What Is Balloon Angioplasty and Stenting?

Coronary Stent

Stents have been usedfor more than a decade to restore the blood flow in CAD. It is now common practice to insert a stent to hold a coronary artery open and to maintain blood flow after an angioplasty.

Stenting is a minimally invasive procedure during which a stent and balloon are used together to push back plaque deposits inside of a diseased coronary artery.

A coronary stent is a tiny, expandable mesh tube made of medical-grade stainless steel or cobalt alloy metal. Stents can aid in the reduction of recurrent blockage or narrowing after an angioplasty procedure. Once the stent is implanted, it will remain in your artery permanently.

The Stent Procedure

Like in any angioplasty procedure, the stent is mounted onto a tiny balloon that is opened inside of a coronary artery to push back plaque and to restore blood flow. After the plaque is compressed against the arterial wall, the stent is fully expanded into position, acting as miniature "scaffolding" for the artery. The balloon is then deflated and removed, and the stent is left behind in the patient’s coronary artery to help keep the blood vessel open. For some patients it may be necessary to place more than one stent in the coronary artery, depending on the length of the blockage.

Stent procedures may have an advantage over angioplasty alone, because stents provide permanent structural support to help prevent the coronary artery from renarrowing (also known as restenosis), although restenosis may still occur.

Drug-Eluting Stents

In addition to providing structural support to the coronary artery, some stents also have a medicated coating to help prevent the vessel from renarrowing.

Both bare metal and drug-eluting stents can effectively reopen coronary arteries.

The use of stents may, on rare occasions, result in what is known as stent thrombosis. Stent thrombosis is a blood clot that occurs following stent implantation. In a small percentage of patients with stents, blood cells can become sticky and clump together to form a small mass – or clot. When a blood clot forms, it can block the free flow of blood through an artery and may cause a heart attack or even death. Stent thrombosis can occur in patients with both bare-metal and drug-eluting stents.

The most important thing you can do is follow your cardiologist’s recommendation for taking anticlotting medication, also known as dual antiplatelet therapy (aspirin with clopidogrel or ticlopidine). It is very important not to stop taking this medication before your cardiologist tells you to.

Next: What is Beating Heart Bypass Surgery

What Is Beating Heart Bypass Surgery?

When your arteries cannot supply enough blood to your heart, your doctor may recommend coronary artery bypass graft (CABG) surgery. CABG surgery restores blood flow to your heart.

Beating heart bypass surgery is – in simple terms – bypass surgery that is performed on your heart while it is beating. Your heart will not be stopped during surgery. You will not need a heart-lung machine. Your heart and lungs will continue to perform during your surgery.

Surgeons use a tissue stablisation system to immobilise the area of the heart where they need to work.

Beating heart bypass surgery is also called off-pump coronary artery bypass surgery (OPCAB). Both OPCAB and conventional on-pump surgery restore blood flow to the heart. However, off-pump bypass surgery may reduce side effects in certain types of patients.

What Happens During Beating Heart Bypass Surgery?

First, your surgeon removes a section of a healthy vein or artery from an area of your body. This is called a graft. The surgeon attaches one end of the graft to an area of the heart above the blockage in your artery. The other end is attached to an area of your coronary artery below the blockage. Once the graft is attached, blood flow to your heart is restored.

Conventional On Pump Coronary Artery Bypass Surgery

More than 70%¹ of all bypass surgeries are performed on a resting heart. Unlike beating heart surgery, during conventional on-pump heart bypass, medication is used to stop your heart.

A heart-lung machine takes over the function of your heart and lungs during the surgery. The heart-lung machine is also called a cardiopulmonary bypass machine. It has a pump to function as the heart and a membrane oxygenator to function as the lungs.

A patient is placed on cardiopulmonary bypass (the heart lung machine) during conventional open heart surgery. Heart-lung machines take over the job of keeping oxygen-rich blood circulating throughout the body during conventional CABG surgery. This allows the surgeon to perform the surgery on a still heart.

Heart-Lung Machine

A Heart-lung machine is used during open heart surgery to support the body during surgicalprocedure while the heart is rested. The heart-lung machine is often referred to as the "pump" , and does the work of the heart and lungs during the operation. The heart-lung machine consistes of a chamber that receives the blood from the body, this blood is them pumped by the machine through the oxygenator which removes the carbon dioxide and adds oxygen, which is normally the work of the lungs. The oxygenated blood is then gently circulated back to the body. The heart-lung machine is connected to the patient by a series of tubes that the surgical teams places. At the end of the operation, the surgeon gradually allows the patient's heart to resume its normal function, and the heart-lung mahine is "weaned off". This proces s is called perfusion. The person who operates the heart-lung machine is the perfusionist.

DURING THE PROCEDURE

The heart is usually rested for about 30-90 minutes of the 3-6 hour surgery. The heart-lung machine makes it possible for the surgeon to work on a still heart. This technique has been used for many years. Once the surgery is over, the surgeon and perfusionist restart your heart.

NEXT: FREQUENTLY ASKED QUESTIONS

Frequently Asked Questions – Beating Heart Bypass Surgery

Below are discussions of some of the common questions about beating heart bypass surgery. Your doctor is the best person to answer any specific questions you may have regarding your treatment.

• What is the difference between beating heart and CABG surgery?
• Is a heart-lung bypass machine used during beating heart surgery?
• Can my arteries get blocked again? How will I know?

What is the difference between beating heart and CABG surgery?

The main difference between beating heart surgery and conventional CABG surgery is the heart-lung machine. During conventional CABG surgery, your heart is stopped. The heart-lung machine handles circulation for your body. For some patients, this can increase their risk of stroke, or other complications.

Beating heart CABG surgery typically requires a heart positioner and a tissue stabiliser. These devices allow the surgeon to hold a portion of the heart still so the graft can be sewn in place. With beating heart surgery, your heart should function normally during surgery. Beating heart CABG surgery typically does not require use of the heart-lung machine.
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Is a heart-lung bypass machine used during beating heart surgery?

Beating heart bypass surgery is usually performed without the use of a heart-lung bypass machine. However, the machine is typically set up nearby. This is a precaution in case the surgeon needs to convert to an on-pump procedure to complete the surgery.

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Can my arteries get blocked again? How will I know?

Yes this may be a possibility. If this happens, you may experience symptoms similar to those you experienced when you first noticed you had coronary artery disease or before your bypass procedure. These symptoms may include chest pain or shortness of breath, especially during physical activity. If you experience pain, inform your doctor immediately.

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Next: Getting The Surgery