The goals of surgical treatment of coronary artery disease is recovery lumen of the artery (revascularization), Narrowing of atherosclerotic plaque. To achieve this drug is impossible. There are several options for operation:
Stenting (percutaneous transluminal coronary angioplasty)
Restoration of the arterial lumen is achieved by introducing into it the stent, which is a mesh metal tube. Under X-ray control stent is mounted directly in front of the plaque and expanded by an inflatable balloon (which is why the operation is sometimes referred to as balloon angioplasty). All operation conducted through a vein thigh with a special wire (catheter) under local anesthesia, so the patient during it is conscious, can talk and run commands doctor.
Result of the operation depends largely on the quality of the stent and its material. There are many types of stents, including those which themselves are able to open without the aid of the balloon and stent, which, after their introduction themselves secrete drugs.
Stenting restores the lumen of the vessel, the normalization of blood flow and the disappearance of symptoms (pain). But to stop the global process of atherosclerosis, it can not, and the patient must take preventive medication. A frequent complication of stenting is re-sprouting of plaque in the same or another location, requiring a second operation.
Currently, stenting is not recommended in stable coronary artery disease, in this case it is better to use drugs. It is justified in the progression of the disease and in cases of suspected myocardial infarction.
Aorto-coronary bypass surgery
Another method of restoring the lumen of the heart arteries, it began to be used before stenting. The essence of it is to create a shunt (bypass), in which blood enters the heart, bypassing the affected area of the artery. This operation is more serious than stenting is performed under general anesthesia for open-heart surgery through an incision in the chest. Often need to connect heart-lung machine. Features of the operation — which vessels are used as a shunt, stopping the heart or not, etc. — depending on the degree of cardiac damage.
CABG preferably with occlusion of multiple arteries in the heart, as well as in patients at high risk — over 65 years, diabetics with heart failure.
Transmyocardial laser revascularization
A rare surgical treatment for coronary artery disease. Is that by using a special laser equipment in the cardiac muscle is from 20 to 40 and moves through thin depth up to the left ventricular cavity. These moves blood to the heart muscle directly from the left ventricle, bypassing the coronary arteries. The processes taking place in the heart muscle after such interventions are not fully understood, but in patients noted improvement in health, improving efficiency, reducing pain. Recently there was a tendency to do TMLR simultaneously with stenting or bypass surgery.
Extreme measure is resorted to in the event of severe injuries of the heart, accompanied by severe heart failure. The operation complicated by the need of finding a suitable donor, due to less than 1% of patients under suitable criteria for heart transplantation, it is prepared.