PD MD Wolfgang Harringer
Heart Bypass Surgery or Coronary Artery Bypass Graft (CABG) is one of the most common cardiac surgeries. It is aimed to create alternative path for blood flowing replacing blocked coronary artery with graft. Heart Surgery Department of the Clinic of Braunschweig, Germany offers to patients both open heart bypass surgery and advanced minimally invasive operations. The cardiologists and cardio surgeons of multidisciplinary team suggest the proper method depending on individual situation and overall health of the patient.
First successful heart bypass was made in 1964 by Soviet cardiac surgeon Vasiliy Kolesov who used technique of anastomosis of mammary and coronary artery. And in 1967 Argentinean surgeon Rene Favaloro performed Coronary Artery Bypass Graft in its modern approach using saphenous vein for bypassing. Saphenous vein is still most common donor vessel for grafting but sometimes a surgeon may decided to use other vessels for that purpose. In Clinic of Braunschweig endoscopic method of harvesting is used for pick up donor vessel that less traumatic for patient’s body.
Obstruction of arteries is usually caused by arteriosclerosis or/and atherosclerosis. A first one is thickening and calcification of arteries that, as a result, become narrow. Atherosclerosis is appearing of lipid plaques on the arterial wall that also results in artery blockage. Both conditions lead to insufficient blood supply of the heart. Bypass surgery is intended to restore blood flowing, relieving symptoms of angina and preventing ventricular heart failure.
Depending on how many arteries to be replaced we may use the terms ‘single bypass’, ‘double bypass’, ‘triple bypass’ or even ‘quadruple bypass’.
Bypass surgery is done under general anesthesia and lasts a few hours. There are few techniques and decision which if them to choose for optimal result is made after thorough examination of the patient with multidisciplinary team. Heart Surgery Department has close relations with the other departments and clinics of Braunschweig Group and specialist in different fields are involved for precise diagnostics. Sometimes minimally invasive method can be recommended. In other cases, traditional open surgery may still better option.
After the patient was given IV anesthesia and went asleep a surgeon makes a vertical cut along the breastbone (sternum) to open the chest. After examination of the exposed heart, the material is harvested from saphenous vein, internal thoracic artery or radial arteries on surgeon’s choice. The patient is given heparin to impede blood clotting.
Once donor vessels have gathered, operating team connects patient to a heart-lung machine which carries the function of the heart during the surgery. After this the heart is stopped and blood is drained out of it. The procedure of supporting blood supply, when the heart does not beat, is called cardiopulmonary bypass.
The cardiac surgeon takes harvested vessels and implant them instead of diseased arteries giving blood another path to flow which we call ‘graft’. One end of the graft is stitched to the artery and another one is attached to the aorta. When all the manipulations are finished, cardiopulmonary bypass is switched off, the heart is restarted and patient is given protamine instead of heparine to avoid excessive bleeding.
The sternum is wired and wound is sewed. Patient may have chest tubes for blood draining from areas around the heart and lungs.
In 1990s with a new approach to heart surgery cardiac surgeons begun to perform operations on beating heart without using cardiopulmonary bypass. The heart is stabilized by means of special devices to beat extremely weak almost still. The technique is more complex than traditional surgery but it is believed that it helps to avoid some complication associated with heart-lung machine and also others including a risk of stroke. Besides this difference the operation is carried out in the same way as conventional open heart surgery.
Less invasive methodic allows accessing the heart through a smaller incision rather than with traditional technique. MIDCAB is usually performed on beating heart. A cut 3-5 inches long (against 10-12 inches with traditional surgery) is made between ribs or, alternatively, it can be a few small incisions to introduce a camera and tools. The benefits of minimally invasive surgery are:
It is worth noting that operating on beating heart via small “key hole” is required higher skill of surgeon so you should double check how experienced your potential surgeon is. The professional team of Heart Surgery Department of the Clinic of Braunschweig guarantees you accurate diagnostic and choosing the right treatment according to your personal situation. The head of the Department, Assistant Professor Dr. Wolfgang Harringer encourages individual approach to every patient. If you wish to apply for consultation or want to know cost of heart bypass surgery in Germany, please use our call back service.