Mercy Cardiothoracic Surgical Associates

Coronary Artery Disease (CAD)/Coronary Atherosclerosis

Coronary artery disease (CAD) is a condition where the coronary arteries have become partially or completely blocked due to a build-up of plaque, inhibiting the flow of oxygen-rich blood within the heart muscle and increasing the risk of heart attack, heart failure, and arrhythmias.  Plaque is made up of fat, calcium, and cholesterol. Plaque build-up in the arteries creates a condition called coronary atherosclerosis. Risk factors for CAD include:

• smoking
• high blood pressure
• high cholesterol
• high levels of triglycerides
• diabetes
• insulin resistance
• metabolic syndrome
• obesity
• lack of physical activity
• advancing age
• family history of heart disease
• stress
• sleep apnea
• alcohol consumption

CAD can be diagnosed by x-rays, blood tests, electrocardiogram (EKG), and coronary angiography. Depending on the extent of the disease progression, cardiologists may recommend:

• lifestyle changes (i.e. weight loss, smoking cessation, exercise plan)
• medication (i.e. beta-blockers or ACE inhibitors, aspirin, statins, and nitrates)
• angioplasty (to re-inflate the artery and restore blood flow)
• bypass surgery to treat the disease and resulting conditions
• cardiac rehabilitation

Our surgeons work in close collaboration with your cardiologist if surgery is prescribed for your coronary condition. Our surgeons specialize in the following CAD-related procedures:

• Hybrid coronary revascularization
  Hybrid coronary revascularization is recommended for patients who have blockage in an artery in the front of the heart and who have at least one other diseased blood vessel. This minimally-invasive procedure enables our surgeons to combine two therapies for optimal patient treatment: coronary artery bypass surgery (CABG) and percutaneous coronary intervention (PCI). During revascularization all blocked arteries are treated with a bypass or stent implantation combination. The technology employed enables us to provide the patient with a quicker recovery time, reduced chance of complications or infection, and less pain.
  
   
• Off-pump coronary artery bypass using arterial conduits
  During coronary artery bypass surgery a surgeon takes arteries from the chest and other parts of the body to create new grafts so that blood can flow again to the blocked coronary arteries. The most common artery used in coronary artery bypass grafting is the internal mammary artery (IMA) which is located in the chest. Alternately surgeons may choose the gastroepiploic artery from the abdomen or the radial artery, which is located in the arm. The surgeon then connects the arterial conduit to the surface of the heart past the area where the blockage is occurring so that the artery can deliver oxygen to the heart.
  
  Being “off-pump” (also referred to as “beating heart surgery”) means that the patient is not on a heart-lung machine but rather, his or her heart continues to beat normally, on its own without mechanical assistance, while the surgeon operates on a localized, stable area of the heart to bypass the blockage.
  
   
• Transmyocardial laser revascularization (TMR)
  Transmyocardial laser revascularization procedure means that surgeons use a small laser to create tiny, new channels in the patient’s heart muscle in order to improve blood flow. TMR is recommended for patients with coronary artery disease for whom angioplasty, stenting and/or coronary artery bypass surgery would not be completely effective or appropriate. It can be performed as a stand-alone procedure or in conjunction with coronary artery bypass surgery.