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Some people have problems with heart disease and this pain causes some problems. If you have problems with heart disease disease and you want to get a professional heart bypass surgery or other treatment, you can make it in Germany. It is best to consult an expert on heart bypass surgery in Germany.

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The medical name for heart bypass surgery is coronary artery bypass graft. It involves removing a blood vessel from the chest, arms, or legs and using it to create a detour or bypass around the blockage. 2020-03-13 Bypass Surgery
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Bypass Surgery

Nowadays in Germany as well as in other countries bypass surgery is one of the most efficient ways of treating ischemic heart disease caused by coronary vessel constriction and reduction of heart oxygen supply. Ischemic heart disease in a neglected condition can result not only in stenocardia, but also in lethal cardiac infarction. Therefore, well-timed and correct treatment sustains patient’s life and improves its quality.

Bypass surgery

Ischemic heart disease treatment in Germany depends on how neglected the disease is. Medicinal treatment is usually assigned at the initial stages of the disease; it is aimed at vasodilatation of damaged vessels which improves heart oxygen and blood supply. At later stages it is possible to use angioplasty treatment (vasodilatation of constricted vessels with the help of a cylinder and possible stent installation. In case it is not possible to use such sparing techniques, German experts suggest a bypass surgery. Heart catheterization conducted with the use of advanced medical technologies (bypass) allows preliminary estimation of the disease scale. Bypass surgery is suggested in case it is expected to give better results than medicinal treatment or angioplasty.

Coronary 3-vessel disease or complex narrowing of the coronary arteries and / or a narrowing of the large coronary arteries in the origin, the so-called main stem stenosis, is a clear indication for coronary artery bypass surgery. In 2019, 50,114 isolated and combined bypass operations were performed nationwide (2018: 51,941). In principle, there is no maximum patient age for bypass surgery. Depending on the severity and the location of the stenosis, blood flow to the heart muscle can be improved again in patients of all ages with bypass surgery.

In this group of patients the proportion of people over the age of 70 has increased continuously over the past few years. Last year, approximately 46.7 percent of bypass patients were 70 years and older, with 77 percent of men being significantly higher than women (23 percent), meaning that only every fourth bypass patient was female.

The patient-specific care concept of the bypass operation for coronary artery disease should always be discussed and coordinated in accordance with the currently applicable national and international guidelines in the heart team in order to give the patient a consensus recommendation. The most common cause of CHD is calcification of the arteries, which can lead to severe vasoconstriction and occlusion as the disease progresses, leading to an insufficient oxygen supply to the heart.

Bypass surgery is an extremely complicated surgical operation aimed to restore heart blood flow, bypassing the contraction of vessels. This open-heart bypass surgery is conducted under general anaesthetic. In Russia as well as in Germany during conventional bypass surgery the heart is stopped and an artificial blood circulation apparatus is connected. In recent years minimally invasive techniques have been used in Germany to conduct bypass surgery without stopping the heart and connecting artificial blood circulation apparatus. Advantages of this method are reduction of cell and tissue damage, decrease of blood loss, absence of complications connected with the use of artificial blood circulation apparatus, reduction of surgery duration and considerably quicker rehabilitation process.

Patient’s blood goes to the apparatus which takes up function of lungs and oxygenates blood for some time before it goes back to the vessels. Taking into account the complexity of the surgery, it is crucial not only to find an experienced and knowledgeable surgeon, but also to use advanced medical technologies (e.g., modern blood circulation system minimizing the contact of blood with foreign elements) because breathing with the help of an artificial blood circulation apparatus can have negative influence on patient’s tissues and viscera.

Our homepage offers a brilliant command of information about the best cardiosurgery specialist in Germany, who specialize in bypass operations.

Unfortunately, even in Germany it is not always possible to conduct minimally invasive surgery. In case of serious vessel damage or combined surgical operations (e.g., simultaneous heart valve replacement) it is necessary to stop the heart and to use artificial blood circulation apparatus to conduct the surgery. After the surgery, the patient stays in an in-patient department and is usually discharged in 10-14 days.

