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Surgical and other procedures may be used to treat severe CAD and CAD that is causing angina when other treatment methods fail.

Surgical Procedures

Coronary Artery Bypass Graft (CABG)

CABG is more commonly known as open-heart or bypass surgery. It is the most common type of heart surgery in the United States.

During this operation, a healthy blood vessel is removed from the leg or another area of the body. The healthy blood vessel is connected to the damaged artery just above and just below the blocked or partially blocked area. This allows some blood to bypass the damaged area by moving through the new blood vessel. If more than one area is blocked, a bypass can be done for each area (referred to as a double, triple, or quadruple bypass).

Types of CABG include:

  • Traditional CABG —A heart-lung machine is used to circulate blood and oxygen throughout the body while the surgeon works on the heart. During surgery, the heart is stopped and is restarted when the surgeon is done.
  • Off-pump CABG —No heart-lung machine is needed. The surgeon works on the heart while it is still beating.
  • Minimally invasive direct CABG —Small incisions are made along the left side of the chest and between the ribs to access front-facing blood vessels. It is a fairly new off-pump procedure that may not be an option for everyone or widely available.

Talk to your doctor about which option is better for you. Although CABG may relieve symptoms, it does not cure heart disease. You still must maintain a healthy lifestyle that includes achieving a healthy weight, eating a heart healthy diet, not smoking, and taking medications.

Transmyocardial Laser Revascularization (TMR)

TMR is generally used in people who have inoperable CAD with severe angina. A laser is used through small incisions on the left side of the chest to create small channels in the affected part of the heart. These channels improve blood flow to the heart muscle. TMR can be done with or without CABG. A computer is used to pulse the laser at a specific time in the least active part of the heart beat cycle.

Other Procedures

Other procedures are used to open blocked arteries include:

  • Coronary angioplasty —Sometimes called a percutaneous coronary intervention (PCI). A guided catheter is inserted into the artery in your groin. Once the blockage is reached, a balloon is quickly inflated and deflated. This opens the artery and restores blood flow. The balloon and catheter are then removed.
  • Stent —During an angioplasty, a mesh stent may be placed in the artery to keep it open. The stent may be coated with a medication to reduce the chances of the artery renarrowing.
  • Laser angioplasty —The plaque is vaporized by a laser beam at the end of the guided catheter, which opens the artery.
  • Atherectomy —Once the blockage is reached, a shaver on the tip of the guided catheter is used to slice the plaque away.
  • Enhanced external counterpulsation (EECP)—Noninvasive procedure that uses inflatable bags around the legs. These bags inflate and deflate in rhythm with the heartbeat to help improve blood flow and decrease angina symptoms. This treatment may be able to decrease the symptoms of angina and improve oxygen flow.
Balloon Angioplasty
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