function, memory impairment, and physical
dysfunctions such as localized loss of feeling or
function- rapid restenosis (within six months) of the
grafts - collapse of venous grafts
Improved technology is making other treat-
ment options, notably ANGIOPLASTY, increasingly
viable. Some studies suggest that angioplasty with
STENTplacement, which is significantly less inva-
sive and less expensive than CABG, is equally
effective for multiple vessel CAD and in a good
number of people lasts as long as CABG. On the
other side of the debate, clinical results with all-
arterial grafts for CABG show increased reliability.
As well, advances in microsurgery and endoscopic
surgery are making MINIMALLY INVASIVE CARDIOVAS-
CULAR SURGERYincreasingly feasible, allowing sur-
geons to perform minimally invasive direct
coronary artery bypass (MIDCAB) procedures
using multiple small incisions rather than fully
opening the chest. Some surgeons are using “off-
pump” procedures, in which the heart continues
to function during the operation, to reduce the
risk for neurologic and pulmonary side effects.
Others are combining angioplasty with MIDCAB
in a procedure called hybrid CABG. Researchers
and surgeons continue to study these approaches
and methods, comparing outcomes to determine
the most appropriate options.
Outlook and Lifestyle ModificationsMost people spend three to five days in the hospi-
tal and another four to eight weeks recovering at
home before making a full return to regular activi-
ties. The improvement in cardiovascular function
is apparent immediately for most people. Cardiol-
ogists typically recommend cardiac rehabilitation
for people who have had CABG, to help establish
a structure for any necessary lifestyle modifica-
tions. The clinical standard for postoperative care
now includes medications such as beta blockers
and statins, drugs to stabilize HEART RATEand lower
cholesterol blood levels, respectively. Statins also
appear to have a stabilizing and strengthening
action on the heart, with numerous clinical stud-
ies showing that people who take statins following
CABG have significantly fewer complications,
notably heart attack, after surgery. Cardiologists
also urge people to eat nutritiously, get a mini-
mum of 30 minutes of physical exercise each day,
stop smoking, and lose weight to achieve a
healthy BODY MASS INDEX(BMI). Most people expe-
rience complete and uneventful recovery from
surgery and return to work and the recreational
activities that interest them.
See also CARDIOVASCULAR DISEASE PREVENTION;
COGNITIVE FUNCTION AND DYSFUNCTION; POSTOPERATIVE
PROCEDURES; PREOPERATIVE PROCEDURES; SMOKING CES-
SATION; SURGERY BENEFIT AND RISK ASSESSMENT.coronary artery disease (CAD) ATHEROSCLEROSIS
of the CORONARY ARTERIESthat reduces BLOODflow
to the HEART. About 14 million Americans have
CAD, though many of them do not know it until
HEART ATTACKstrikes. CAD causes 1.2 million heart
attacks and more than 600,000 deaths in the
United States every year. Autopsy findings show
that two thirds of women and nearly half of men
who lose their lives to SUDDEN CARDIAC DEATHhad
unsuspected CAD. Although CAD is more com-
mon in people age 60 and older, it is becoming
increasingly common among younger people.
Genetic factors may underlie CAD in some people,
though most often CAD is an acquired condition
that is the direct consequence of lifestyle factors
such as cigarette smoking, EATING HABITS, and phys-
ical inactivity.HEART ATTACKis a life-threatening emer-
gency. Call 911 immediately with symp-
toms or when heart attack is possible.
Many people delay, wanting to be sure.
Waiting can be fatal.CAD, like generalized atherosclerosis, develops
over decades. Many cardiologists believe CAD
begins in childhood. The most commonly affected
coronary arteries are the left anterior descending
(LAD), the circumflex, and their branches. These
coronary arteries provide the blood supply for
most of the heart MUSCLE, including nearly all of
the left ventricle. CAD may affect the right coro-
nary ARTERY as well. Cardiologists classify CAD
according to the number of occluded coronary
arteries. A coronary artery can be 70 percent
occluded before the restricted blood flow impairscoronary artery disease (CAD) 43