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Current Trends in Coronary Artery Bypass Surgery
Coronary bypass surgery is a very common type of heart surgery. Dr. Charles Klodell, Cardiothoracic Surgeon at Florida Heart and Lung Institute, discusses when this treatment is necessary and how it works.
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Learn more about Charles Klodell, MD
Charles Klodell, MD
Dr. Charles T. Klodell is a cardiothoracic surgeon that specializes in heart and lung surgical procedures including minimally invasive aortic and mitral valve repair or replacement, aortic aneurysm repair, transcatheter aortic valve replacement (TAVR) and open heart surgery. He has a special interest in minimally invasive procedures, valve repair, and innovative uses of technology and pharmacology to alleviate patient discomfort.Learn more about Charles Klodell, MD
Transcription:
Prakash Chandran (Host): Heart bypass surgery is the most common type of heart surgery performed on adults. It’s a procedure that can be complicated and can have a very long recovery time. But the good new is, there are new treatments and methods available for this serious condition. Let’s talk about it with Dr. Charles Klodell, a cardiothoracic surgeon at Florida Heart and Lung Institute.
This is Helmet of Health, the podcast from North Florida Regional Medical Center. I’m Prakash Chandran. So, first of all Dr. Klodell, I want to learn a little bit more about what coronary bypass surgery is.
Charles Klodell, MD (Guest): Well so coronary artery bypass surgery or CABG, you’ll see it abbreviated or sometimes people will just say cabbage because that’s how that CABG looks. It is not something you buy at Publix, it’s actually the surgery. What we are talking about is when there are multiple blockages of the heart that really aren’t amenable or it’s not appropriate to treat them with just a balloon and a stent; then those patients get coronary artery bypass grafting.
And it’s kind of, I tell patients it’s kind of like when they are working on the interstate and they take you off the offramp and around where they are working and then right back onto the good road beyond it. and that’s exactly what we do in the operating room. Our goal is to take areas of the heart that are not getting enough blood flow and detour the blood around the blockage to tie it into the distal road where there is good blood flow needed to make the heart muscle function better.
Many people will have areas of their heart that at rest, when they are just sitting and talking like this, perhaps their heart gets enough blood flow. But it’s then when they begin to stress the heart by exercising or walking or climbing a flight of stairs or whatever they happen to do that those areas of the heart then don’t have enough blood flow to sustain that additional demand and they get what’s called demand ischemia or pain in their chest, angina. And those are early signs that perhaps they are about to get into real trouble.
Host: Got it. So, what are some of risk factors that cause our arteries to be blocked in the first place?
Dr. Klodell: Well the first is genetics. Again, you always start with that, right. You can pick your friends but not your parents and the DNA we have is the DNA we have. So, if your father and three of your uncles and your grandfather all had coronary disease and had to have coronary bypass surgery; you better make your reservation because it’s coming. But there are better medicines now to help mitigate that than what there were 10, 20, 30 years ago. The second are the obvious bad environmental things that we do. Smoking, bad diet, and then failure to take their medications. Sometimes particularly primary care doctors are very good about keeping people on lipid lowering agents, cholesterol lowering agents, things like that and so the best thing you can do is take all the prescribed medicines you are supposed to take, control your blood pressure, and try not to have many of the social vices that we know lead to bad health conditions.
Host: Okay so, I’d love to learn a little bit more about the latest treatment and surgical options for blocked arteries. Can you talk a little bit about that?
Dr. Klodell: Sure. So, one of the things that’s very forward thinking about these is we want to revascularize all the areas of the heart that we possibly can, that have blockages. The older thinking of well, we are going to put a bypass to the front distribution, side distribution and the back distribution of the heart. That’s a little antiquated now and really, we should be doing complete revascularization of all the areas that have blockages whenever it’s possible.
We should be doing that with arterial conduits whenever it’s possible meaning particularly in a young patient that’s not diabetic, one of the things we talk about is the conduit we are going to use to get the blood flow there and the holy grail of conduits is the left internal thoracic artery which runs right under the breastbone. And that artery, we know when we put it to that front artery in the heart, the left anterior descending; that graft almost always is going to last the patient the rest of their life. Well, as people have suspected and researched and proved; if one mammary it good for you then two is even better. And so we want to use the right mammary in patients that it’s appropriate to do additional arterial revascularization.
We will sometimes still use a vein out of the leg as well. But we really want to do everything we can to set the patient up for success down the road where they either don’t ever need another intervention or if they do need an intervention, enough of their heart is still well-supplied that it can be performed just in the Cath lab with a stent.
Host: Okay and then finally, I know you said a lot of it was genetics, but I imagine that our lifestyles do play into this. so, what can you tell people reducing the risk of developing a blocked artery?
Dr. Klodell: Probably the same thing. Everybody that’s ever worn a white coat that says MD on it says which is try to eat clean, don’t smoke, keep your blood pressure under control, use alcohol only in moderation and take all the pills you are supposed to take.
