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18.02.2019 10:10:26
Coronary heart disease (CHD) is the most common heart disease in the world. In Germany, about 1.5 million people suffer from it. It is a disease of the coronary vessels, in which the calcification of the vessel walls leads to their constriction. The result is impaired blood circulation and, thus, impaired oxygen delivery to the heart muscle.
Typical symptoms of myocardial oxygen deprivation are stinging chest pains and stenocardia. Complete coronary occlusion leads to a heart attack with the death of the heart muscle cells.
There is no cure for coronary heart disease. However, its progression can be slowed down by changing the diet and lifestyle, as well as taking medications.
Hereditary predisposition, high cholesterol, overweight, smoking, hypertension, as well as diabetes and lack of motion are considered to be the most important risk factors for developing CHD.
Bypass surgery is performed by a cardiac surgeon. This type of heart surgery is most often performed. A new pathway to bypass the constricted or blocked coronary vessels is created. For this purpose, vessels from other parts of the body, mainly from the thoracic artery, arteries of the upper or lower extremities are used as alternatives. Arterial bypasses last longer than venous bypasses. 10 years after surgery, up to 95% of arterial bypasses are still open. What concerns venous bypasses, only 65% of them remain open. The bypass begins and ends in healthy areas of the vessels. It unloads the constricted areas, even if several vessels are affected.
In most cases, the surgery is performed on the open heart by using a heart-lung machine (CBM). In this case, the heart is excluded from the systemic circulation. The blood flow is redirected to the CBM. It performs the functions of the heart and the lungs during surgery. Then the blood, bypassing the heart, returns to the systemic circulation.
Bypass surgery can be performed on the beating heart without connecting the CBM. In order to sew the bypass safely, the heart is calmed locally by using a special technique. This method is technically more complicated than open heart bypass surgery.
The advantage of bypass surgery on the beating heart is, above all, lower risks of stroke. When using the heart-lung machine, there is a danger that calcium deposits will come off the walls of the blood vessels and enter the brain. In addition, blood contact with the CBM coating materials leads to a general inflammatory reaction in the body. In this regard, the functioning of such vital organs as the lungs and kidneys may worsen.
International experts have worked out recommendations for the optimal treatment of coronary heart disease. This should ensure the treatment of each patient according to the current state of science. Thus, a stent is the appropriate treatment in the following cases:
With more complicated constrictions affecting the left coronary arteries (main trunk stenosis), and with changes in all the three coronary arteries, bypass surgery is chosen. Studies have unequivocally proved a higher percentage of successful treatment in such cases.
Patients are often afraid of the laborious bypass surgery and ask for an intervention with a catheter. However, the installation of a stent in a constricted segment of the vessel can also lead to complications.
