Coronary Artery Stenting and Bypass Grafting

Coronary Artery Disease

  • Coronary artery disease (CAD) plays a major role in the leading cause of death in this country: heart attack. CAD occurs when the coronary arteries — the arteries that bring blood to the heart muscle — become hardened and narrowed. The arteries harden and narrow because plaque has built up on the insides of their walls. This is called atherosclerosis.

Coronary Artery Stenting

A coronary stent is a small, slotted round tube made of medical-grade stainless steel designed to support the walls of the coronary arteries. This is used to prevent re-narrowing (restenosis) of the vessel. The stent is placed over a balloon catheter, passed through the blockage and expanded to stay inside the artery.

Drug-eluting stents release a particular drug at the stent implantation site. This drug limits the overgrowth of normal tissue as the healing process occurs. Studies have shown that this process significantly lowers the incidence of repeat procedures.

Coronary Artery Bypass Grafting (CABG)

Coronary artery bypass grafting (CABG) surgery is a procedure that uses arteries or veins from the body to reroute blood around a blockage in the coronary arteries (the arteries that carry blood and oxygen to the heart).

Indications for CABG

Coronary artery bypass grafting may be performed when:

  • Angina (chest pain) and other symptoms can’t be managed with medications.
  • Heart attack risk is high due to diminished blood flow.

About the Procedure

During coronary artery bypass grafting, the blockage in the artery is bypassed using a grafted vein, generally from the leg. One end of the vein is sewn to the aorta (the large artery that carries blood from the heart), and the other end is attached to the coronary artery below the point at which it’s blocked. The new channel allows blood to flow to the heart and relieve symptoms.

Traditional bypass surgery is an open-chest procedure that involves making a large incision in the chest to expose the heart and arteries. It also requires the use of a heart-lung bypass machine, which takes over the role of the heart and lungs during surgery and permits the heart to be stopped to perform the surgery. UC San Diego Health System’s cardiothoracic surgery team is highly experienced in traditional bypass techniques.

Beating-Heart Surgery: A Less Invasive CABG Technique

UC San Diego heart surgeons now offer a less invasive coronary artery bypass grafting procedure that can help reduce complications as well as minimize scarring and improve recovery time. This technique is called beating-heart surgery or off-pump coronary artery bypass (OPCAB), and it is performed without the use of the heart-lung bypass machine.

Instead of a heart-lung bypass machine, a stabilizing device is attached to the beating heart to reduce its movement during the procedure. OPCAB can be used to perform several bypass procedures at once.

Benefits of Off-Pump Coronary Artery Bypass

Benefits of beating heart surgery performed without the use of heart-lung bypass machine include:

  • Reduced risk of stroke
  • Fewer complications associated with the lungs
  • Less need for blood transfusions
  • Less injury to the heart muscle

Patient Eligibility for OPCAG

Patients who are at increased risk of complications from cardiopulmonary bypass may be good candidates for off-pump coronary artery grafting. These risks may include having carotid artery stenosis or compromised pulmonary or renal function.

Minimally Invasive Direct Coronary Artery Bypass

UC San Diego Health System heart surgeons also perform another beating-heart procedure known as minimally invasive direct coronary artery bypass (MIDCAB).

During MIDCAB several small incisions are used to access the coronary arteries instead of the one large incision (sternotomy) used in traditional CABG surgery.

Which Coronary Artery Bypass Graft is Best?

Each patient is unique, and there is no single answer to this question. At UC San Diego Health System, heart surgeons work with each patient, performing an extensive medical evaluation and considering all possible risks and complications, before making a recommendation on which procedure offers the optimal balance of safety and effectiveness.