What operations are done for myocardial infarction: coronary and coronary artery bypass grafting, coronary angioplasty

Among the most common are coronary artery bypass surgery, coronary angioplasty and coronary artery bypass surgery. You will learn more about each of these methods and who performed the first successful operations by reading the material on this page.

Bypass surgery and angioplasty of the coronary arteries

Currently, cardiac surgeons have learned to perform whole organ transplantation operations (heart transplantation) or to connect an artificial ventricle, but the most popular method is to take measures to limit the zone of myocardial damage in order to preserve those tissues that have not yet undergone necrosis.

During surgery for myocardial infarction, the artery with atherosclerotic changes and the aorta are connected by a vessel – a shunt (more often they are the area of ​​the saphenous vein of the patient's thigh). As a result, blood enters the artery of the heart directly from the aorta, bypassing the atherosclerotic plaque that prevents normal blood flow. Sometimes one of the small arteries in the chest is redirected to the heart. There may be several shunts, depending on the number of affected arteries. The first successful coronary artery bypass surgery was performed in the United States on May 2, 1960 by Dr. Robert Goetz.

What other operation is done for myocardial infarction in modern clinics?

In the treatment of IHD, chronic arterial obstruction, etc., the method of coronary angioplasty is widely used. This method of treating myocardial infarction was first used by the Swiss cardiac surgeon Andreas Grünzig in 1977. During angioplasty of the coronary arteries, an atherosclerotic plaque is crushed with a special balloon, which is introduced into the artery of the heart under fluoroscopy control, without opening the chest and without connecting a heart-lung machine. Often, the place of the vessel where the plaque was is strengthened with a special spring – a stent.

Insertion of a catheter. The doctor inserts a miniature balloon attached to a thin tube (catheter) into a blood vessel through a small, pencil-tip-sized incision in the skin. Under the control of fluoroscopy, the catheter is passed to the site of narrowing of the artery.

Balloon inflation. Having reached the damaged area, the balloon is inflated in order to increase the lumen and improve blood flow in the vessel.

Insertion of a stent. After the lumen of the vessel has been successfully dilated, the catheter and balloon are removed from the vessel. However, in some cases, to maintain the lumen of the vessel, a stent is placed in the lumen of the artery – a wire, cylindrical structure that serves as a frame for a section of the artery.

Coronary artery bypass grafting: surgery for myocardial infarction

Coronary artery bypass grafting (CABG) is an operation, the essence of which is to create anastomoses (bypass routes), bypassing the coronary arteries of the heart affected by atherosclerosis. The first elective surgery was performed in the United States at Duke University back in 1962.

The decision on CABG is made after an examination, including coronary angiography, a procedure that allows you to determine the state of the vessels that feed the heart. Most often, the indications are severe angina pectoris (interfering with the implementation of elementary household loads), damage to three or more coronary arteries of the heart, the presence of aneurysm in atherosclerosis of the coronary arteries.

To create bypass shunts, the veins of the patient's leg are used, as well as the internal thoracic artery (a person can easily do without these vessels). Arterial shunts are more durable and reliable than vein shunts, but it is not always possible to use them alone.

The operation of coronary artery bypass grafting is performed with one goal – to save the patient from angina pectoris (a significant improvement is observed in 95% of patients) and to reduce the frequency of his hospitalizations.

For all other criteria (such as, for example, the risk of re-infarction or possible death within 5 years), the rates for CABG, stenting, and conservative treatment are comparable.