Coronary Artery Disease

Coronary artery disease (CAD), also called ischemic heart disease, is one of the most common heart ailments affecting the U.S. population. Yale New Haven Hospital (YNHH) offers comprehensive treatment of coronary artery disease.

CAD is due to buildup of calcium blockage in arteries that supply oxygen and nutrients to the heart muscle. While typically marked by chest pain, CAD symptoms can also include fatigue and shortness of breath. CAD is most commonly treated with medication. Advanced care requires intervention that increases blood flow to the heart either through percutaneous coronary intervention or surgery.

Medical treatment

Medications to treat coronary artery disease include anti-platelet (blood thinner) such as aspirin, clopidogrel, or ticagrelor; cholesterol-lowering such as statins; and those that reduce the workload of the heart including beta blockers. In addition, your healthcare provider may recommend medications that aid blood flow through the arteries, such as nitroglycerin. 

Treatment procedures:

  • Angioplasty
  • Stenting
  • Surgery

Surgery for CAD

If surgery is needed, these surgical procedures are performed at YNHH:

Coronary artery bypass grafting (CABG) is the most common operation to treat blocked coronary arteries (coronary artery disease), particularly when it affects multiple coronary arteries and in patients with diabetes. Based on the size, number and locations of artery blockages, your doctor may decide that bypass surgery, often referred to as open-heart surgery, is the best treatment. At YNHH the operation may be done with or without the heart-lung machine, depending on patient anatomy and surgeon preference. Off-pump coronary artery bypass surgery (when the heart-lung machine is not used) offers benefits for some patients, including a reduced need for blood transfusions; less risk of bleeding, stroke, and kidney failure. 

Arterial bypass grafting involves using grafts of artery from the arm or both sides of the chest, based on patient anatomy and patient preference.

Minimally invasive direct coronary artery bypass
(MIDCAB), including robotic MIDCAB, is offered for patients with isolated blockage of the left anterior descending artery or as part of a surgical procedure that combines coronary artery stenting and surgical bypass, also called hybrid procedure. Hospital stays are shorter, and patients can make a quicker return to day-to-day activities.

Complex and high-risk cases are discussed at Heart Care Team meetings where cardiac surgeons and cardiologists jointly review each patient′s case and provide a recommended treatment plan toward best outcomes.