Open heart bypass surgery or Coronary Artery Bypass Grafting (CABG) is a one of the most demanded cardiac operations intended for those patients who have permanent problems with coronary arteries. Heart bypass normally required when more than one of heart arteries are clotted and it is necessary to create another way for blood flowing to avoid significant discomfort and even mortal risks in patients.
The high-risk group targeted for bypass heart surgery are those who older than 65 years, patients with chronic coronary heart disease, diabetics suffering from heart failure, and those who have multiplied blocked vessels. When coronary lumen has been decreased due to the different reasons including sclerosis or thrombosis, a body – and a brain especially – does not have sufficient blood supply, that can cause serious problems.
Diagnostics and Preparations
Different kind of diagnostic procedures are used for precise diagnosing and making a final decision on expediency of heart bypass. Coronary catheterization is one of them. During this procedure coronary circulation is examined with introduced catheter using X-rays imaging, which visually represent a whole situation with vascular occlusions, thrombus and plaques, as well as stenosis and aneurysms. Based on the coronary angiograms a cardiologist makes a conclusion to perform CABG or, maybe, balloon angioplasty. Also the common checkup methods are applied as blood tests, electrocardiograms and others.
When it is decided in favor of bypass surgery, it is necessary to prepare the patient for operation. It could take quite a long time. First, the patient should stop using any medications which could cause blood clotting. The smokers should quit smoking. If any unexpected problems occur as flu or inflammation it is strongly recommended to inform a physician because if hidden, those symptoms could affect complications.
When in hospital, the patient stops eating and drinking in a night before the surgery. The doctor also could prescribe some sedative medicaments. Immediately before bypass grafting the patient has given IV anesthesia and, then, goes asleep.
The aim of coronary bypass is to replace diseased arteries with others, which are normally taken from different parts of the patient’s body, as left thoracic artery or the veins removed from the legs and wrists. Depending on how many coronary arteries are bypassed the operation is called single bypass, double bypass etc.
When a patient has received IV and loosen perceptions, a first what a surgeon does is an incision 20-25 cm long in the chest to open the heart for invasion. Then, a heart-lung machine takes oxygen supplying function and, finally, the heart is stopped. After that, a healthy vessel is taken from the body for implantation instead of blocked coronary artery and bypass is made. This action could be repeated a few times. At the end of the procedure, the heart-lung machine is removed and, after checking bypass functioning, the incision is stitched and the patient moves to intensive care unit to be under control of the reanimation team.
Minimally Invasive Bypass Surgery
Generally, aortocoronary bypass always was performed on open heart that is stopped during the operation. But today another option is appeared as alternative to the classical method – minimally invasive surgery. It has advantage that it is less traumatic because, instead of one big breast cut, a few small incisions are carried out and, as a result, recovery period is decreased.
Another advantage is a possibility to operate on beating heart. It is called ‘off pump’ method or coronary revascularization. It always was thought it is better to perform surgical manipulations on motionless heart drained from all the blood, and that still hold true, but there are also some additional risks associated with heart-lung heart machine. Sometimes it is reasonable to use modern technique when veins are harvested through the small cuts by endoscope and, then, they are delivered to the heart also via a few small ports in a patient’s chest by means of special miniature tools.
Though CABG is traditionally associated with open heart surgery, at the moment it is not always so. In any case, a decision, which of the methods to use, normally depends of entire state of the patient’s health, the numbers of diseased arteries and many other related factors as necessity of additional surgery on other parts of the heart, e.g. the valve replacement. It is not possible for patients to determine independently what kind of therapy or surgery they need, so it is better to consult with a qualified specialist. With a choice of clinics in Germany it is easy to find a proper method which is suitable for the patient, taking into account an individual situation and preferences.