Host: Okay that sounds good. Thanks so much for your time Dr. Klodell. I really appreciate it. That’s Dr. Charles Klodell, a cardiothoracic surgeon at Florida Heart & Lung Institute. Thanks for checking out this episode of Helmet of Health. Head to FLHeartAndLung.com to get connected with a provider. If you found this podcast helpful, please share it on your social channels. That would really help us out. And be sure to check out the entire podcast library for topics of interest to you. Thanks and we’ll see you next time.
Prakash Chandran (Host): Heart bypass surgery is the most common type of heart surgery performed on adults. It’s a procedure that can be complicated and can have a very long recovery time. But the good new is, there are new treatments and methods available for this serious condition. Let’s talk about it with Dr. Charles Klodell, a cardiothoracic surgeon at Florida Heart and Lung Institute.
This is Helmet of Health, the podcast from North Florida Regional Medical Center. I’m Prakash Chandran. So, first of all Dr. Klodell, I want to learn a little bit more about what coronary bypass surgery is.
Charles Klodell, MD (Guest): Well so coronary artery bypass surgery or CABG, you’ll see it abbreviated or sometimes people will just say cabbage because that’s how that CABG looks. It is not something you buy at Publix, it’s actually the surgery. What we are talking about is when there are multiple blockages of the heart that really aren’t amenable or it’s not appropriate to treat them with just a balloon and a stent; then those patients get coronary artery bypass grafting.
And it’s kind of, I tell patients it’s kind of like when they are working on the interstate and they take you off the offramp and around where they are working and then right back onto the good road beyond it. and that’s exactly what we do in the operating room. Our goal is to take areas of the heart that are not getting enough blood flow and detour the blood around the blockage to tie it into the distal road where there is good blood flow needed to make the heart muscle function better.
Many people will have areas of their heart that at rest, when they are just sitting and talking like this, perhaps their heart gets enough blood flow. But it’s then when they begin to stress the heart by exercising or walking or climbing a flight of stairs or whatever they happen to do that those areas of the heart then don’t have enough blood flow to sustain that additional demand and they get what’s called demand ischemia or pain in their chest, angina. And those are early signs that perhaps they are about to get into real trouble.
Host: Got it. So, what are some of risk factors that cause our arteries to be blocked in the first place?
Dr. Klodell: Well the first is genetics. Again, you always start with that, right. You can pick your friends but not your parents and the DNA we have is the DNA we have. So, if your father and three of your uncles and your grandfather all had coronary disease and had to have coronary bypass surgery; you better make your reservation because it’s coming. But there are better medicines now to help mitigate that than what there were 10, 20, 30 years ago. The second are the obvious bad environmental things that we do. Smoking, bad diet, and then failure to take their medications. Sometimes particularly primary care doctors are very good about keeping people on lipid lowering agents, cholesterol lowering agents, things like that and so the best thing you can do is take all the prescribed medicines you are supposed to take, control your blood pressure, and try not to have many of the social vices that we know lead to bad health conditions.
Host: Okay so, I’d love to learn a little bit more about the latest treatment and surgical options for blocked arteries. Can you talk a little bit about that?
Dr. Klodell: Sure. So, one of the things that’s very forward thinking about these is we want to revascularize all the areas of the heart that we possibly can, that have blockages. The older thinking of well, we are going to put a bypass to the front distribution, side distribution and the back distribution of the heart. That’s a little antiquated now and really, we should be doing complete revascularization of all the areas that have blockages whenever it’s possible.
We should be doing that with arterial conduits whenever it’s possible meaning particularly in a young patient that’s not diabetic, one of the things we talk about is the conduit we are going to use to get the blood flow there and the holy grail of conduits is the left internal thoracic artery which runs right under the breastbone. And that artery, we know when we put it to that front artery in the heart, the left anterior descending; that graft almost always is going to last the patient the rest of their life. Well, as people have suspected and researched and proved; if one mammary it good for you then two is even better. And so we want to use the right mammary in patients that it’s appropriate to do additional arterial revascularization.
We will sometimes still use a vein out of the leg as well. But we really want to do everything we can to set the patient up for success down the road where they either don’t ever need another intervention or if they do need an intervention, enough of their heart is still well-supplied that it can be performed just in the Cath lab with a stent.
Host: Okay and then finally, I know you said a lot of it was genetics, but I imagine that our lifestyles do play into this. so, what can you tell people reducing the risk of developing a blocked artery?
Dr. Klodell: Probably the same thing. Everybody that’s ever worn a white coat that says MD on it says which is try to eat clean, don’t smoke, keep your blood pressure under control, use alcohol only in moderation and take all the pills you are supposed to take.
Host: Okay that sounds good. Thanks so much for your time Dr. Klodell. I really appreciate it. That’s Dr. Charles Klodell, a cardiothoracic surgeon at Florida Heart & Lung Institute. Thanks for checking out this episode of Helmet of Health. Head to FLHeartAndLung.com to get connected with a provider. If you found this podcast helpful, please share it on your social channels. That would really help us out. And be sure to check out the entire podcast library for topics of interest to you. Thanks and we’ll see you next time.