Heart bypass surgery, commonly known as coronary artery bypass grafting, is internationally recognized as the most effective treatment for coronary artery disease, and refers to coronary artery bypass grafting or heart bypass surgery when one or more coronary arteries are severely blocked or have a very inadequate blood supply. A thorough examination should be performed prior to surgery to confirm the exact site of the blockage. When the procedure is performed, the blood supply to the body from the heart is cut off, so a heart-lung machine is used to circulate the blood outside the body to protect the normal movement of vital organs such as the brain. Procedure Details Coronary artery stenosis in coronary heart disease is mostly segmental in distribution. It is mainly located in the proximal and middle segments of the coronary arteries, while the distal segments are mostly normal. Coronary artery bypass grafting is to create a channel between the proximal and distal coronary artery stenosis, so that the blood bypasses the narrow median and reaches the distal end, like a bridge that allows a highway to cross a ravine or river. However, the material used is not steel and concrete, but the patient’s own saphenous vein, internal mammary artery, right gastric retinal artery, and radial artery. The saphenous vein on the calf or thigh is taken and anastomosed to the distal end of the coronary stenosis at one end and to the ascending aorta at the other end, or several lateral holes can be opened in one vein at the same time to anastomose to several coronary arteries side-by-side, which is called sequential bypass or serpentine bridge. Coronary artery bypass surgery is an open heart surgery. The procedure will be performed in two parts simultaneously: the heart itself and the leg bypass vessel extraction. The bypass vessel will be bridged over the blocked area of the coronary artery to restore blood supply to the heart muscle. In some patients with multiple blocked coronary arteries, multiple bypasses will be created, including the radial artery and the internal thoracic artery. After surgery, the patient will be hospitalized for 7 to 10 days for observation. The first 1 to 3 days will be spent in the intensive care unit (ICU). Thoracic drains will be placed for 2-3 days to allow drainage of fluid and to monitor cardiac function around the clock. The outcome of the procedure will not be determined until 3-6 months after surgery. Intercourse should be prohibited for 3-4 weeks after surgery. However, other general exercises are allowed. Types of surgery (a) Saphenous vein bypass The saphenous vein bypass is less invasive and simpler, but the long-term effect is worse than that of arterial bypass, therefore, the saphenous vein bypass can be used alone for elderly people over 80 years old, arterial bypass can be considered for those under 55 years old, and an internal mammary artery plus saphenous vein can be used for other ages. (B) Arterial bypass Arterial bypass is more damaging, technically demanding and more difficult to operate, but the long-term effect is better than saphenous vein, and it is suitable for young patients. Suitable for patients Intervention and bypass are two important means of treating cardiovascular disease. Among them, stenting, especially drug stenting, as a latecomer, has been favored by many patients for its minimal trauma. According to the New York Times, the number of patients receiving bypass in the United States in 2006 was about 365,000, a drop of 1/3 compared to 10 years ago; while the number of patients receiving interventional treatment soared all the way up to about 1 million. But the article also points out: many cardiovascular specialists urge that, despite this, people should not ignore the advantages of bypass surgery in favor of interventions. So, which of the two is more important? Under what circumstances should a patient undergo surgical bypass surgery? Patients with coronary artery disease with the following lesion characteristics should opt for bypass. Left main stem lesions: According to national and international guidelines, surgery is the first choice for left main stem lesions. This is because left main stem can be fatal in the event of blockage or restenosis. To minimize the risk, bypass is the best choice. Three-branch lesion: The lesion has more vessels, and if interventional treatment is chosen, many stents have to be placed, which will greatly increase the chances of restenosis and thrombosis. Moreover, the financial burden on the patient is higher. Patients with cardiac insufficiency: These patients need complete hemodynamic reconstruction to promote recovery of ischemic myocardium, which is difficult to do with intervention. Patients with diabetes mellitus: Normal stents have a high restenosis rate in diabetic patients, while pharmacological stents have been introduced for a relatively short period of time, and there is no clear evidence that intervention will have better efficacy than bypass. Patients with post-coronary myocardial infarction complications: ventricular rupture, septal perforation, and mitral valve closure insufficiency must be treated with surgical bypass surgery as an option. Since stents require patients to take antiplatelet drugs, patients who are allergic to this drug should also consider bypass surgery. “However, if a patient has respiratory disease, it may be dangerous to receive general anesthesia and is not a good candidate for conventional extracorporeal bypass in favor of interventional treatment.” Pros and cons of heart bypass vs. stent intervention There are three main ways to treat coronary artery disease: medication, surgery and stent intervention, and each of the three has its own strengths and weaknesses. Medication does not change the condition of the narrowed blood vessels, but it is still the basis of coronary heart disease treatment and an important tool. In the past, heart bypass surgery was considered when severe stenosis occurred in the heart vessels. Nowadays, when there is severe stenosis (70% or more) or occlusion in the coronary vessels, stent intervention can be considered. With increasingly sophisticated methods of treating coronary heart disease, less invasive stenting has become the first choice for many heart patients. Some people even claim that “heart bypass” surgery will soon be retired from the stage of history. In fact, the advantages of bypass surgery are irreplaceable. First of all, restenosis rate has always been the weakness of interventional treatment. The restenosis rate of ordinary stents placed at the narrowed coronary arteries is about 30% in six months, and even with drug-coated stents, the restenosis rate is about 5%. With heart bypass surgery, there is no need to worry too much about restenosis. In addition, not all patients with coronary artery disease are suitable for stenting, for example, it is difficult and risky to put a stent at the bifurcation of a vessel, or a vessel with more than two stenoses, or a completely occluded vessel. In fact, for complex lesions, surgical coronary artery bypass surgery is still the best choice. The post-operative effect of bypass surgery is aptly described as “immediate”. Many patients can walk up and down stairs a few days after receiving “heart bypass” surgery, and can walk out of their homes a week later, and can go to work 1-2 months after surgery. In recent years, with the rapid development of minimally invasive surgical techniques, bypass surgery can be completed without cutting open the sternum. Therefore, “heart bypass” has a broad development prospect.