There are several ways of treating coronary artery disease.
Medical Management: Medical Treatment: Medications are prescribed to ease the workload of the heart, helping it manage reduced blood flow. Efforts are made simultaneously to enhance blood circulation and prevent blood clot formation in blocked vessels. Medications may be used alone or in conjunction with other procedures. In approximately 10% of cases, the disease may be too advanced, and the heart muscle too severely affected for significant benefits to be expected from bypass surgery or angioplasty. In such instances, medical therapy alone may be the preferred approach.
Coronary Intervention: Percutaneous Transluminal Coronary Angioplasty (PTCA), also known as Balloon Angioplasty, Atherectomy, and Stent placements, are increasingly utilized as coronary interventional procedures, particularly for patients who do not respond well to medical therapy.
PTCA is a non-surgical technique aimed at widening narrowed coronary arteries. During the procedure, a small inflatable balloon attached to a catheter is inserted into the narrowed section of the coronary artery. Once in place, the balloon is inflated, pushing against the narrowing and the surrounding arterial wall. This action helps improve blood flow to the heart muscle.
The entire PTCA procedure takes place in the cardiac catheterization laboratory, where it is monitored using X-ray imaging. Throughout the procedure, the patient’s heart activity is closely monitored for any abnormal ECG changes. Patients typically remain conscious throughout the procedure, experiencing minimal discomfort, while following the cardiologist’s instructions. A successful PTCA aims to restore normal blood flow and alleviate symptoms associated with coronary artery disease.
- Atherectomy: Atherectomy involves two main techniques. Directional atherectomy utilizes a catheter equipped with a small cutter driven by mechanics to shave off plaque, which is then collected in a chamber and removed when the device is withdrawn. Mechanical rotational atherectomy employs a diamond-shaped burr that rotates to shave plaque into tiny particles, allowing them to pass through the coronary circulation.
- Stent: A stent is a small, lattice-like stainless steel tube inserted into the coronary vessel using a balloon catheter. It helps prevent the collapse of the coronary artery segment. While stenting adds to the financial burden, it reduces the likelihood of restenosis. However, the long-term effects on arterial walls are still unknown. Newer stents, coated with substances like heparin or hirudin, or made of materials like gold or diamond-like hard carbon, show promise in reducing restenosis. Additionally, studies on radioactive, β-emitting stents are promising for preventing restenosis.
- Transmyocardial Revascularization (:TMR)/Percutaneous Transmyocardial Revascularization (PTMR): TMR/PTMR presents a hopeful therapy for patients who may not be suitable candidates for PTCA/CABG or who have exhausted all medical options. This technique involves creating new channels in the myocardium using a laser device, allowing direct contact between blood and myocardial tissue. These channels stimulate the growth of new blood vessels (vascular neogenesis).
Coronary Artery Bypass Surgery (CABG)
CABG is a surgical procedure used to bypass obstructions in the coronary arteries using veins taken from the leg (venous grafts) or an internal mammary artery graft.
A segment of the saphenous vein from the leg is removed and attached to the aorta and the blocked coronary artery, improving blood flow to previously deficient areas of the heart.
Surgeons cannot replace the coronary artery itself; they can only bypass obstructions within the arteries.
Long-term outcomes depend on the extent of coronary artery disease and the patient’s commitment to modifying risk factors.
Advances in CABG include the use of Internal Mammary Artery (IMA) grafts, which have shown improved survival rates and fewer major cardiac events compared to saphenous vein grafts alone.
Minimal Invasive Cardiac Bypass Surgery (MIDCAB)
MIDCAB utilizes minimally invasive techniques to graft the internal mammary artery onto an obstructed left anterior descending coronary artery through small chest incisions, eliminating the need for a sternotomy or heart-lung bypass.
Patients can be discharged after a few days of recovery, but the merits and demerits of this approach require further evaluation compared to conventional CABG.
Post-Surgery Care
Bypass surgery is performed by a highly skilled and experienced cardiac surgery team, with a low risk of complications. The procedure involves making an incision over the chest midline, dividing the breastbone, removing the saphenous vein from the leg, and connecting the patient to a heart-lung machine for the bypass procedure.
After surgery, the patient is transferred to the ICU, where vital signs, ECG, and breathing are closely monitored. Pain relief medication is provided, and breathing exercises and coughing are encouraged to prevent respiratory complications.
Recovery typically takes 4-6 weeks, and emotional fluctuations are normal but should not hinder progress. During recovery, it’s important to follow medical advice and engage in prescribed exercises to aid healing and prevent complications.
Common Post-Surgery Issues and Tips
Sore Throat: Irritation from the breathing tube used during and after surgery may cause a sore throat.
Low-grade Fever: Common after major surgeries, particularly heart operations. Typically resolves within 2 to 3 days.
Swelling of the Foot/Leg: Removal of veins from the leg can disrupt venous drainage, leading to swelling. Elevating legs, wearing elastic support stockings, and avoiding prolonged standing can help alleviate swelling.
Loss of Appetite: Medications, especially antibiotics, given after surgery may affect appetite, but it usually return to normal within a few days.
Clicking Sound from the Breastbone: The breastbone is divided during surgery and wired back together. Some patients may experience a clicking sound when turning, which usually resolves within a few days.
Numbness and Residual Pain: Nerves accompanying the mammary artery and saphenous vein may be cut during surgery, leading to numbness or abnormal sensations. This usually improves over time.
Depression: Hospitalization and major surgery can trigger temporary depression. Support from the rehabilitation team and engaging in activities like reading or watching TV can help alleviate it.
Rest: Your body needs ample rest during the initial recovery period. Pace your activities and prioritize rest to avoid extreme fatigue.
Bathing: Once stitches are removed, you can bathe gently, avoiding scrubbing the incision area. Use lukewarm water and pat the wound dry immediately after.
Household Chores: Avoid strenuous activities until advised otherwise by the rehabilitation team. Consult your doctor if you notice any discharge, redness, or tenderness around the incision site.
Returning to Work: Desk or sedentary job holders typically return to work 4-6 weeks after surgery, while those with physically demanding jobs may require a longer recovery period.Follow your doctor’s instructions and listen to your body’s needs during the recovery process to ensure a smooth and successful healing journey. Detailed personal advice can be obtained from our experts.