What is Coronary Artery Bypass Surgery?

Coronary artery bypass grafting or "CABG" (often pronounced "cabbage") is one of the most commonly performed "open heart" operations in the United States.  It is performed when there is either a narrowing or blockage in one or more of the coronary arteries.  Increasing blood flow to the heart muscle can relieve chest pain and reduce the risk of heart attack.  Bypass surgery improves the blood flow to the heart with a new route, or "bypass," around the section of narrowed artery.

This surgery involves taking a segment of a healthy blood vessel usually a vein in your leg or an artery from either your chest or arm and sewing it to bypass the section of the diseased coronary artery. This creates a new route for blood to flow so that the heart muscle will get the oxygen-rich blood it needs to work properly.  Depending on how many coronary arteries are blocked one, two, three or more bypasses can be done.

When Coronary Bypass is not enough… Transmyocardial Revascularization (TMR) can be considered. 

TMR is a treatment aimed at improving blood flow to areas of the heart that were not treated by angioplasty or surgery or in which surgery alone will not suffice. Patients with coronary artery disease are treated with interventional procedures (angioplasty and stenting), coronary artery bypass grafting and medications to improve blood flow to the heart muscle. Sometimes these procedures do not eliminate the symptoms of chest pain, transmyocardial laser revascularization or TMR is another treatment option. A special carbon dioxide (CO2) laser is used to create small channels in the heart muscle, improving blood flow in the heart. The procedure is performed through a small left chest incision or through a midline incision. Frequently, it is performed with coronary artery bypass surgery, but occasionally it is performed independently.

How does it work?

How TMR reduces angina still is not fully understood.  The laser may stimulate new blood vessels to grow and/or it may destroy nerve fibers to the heart, making patients unable to feel their chest pain.   TMR  will not replace coronary artery bypass or angioplasty as the most common method of treating coronary artery disease. These alternatives have been proven over time to be safe, effective ways to restore blood flow to the heart muscle.  However TMR can be considered in:

• people who are high-risk candidates for a second bypass or angioplasty
• people whose blockages are too diffuse to be treated with bypass alone
• some patients with heart transplants who develop atherosclerosis in their transplanted heart.

For more information please visit these web sites:
http://healthcare.utah.edu/healthinfo/adult/cardiac/coronary.htm
http://www.americanheart.org/presenter.jhtml?identifier=3007454
http://www.sts.org/