Total Arterial Bypass Surgery

Heart bypass surgery or angioplasty?

Angioplasty is a minimally invasive method of widening a coronary artery. It uses a balloon catheter to widen the artery from within, and a stent is usually placed in the artery to keep it open. No anaesthetic is needed (although the patient may be offered sedation), and patients can often go home the same day or the next day.
The number of people having heart bypass has decreased by about a third in the past 10 years, which is linked to the development of drug-eluting stents that are used during PCI. Drug-eluting stents have a polymer coating that slowly releases a drug over time to help prevent the blockage from recurring.

Heart bypass is one of two techniques used in the treatment of coronary heart disease. The other is angioplasty and stenting. We explain the difference.

Total arterial bypass surgery, also known as multiple arterial grafting or complete arterial revascularization, is a cardiac surgical procedure used to treat coronary artery disease (CAD). In this procedure, the surgeon uses arteries from various parts of the patient's body to create multiple bypass grafts to reroute blood flow around blockages or narrowed coronary arteries. Unlike traditional coronary artery bypass grafting (CABG), which often involves using a combination of arteries and veins as grafts, total arterial bypass surgery exclusively uses arteries for grafting.

Internal Mammary Arteries (Internal Thoracic Arteries or ITAs):These arteries, located inside the chest, are often used as grafts in total arterial bypass surgery. The left internal mammary artery (LIMA) is particularly favored because it has a high long-term patency rate and is associated with excellent outcomes when used to bypass the left anterior descending (LAD) coronary artery.

Radial Artery: The radial artery, located in the forearm, can also be used as a graft in total arterial bypass surgery. It offers good long-term results and can be used to bypass other coronary arteries, including the right coronary artery (RCA).

Gastroepiploic Artery (GEA): In some cases, the gastroepiploic artery, which is found in the stomach area, may be used as a graft. Saphenous Vein: While the focus of total arterial bypass surgery is on arterial grafts, occasionally, the surgeon may use saphenous veins if no suitable arteries are available for grafting.

The advantage of total arterial bypass surgery is that it can provide multiple high-quality grafts composed of arteries, which tend to have better long-term patency rates compared to veins. This can potentially result in improved long-term outcomes and reduced risk of graft failure.

Total arterial bypass surgery is typically recommended for patients with multivessel coronary artery disease, especially those at low risk for complications. The decision to use total arterial grafts depends on the individual patient's anatomy, the surgeon's experience, and other factors that may influence the choice of grafts.

As with any surgical procedure, there are risks associated with total arterial bypass surgery, including infection, bleeding, and complications related to the use of grafts. Patients should discuss the benefits, risks, and potential alternatives with their cardiac surgeon to make an informed decision about the most suitable treatment for their specific condition.