coronary artery bypass

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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.
Miller-Keane Encyclopedia and Dictionary of Medicine, Nursing, and Allied Health, Seventh Edition. © 2003 by Saunders, an imprint of Elsevier, Inc. All rights reserved.

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.
Farlex Partner Medical Dictionary © Farlex 2012

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.
Medical Dictionary for the Health Professions and Nursing © Farlex 2012
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
Medical Dictionary, © 2009 Farlex and Partners

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.
Collins Dictionary of Medicine © Robert M. Youngson 2004, 2005

Coronary artery bypass

Surgical procedure to reroute blood around a blocked coronary artery.
Mentioned in: Heart Failure
Gale Encyclopedia of Medicine. Copyright 2008 The Gale Group, Inc. All rights reserved.

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.
Medical Dictionary for the Dental Professions © Farlex 2012
References in periodicals archive ?
Secondary prevention after coronary artery bypass graft surgery: A scientific statement from the American Heart Association.
Coronary artery bypass graft surgery versus percutaneous coronary intervention in patients with three-vessel disease and left main coronary disease: 5-year follow-up of the randomised, clinical SYNTAX trial.
(1988) Excellent patency and growth potential of internal mammary artery grafts in pediatric coronary artery bypass surgery.
Bell, "A systematic review of outcomes following staged and synchronous carotid endarterectomy and coronary artery bypass," European Journal of Vascular and Endovascular Surgery, vol.
Prevalence and Variability of Internal Mammary Artery Graft Use in Contemporary Multivessel Coronary Artery Bypass Graft Surgery Analysis of the Society of Thoracic Surgeons National Cardiac Database.
Lawton, "Successful management of unremitting spasm of the nongrafted right coronary artery after off-pump coronary artery bypass grafting," Journal of Thoracic and Cardiovascular Surgery, vol.
[12.] Izutani H, Gill IS (2003) Acute graft failure caused by an intracoronary shunt in minimally invasive direct coronary artery bypass grafting.
Respiratory complications after coronary artery bypass surgery with unilateral or bilateral internal mammary artery grafting.
Coronary artery bypass grafting (CABG) along with cardiopulmonary bypass is commonly used to graft the diseased vessels.3 CABG is associated with many perioperative complications including: bleeding, infections of the chest wound, kidney failure and conduction disturbances.4
[17] Thus magnesium supplementation is particularly relevant in patients with impaired heart function after off-pump coronary artery bypass.
On-pump versus off-pump coronary artery bypass grafting in diabetic patients: a propensity score analysis.
Coronary artery bypass grafting vs percutaneous coronary intervention and long-term mortality and morbidity in multivessel disease.

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