Before you consent to this extremely complicated surgery it is important to choose an experienced specialist and a well-equipped clinic. In Germany the bypass surgery is always conducted in accordance with current international standards and is notable for its quality and reliability.

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.

Operational Process

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.

Open Heart Bypass Surgery

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.

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.

Approximate cost of coronary artery bypass surgery in Germany (in EUR)

Coronary artery bypass surgery in Germany is guaranteed to treat patients from stenocardia and short breath. On the following day after the surgery patients already feel better; they can get up from the bed and walk. The cost of the surgery ranges from 18 000 to 30 000 euro. It is often necessary to conduct coronarography before the surgery (from 2000 euro).

Specialized German clinics will provide you with consultations of highly skilled doctors and quality treatment. Individually selected methods of diagnostics, therapy and surgical operations are conducted with the help of ultra-modern medical equipment. Our Friedrichshafen clinic also ensures high standards of hygiene and medical care as well as courteous staff. Health is the most important thing in everyone’s life. Trust us and we will take good care of it!

Latest News in Bypass Surgery

Bypass from the 3D printer


A glimmer of hope for bypass patients: Together with a scientific team, the Kiel vascular surgeon Dr. med. Rouven Berndt to develop the prototype of a new type of 3D bioprinter to create fine blood vessels for bypass implants.

Narrowed or blocked coronary arteries, known as coronary artery disease (CHD), are dangerous because, if left untreated, they can lead to life-threatening complications such as heart attacks. One- or two-vessel diseases that are easy to treat, i.e. constrictions in one or two coronary arteries, can usually be treated interventionally. They are expanded with a balloon or an implanted stent. In the case of three-vessel diseases and main trunk stenosis, the bottlenecks usually have to be surgically bridged with a bypass.

In a bypass operation, the cardiovascular surgeon bypasses the clogged vessels with arteries or veins from the body. Bypass means bypassing. The healthy vessels are sewn onto the coronary arteries as vascular bridges in front of the constrictions so that the blood can flow unhindered to the heart.

Bypass operations are now routine interventions, with cardiac surgeons in this country performing around 45,000 bypasses per year. However, in around 20 percent of those affected who need bypass surgery, there are no suitable endogenous vessels. "This problem is particularly serious in patients who have to undergo another procedure," explains Berndt. "Many patients also bring with them venous diseases such as varicose veins, so that we don't have enough material to treat all the constrictions." Almost half of venous bypasses are narrowed or blocked after about ten years. If the arteries of the pelvis and legs are bridged with a plastic bypass in peripheral arterial occlusive disease (PAD), these will be blocked again in up to 40 percent of those affected after three to five years.

Against this background, the senior physician at the Clinic for Cardiovascular Surgery at the University Medical Center Schleswig-Holstein (UKSH), Campus Kiel, together with a team of physicians, biologists and engineers from the technical universities in Kiel and Hamburg Prototype of a 3D bio printer developed. With the new device it is possible to create fine blood vessels. For this project, Dr. Berndt is now the DSHF-financed Dr. Rusche research grant received.

The scientists in his team already have experience in stem cell research, cell therapy and bioengineering in cardiovascular medicine. "The print head we designed can print a tube made of the body's own living endothelial and muscle cells," says the head of the project.

The wafer-thin, flat endothelial cells line the vessels from the inside. The muscle cells above ensure that vessels can contract and widen. These are important properties that ensure that bypasses last a long time and stay open. "The tube produced has the required thin vessel wall and a diameter of four to six millimeters," says Berndt. According to him, the production of comparatively small artificial bypasses is always a holy grail in cardiovascular surgery, because most materials do not seem suitable and premature occlusions can occur. The printed vessels have already proven themselves in laboratory experiments. The first results will shortly be published in scientific journals.

The prototype of the bio printer developed by the researchers is now to be produced industrially by an aerospace company. For example, the commercially available bioprinters to date are not able to produce vascular grafts in the total length of 30 to 40 centimeters that is often required for bypasses. The scientists also want to investigate whether the printed blood vessels can be biologically integrated into the existing vascular system in the long term. Another goal: to print blood vessels both for bypass surgery on the cell donor and for other recipients. "Different cell lines can be genetically modified in such a way that they do not develop certain characteristics and properties," explains Bernd, "and thus cannot be recognized as foreign."

