Coronary artery bypass is a revascularization surgery used to treat ischemic heart disease, the disease caused by insufficient oxygenation of the heart muscle to improve blood flow to the heart in patients.

The disease develops due to narrowing or even complete blockage of the coronary arteries, arteries responsible for "feeding" the heart, leading to chest pains, so-called Angina Pectoris. Coronary artery disease occurs when the arteries that supply blood to the heart muscle (called coronary arteries) become blocked due to an obstruction with a material called plaque that forms inside the blood vessel.

If the blockage is severe, symptoms can include:

•  Chest pain (angina);
•  Shortness of breath;
•  In some cases, acute myocardial infarction.

Coronary artery bypass is a treatment for these conditions. During this operation, a healthy artery or vein is harvested from another part of the body and grafted to the diseased artery. The grafted artery or vein bypasses the blocked portion of the coronary artery. The aorto-coronary bypass creates a "bridge" that brings blood from another area (aortic artery) and carries it into the blocked or narrowed coronary artery beyond the area of the injured artery. In this way, the coronary artery being bypassed will be normally supplied with blood that will reach the damaged myocardial territory. This new passage will bring oxygen-rich blood to the heart muscle. With this technique, the patient's heart will become normally vascularized and the symptoms of coronary artery disease (angina, shortness of breath) will disappear, along with the risk of acute coronary events.

Multiple bypasses can be performed during an operation depending on the complexity and severity of the coronary arteries involved in the atherosclerotic process. This is one of the most common open-heart operations performed in the world. The doctors who perform it are called cardiac surgeons (cardiovascular or cardiothoracic).

Coronary artery bypass cannot be done to every patient with diseased coronary arteries. Many people with these conditions can be treated by other means, such as lifestyle changes, medications, or other revascularization procedures called angioplasty. Coronary artery bypass grafting may be a treatment option if the patient has a severe blockage in a large coronary artery supplying blood to an important area of heart muscle - especially if the heart's pumping action has already been impaired. It may also be an option if the coronary blockage cannot be resolved by angioplasty. In this situation bypass is considered most effective.

If the patient is a candidate for coronary artery bypass grafting, the aims of the procedure are:

•  Improve quality of life and decrease the frequency of angina attacks and other symptoms of coronary heart disease;
•  Resume a more active lifestyle;
•  Improve the heart's pumping ability if it has been damaged by a heart attack;
•  Decreased risk of myocardial infarction (in some patients, such as those with diabetes);
•  Improve your chances of survival.

Prescription medication and lifestyle changes can decrease the risk of blockage of the grafted artery. In patients who are candidates for this type of surgery, the results are usually excellent: 85% of them have a significant reduction in symptoms, a lower risk of subsequent myocardial infarction and a decreased risk of death within 10 years of surgery.

Mortality in coronary surgery is currently 1%, being the lowest in cardiac surgery. Although complications from coronary bypass surgery are unlikely, the risks are related to:

•  Bleeding or surgical wound infection;
•  Reactions to anesthesia;
•  Fever;
•  Pain;
•  Stroke, heart attack or even death.

In general, rthe risk of complications is higher when bypass surgery is done in an emergency (for example, when performed during a heart attack), if the patient is over the age of 70 and has a history of smoking. The risk is also higher in patients who have other conditions such as diabetes, kidney or lung disease or peripheral circulation disorders. Over the last 10 years, the risk of open-heart surgery has fallen dramatically.

Cardiovascular medical recovery significantly improves physical and mental condition of the patient, leading to increased survival rate.

For patients who have had open-heart surgery, recovery begins from the first day after surgery, in intensive care. Light supine exercises, sitting on the edge of the bed and breathing exercises are very important. The next day on the ward, in addition to exercises of lifting from the edge of the bed and active or passive mobilizations, the following are done first stepsand on the 5th day the patient can already going up one floor.

Cardiovascular rehabilitation will be performed between 3-5 sessions per week. A minimum of 12 weeks to achieve the training effect. Once achieved, the level of effort will be increased progressively, in increments, by increasing the intensity or duration of effort. Subsequently, to maintain this training effect, a minimum of 2 weekly meetings. Total recovery time is about 3 to 6 months. A session lasts between 40-50 minutes, including an initial warm-up period of 10-15 minutes, which prepares the body for exercise.

Patients need to be made aware of the importance of lifestyle change through recommendations on physical activity, smoking, body weight, diet, blood pressure, lipids and diabetes, as well as avoiding intense and complex psycho-emotional demands.

For more details about bypass, visit the dedicated website: www.by-pass.ro.