 Hello, I am Dr. Arun Veerambrethi, consultant cardiac surgeon at Manipal Hospital Whitefield, Bangalore. Today I am going to talk about one of the most important problems that has been brought to focus with recent tragic events involving celebrities and near and dear ones to you. It's coronary artery disease. The main function of the heart is to provide blood supply to the whole body. So it provides blood supply to all the organs in the body and it has to pump at a specific rate and at a specific blood pressure to be able to sustain blood supply to all the organs in the body. To do this, it needs blood supply also. So the arteries that are carrying blood supply to the heart and the pipes that are carrying blood supply to the heart are called coronary arteries because core is the name for heart in Latin literature through which a lot of medical terms are derived. Acrenal is for kidney, pulmonary is for lungs, and core is the one that we use for heart. So the arteries supplying the heart are called coronary arteries. 40 to 50 percent of the patients come with the typical symptoms that you would have heard in a lot of medical forums and even awareness programs which is tightness in the chest, radiating to the jaw and to the left arm and all these things. But that is not always the case. So 20 to 30 percent of patients just especially diabetics are not even aware that they have all these symptoms because of the neuropathy that they have due to poor blood sugar control. So they may not really have any symptoms that are typical but they may have blocks. And some of them are picked up when we do treadmill testing as part of regular health checkups that are sponsored by a lot of companies these days. The only way to really know if there are blocks in the heart and the arteries supplying the heart is to do a coronary angiogram. So there are two coronary arteries. One arises from the right side just above the heart, one from the left side. The right side is a single artery whereas the left one divides into two. Heart is a conical organ, right? So the left one, one of the arteries runs down the front of the heart and the second one turns around and supplies the back of the heart. So angiogram is usually done by a small prick near the right wrist. It's in the groin and where a thin catheter is passed and it is engaged into the place where the coronary artery starts just above the heart and a dye is injected. So how we have to imagine this is like a black dye filled water is pushed through a transparent glass pipe. So wherever we don't see a filling of the dye, like pinching of the dye will suggest that there is a block there. So when we do an angiogram we will get an idea if there are blocks and if the blocks are significant. So anything less than seventy-seventy-five percent in a single artery is considered not significant enough to warrant an intervention. So such people may just need to be on medications and be on follow of six months or one year and in case any symptoms develop they may have to come back earlier. There are two ways of going about it. One is called angioplasty. Again through a small puncture wound, a thin wire is passed across the narrowest portion. On top of the wire is a collapsed balloon and on top of that balloon is a tubular mesh which is called a stent which is incorporated with drugs to prevent clotting due to the foreign body nature of the stent. So this is one method which is done by the cardiologist and not all patients are candidates for stenting. With improved techniques in stenting and with the fear associated with surgeries more and more patients are opting for stenting while it may be indicated for a lot of patients with blocks not all of them the treatment is stenting. Like in fractures suppose there is a fracture we would like it that we don't have to undergo any procedure surgical procedure for it but we know that some fractures heal by just putting a plaster of paris cast whereas some of them require a surgical procedure. So some so the patients who have been found to have blocks which are not available to stenting are handled by surgical team. The procedure is called coronary artery bypass grafting CABG you would have heard this term a lot of times. So in CABG what we do is it's like constructing flyovers we don't do anything to the block per se what we do is we take alternative arteries that's why it's called CABG say coronary artery bypass grafting arteries from under the chest from the legs range from the legs and make connections before and after the block so that there is smooth flow of blood to the end organ which is the heart muscle. So patients who are having symptoms depending on the symptoms if they have symptoms at rest due to low blood supply some people don't have symptoms at rest but on exertion even walking for a few minutes they have chest pain on these things. Once the blood flow is restored their heart function is preserved and they can last a very long time because the arteries that we place that we bypass they are put into nice open territories so that for new disease to develop in then and progress gives a lot of time and for a long long time CABG was the only treatment available now with the advent of stents more and more people are opting for stenting but it is not for everybody. In CABG surgery there are two ways of doing it one is called off-pump surgery where the heart is kept beating and only the place where the connection needs to be made is immobilized and the arteries are sewn connections are made earlier and even now in some places and a lot of places in US, Australia they still do something called on-pump surgery where the blood flow is diverted to a heart lung machine while the surgery is performed with the heart and once the connections are made securely the blood is diverted back to the heart and the heart starts beating again now with renewed blood supply because the arteries that are blocked are now bypassed. One more advancement in recent times is the advent of minimally invasive cardiac surgery where the same procedure is carried out through a non-bone splitting small incision from the side about two inches in size. One thing that you have to understand is that no single procedure is the best for all patients depending what is most important is the connections that are made which is on to arteries that are two to three millimeter in diameter the coronary arteries are usually two to three millimeter in diameter they have to be made properly and securely that is the first goal of all surgery whether we do it on-pump whether we do it off-pump whether we do it from an open sternotomy approach or through minimally invasive cardiac surgery is secondary so provided if we can what we would say is if the patient can get the same job done same connections made through a minimally invasive cardiac surgery approach that is the best thing but because very few centers do it you should not insist on that because all the benefits are long-term benefits of surgery are long-term but recovery is much faster if we can do it through minimally invasive cardiac surgery so you have to make your enquiries whether minimally invasive cardiac surgery something that is an option for you and if it is done competently that will be better if you can do it but if the center that you have approached and ended up is more comfortable doing in any other way then there is no point pushing for it just because you heard of it somewhere so I would say that you should consult your cardiologist and cardiac surgeons get an opinion from as a frequent and then plan the procedure accordingly thank you