Coronary artery disease: bypass better than stent?


Bypass or stent? Choosing one or the other therapy for coronary heart disease is not always easy. A recent study suggests that in patients with multiple vessels narrowed, bypass surgery is superior to stenting.

Patients who had used stents of the newer generation after widening the affected arteries had a 47 percent greater risk of having to be treated for congestive arteries, having a heart attack, or having a heart attack during the course of the study, compared to patients undergoing bypass surgery to die. This was reported by the cardiologist Seung-Jung Park from the Asan Medical Center in Seoul, South Korea, together with colleagues at a cardiologist meeting in the USA. In the stent group, these events occurred in 15 percent of the patients, in the bypass group in 11 percent. "Our data indicate that bypass surgery is the best alternative for people with coronary heart disease with multiple affected vessels," said Park.

In a bypass operation, a blood vessel from another area of ​​the body is used to bridge a narrowed or blocked coronary artery so that more blood can reach the heart. It is a major intervention. On the other hand, less invasive is angioplasty, in which a narrowed vessel is widened with the help of a balloon catheter, for example. Subsequently, a vascular support, a so-called stent, is often placed in the artery. This is to ensure that the artery remains open. Newer stents are coated and gradually release drugs to prevent blood clots. In the current study, the stents released the active ingredient everolimus.

However, the researchers restrict the statistical validity of their results. As the study was unexpectedly delayed, it had to be completed sooner than planned. The reason for this is probably that in the course of the study, a new process - the so-called functional flux reserve - had emerged. With its help, physicians can more accurately determine the condition of arteries. This leads to better results in angioplasty. In a new study, the researchers now want to compare how effective a bypass operation is compared to an angioplasty under measurement of functional flow reserve.

Bypass surgery on the beating heart


With favorable localization of the affected coronary artery, today's doctors can carry out the bypass operation on the beating heart and dispense with the use of the heart-lung machine. This may be useful, especially in older patients and in patients with comorbidities, to reduce the risk of surgery. However, this operation method requires a corresponding experience of the surgeon. When the heart surgeon opens the chest as in the conventional bypass surgery in the region of the sternum, one speaks of the OPCAB operation (off-pump coronary artery bypass). If instead he opens it laterally between the ribs, the method is called MIDCAB (minimally invasive direct coronary artery bypass) surgery. General anesthesia is also required in these procedures.

After a bypass operation, patients are monitored for one to three days in an intensive care unit. Then they come to a normal ward for about one to two weeks. Amongst other things, physiotherapists perform a bodybuilding training with the patients there. Thereafter, training and further treatment are usually continued in a three-week follow-up treatment.

What types of vascular bypasses are there?


Bypasses can be used in various parts of the body, for example, in the context of peripheral arterial disease (paVK) on the leg vessels, or in coronary heart disease (CHD) on the coronary arteries.

Most often, the coronary arteries are supplied with a bypass. To bridge the gap, doctors often use leg veins that they previously removed from the upper or lower legs of the same patient (aortocoronary venous bypass). Or they sew the end of the mammary artery on a coronary artery so that it participates in the blood supply (internal mammary artery bypass). Another possibility is the removal of arteries from the forearm (Arteria radialis bypass) in question.

In a narrowing of the coronary arteries by arteriosclerosis come in principle several treatment options in question. The doctor can either order medication only, recommend balloon dilatation (PTCA), usually with stenting, or bypass surgery. Which method of treatment the doctor and patient ultimately decide depends on several factors. In addition to age, the doctor must also consider the comorbidities of the patient (such as diabetes mellitus). In addition, it matters how many coronary arteries are affected, where the constrictions are, how severe they are, and whether cardiac function is impaired.

Often, a bypass operation is performed when the main coronary artery of the left ventricle or multiple coronary arteries are affected at different locations. The basis for the decision is usually a cardiac catheterization in advance, which represents the coronary vessels with all constrictions accurately. Afterwards, a heart team of cardiologists and cardiac surgeons usually discusses which is the best treatment alternative

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