as bypass grafting under heartbeat, coronary artery endothelial stripping plus bypass grafting, total arterialization bypass grafting, ventricular wall aneurysm resection plus bypass grafting, small incision bypass grafting, and flap replacement plus bypass grafting, etc., with a very high success rate. The success rate is 98%. The “bypass” experts here only want to dedicate their excellent medical skills to the majority of patients with coronary heart disease who are most in need of treatment.