coronary artery bypass


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bypass

 [bi´pas″]
an auxiliary flow; a shunt; a surgically created pathway circumventing the normal anatomical pathway, such as in an artery or the intestine.
Bypass. Single artery bypass of an occluded right coronary artery. From Dorland's, 2000.
aortocoronary bypass coronary artery bypass.
aortofemoral bypass insertion of a vascular prosthesis from the aorta to the femoral artery to bypass atherosclerotic occlusions in the aorta and the iliac artery.
aortoiliac bypass insertion of a vascular prosthesis from the abdominal aorta to the femoral artery to bypass intervening atherosclerotic segments.
axillofemoral bypass insertion of a vascular prosthesis or section of saphenous vein from the axillary artery to the ipsilateral femoral artery to relieve lower limb ischemia in patients in whom normal anatomic placement of a graft is contraindicated, as by abdominal infection or aortic aneurysm.
axillopopliteal bypass insertion of a vascular prosthesis from the axillary artery to the popliteal artery to relieve lower limb ischemia in patients in whom the femoral artery is unsuitable for axillofemoral bypass.
cardiopulmonary bypass diversion of the flow of blood from the entrance to the right atrium directly to the aorta, usually via a pump oxygenator, avoiding both the heart and the lungs; a form of extracorporeal circulation used in heart surgery.
coronary bypass (coronary artery bypass) a section of saphenous vein or other conduit grafted between the aorta and a coronary artery distal to an obstructive lesion in the latter; called also aortocoronary bypass.
extra-anatomic bypass an arterial bypass that does not follow the normal anatomic pathway, such as an axillofemoral bypass.
extracranial/intracranial bypass anastomosis of the superficial temporal artery to the middle cerebral artery to preserve function or prevent stroke or death in patients with stenosis of the internal carotid or middle cerebral artery.
femorofemoral bypass insertion of a vascular prosthesis between the femoral arteries to bypass an occluded or injured iliac artery.
femoropopliteal bypass insertion of a vascular prosthesis from the femoral to the popliteal artery to bypass occluded segments.
gastric bypass see gastric bypass.
hepatorenal bypass insertion of a vascular prosthesis between the common hepatic artery and the renal artery, serving as a passage around an occluded segment of renal artery.
intestinal bypass (jejunoileal bypass) see intestinal bypass.
left heart bypass diversion of the flow of blood from the pulmonary veins directly to the aorta, avoiding the left atrium and the left ventricle.
partial bypass the deviation of only a portion of the blood flowing through an artery.
partial ileal bypass anastomosis of the proximal end of the transected ileum to the cecum, the bypass of the portion of the small intestine resulting in decreased intestinal absorption of and increased fecal excretion of cholesterol; sometimes used in treatment of hyperlipidemia.
right heart bypass diversion of the flow of blood from the entrance of the right atrium directly to the pulmonary arteries, avoiding the right atrium and right ventricles.

cor·o·nar·y artery by·pass

conduit, usually a vein graft or internal thoracic artery, surgically interposed between the aorta and a coronary artery branch to shunt blood beyond an obstruction.

cor·o·nar·y ar·te·ry by·pass

(kōr'ŏ-nār-ē ahr'tĕr-ē bī'pas)
Conduit, usually a vein graft or internal thoracic artery, surgically interposed between the aorta and a coronary artery branch to coronary shunt blood beyond an obstruction.
Enlarge picture
CORONARY ARTERY BYPASS: Myocardial reperfusion by coronary artery bypass graft surgery

coronary artery bypass

Surgical establishment of a shunt that permits blood to travel from the aorta or internal mammary artery to a branch of the coronary artery at a point past an obstruction. It is used to treat coronary artery disease.

Traditional surgery requires opening the chest and sternum, spreading the ribs, and use of external heart/lung oxygenation. Less invasive techniques use several small incisions (keyhole surgery), smaller surgical instruments, and fiber-optic cameras. Recovery time is reduced and there are fewer postoperative complications. See: illustration

Patient care

Preoperative: The surgical procedure and the equipment and procedures used in the postanesthesia and intensive care units are explained. If possible, a tour of the facilities is arranged for the patient. The nurse assists with insertion of arterial and central lines and initiates cardiac monitoring when the patient enters the operating room.

Postoperative: Initially the postoperative patient will be intubated, mechanically ventilated, and will undergo cardiac monitoring. He will also have a nasogastric tube, a chest tube and drainage system, an indwelling urinary catheter, arterial and venous lines, epicardial pacing wires, and, often, a pulmonary artery catheter.

Signs of hemodynamic compromise, e.g., severe hypotension, decreased cardiac output, and shock, are monitored; vital signs are obtained and documented according to protocol until the patient's condition stabilizes. Disturbances in heart rate or rhythm are monitored; any abnormalities are documented and reported. Preparations are made to initiate or assist with epicardial pacing, cardioversion, or defibrillation as necessary. Pulmonary artery, central venous, and left atrial pressures are monitored, and arterial pressure is maintained within prescribed guidelines (usually between 110 and 70 mm Hg). Peripheral pulses, capillary refill time, and skin temperature and color are assessed frequently; the chest is auscultated for changes in heart sounds or pulmonary congestion. Any abnormalities are documented and reported to the surgeon. Tissue oxygenation is monitored by assessing breath sounds, chest excursion, symmetry of chest expansion, pulse oximeter, and arterial blood gas (ABG) values. Ventilator settings are adjusted as needed. Fluid intake and output and electrolyte levels are assessed for imbalances. Chest tube drainage is maintained at the prescribed negative pressure (usually -10 to -40 cm H2O); chest tubes are inspected for patency. The patient is assessed for hemorrhage, excessive drainage (> 200 ml/hr), and sudden decrease or cessation of drainage. Prescribed analgesics and other medications are administered.

Throughout recovery the patient is evaluated for changes in oxygenation, ventilation, neurological status, and urinary output. After the patient is weaned from the ventilator and extubated, chest physiotherapy and incentive spirometry are used, and the patient is encouraged to breathe deeply and to cough to prevent atelectasis of the lung and to clear mucus from the airway. The patient is helped to change position frequently. Help is also given with range-of-motion exercises and with active leg movement and gluteal and quadriceps setting exercises.

Before discharge the patient is instructed to report any signs of infection (fever, sore throat, redness, swelling, or drainage from the leg or chest incisions) or cardiac complications (angina, dizziness, rapid or irregular pulse, or increasing fatigue or prolonged recovery time after activity or exercise). Postpericardiotomy syndrome often develops after open heart surgery. Postoperative depression may also develop weeks after discharge; both patient and family are reassured that this is normal and usually passes quickly. The patient is advised to observe any tobacco, sodium, cholesterol, fat, and calorie restrictions, which may help reduce the risk of recurrent arterial occlusion. The patient needs to maintain a balance between activity and rest and should schedule a short afternoon rest period and plan to get 8 hr of sleep nightly. Frequent rest should also follow any tiring activity. Participation in the prescribed cardiac rehabilitative exercise program is recommended, and any activity restrictions (avoiding lifting heavy objects, driving a car, or doing strenuous work until specific permission is granted) are reinforced. Appropriate reassurance is offered that the patient can climb stairs, engage in sexual activity, take baths or showers, and do light chores. The patient is referred to local information and support groups or organizations, such as the American Heart Association. Synonym: aortocoronary bypass

See also: bypass

coronary artery bypass

The use of a short length of vein to connect the AORTA to a point on a CORONARY artery beyond a narrowing or obstruction. A triple bypass is often performed at the same operation. The veins soon thicken and become arterialized. Alternatively, an internal mammary artery can be disconnected and sewn into the coronary artery beyond the obstruction.

Coronary artery bypass

Surgical procedure to reroute blood around a blocked coronary artery.
Mentioned in: Heart Failure

cor·o·nar·y ar·te·ry by·pass

(kōr'ŏ-nār-ē ahr'tĕr-ē bī'pas)
Conduit, usually a vein graft or internal mammary artery, surgically interposed between the aorta and a coronary artery branch to coronary shunt blood beyond an obstruction.

coronary artery bypass,

n an open-heart surgery in which a section of a blood vessel is grafted onto one or more of the coronary arteries to improve the blood supply to the muscles of the heart.
Coronaviridae
n.pl a family of enveloped, helical, airborne RNA viruses responsible for some respiratory and gastrointestinal diseases. It can also be contracted from unsanitary equipment or from human carriers.
References in periodicals archive ?
Coronary artery bypass surgery has become widely performed for coronary artery disease in this group (1, 2).
Coronary angioplasty versus coronary artery bypass surgery: The randomized intervention treatment of angina (RITA) trial.
MRG's US Markets for Coronary Artery Bypass Graft Devices 2011 report includes analysis on on-pump coronary artery bypass devices, off-pump coronary artery bypass devices, endoscopic vessel harvesting devices, and anastomosis assist devices.
The Center specializes in coronary artery bypass grafts, pacemaker surgery, thoracic aortic aneurysm surgery, and mitral and aortic valve repair and replacement.
The proceeds from this transaction have been budgeted by the Company for the continued development of the Coronary Artery ByPass and performance of clinical trials, with the ultimate intent of securing the necessary FDA approvals that will enable the Company to introduce the Coronary Artery ByPass Graft to a market that is believed to be approximately $1.
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In 1990, there were 262,000 patients who underwent coronary artery bypass surgery.
Gaston Memorial Hospital was rated in the top deciles, based on overall quality scores, for Coronary Artery Bypass Graft, Acute Myocardial Infarction, Congestive Heart Failure, and Pneumonia care.
NASDAQ: GNSA) announced that the Phase 3 data from two multicenter trials on the use of Arasine in coronary artery bypass surgery was presented today at the 42nd Annual Scientific Session of the American College of Cardiology (ACC) in Anaheim, Calif.
CardioVations manufactures and markets cardiovascular surgical products and technologies for the areas of off-pump coronary artery bypass grafting and valve surgery.

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