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Heart specialist A bypass saves the heart and the life
Our heart: fist-sized, about 350 grams heavy and tireless motor of the human body. Over the course of a lifetime, this fascinating hollow organ pumps around 250 million liters of blood through the body with up to three billion strokes. One of the most common heart diseases in Western industrialized countries is coronary heart disease (CHD). Cardiac Surgeon and Managing Director of the German Society of Thoracic and Cardiovascular Surgery Andreas Beckmann, gives answers to the coronary heart disease and to one of the invasive treatment measures: the bypass surgery of the heart.
Briefly explain the coronary heart disease
Coronary heart disease refers to the disease of the arteries that supply the heart muscle with blood to the so-called coronary arteries. The trigger is often arteriosclerosis, which leads to deposits on the vessel walls via plaque formations in vascular constrictions and ultimately leads to a permanent vascular calcification. This endangers the oxygen supply of the heart muscle and creates a mismatch between oxygen supply and demand. At the end of this usually creeping process, it can lead to a life-threatening occlusion of the coronary arteries. Patients with CHD have no symptoms, but often report symptoms such as chest tightness, called angina pectoris, or shortness of breath at rest or during exercise. Other alarming symptoms can range from cardiac arrhythmias to life-threatening heart attacks. The myocardial infarction is caused by an acute coronary artery occlusion, on the floor of a previously existing constriction of the artery, which then leads to a persistent circulatory disturbance of a region of the heart muscle.
A bypass op can save lives! (Image: hriana / fotolia.com) What are the meaning, purpose and goal of the therapy?
First, it should be mentioned that the coronary heart disease is not curable. However, very good treatment options are available today for the patients concerned, which offer them excellent opportunities to be able to live permanently well with the disease. Depending on the severity of the disease and the degree or type of vasoconstriction different therapies are indicated, which can be roughly differentiated into invasive and non-invasive treatment approaches. The main goals of the treatment of CHD are to eliminate any symptoms, to minimize the progression of vascular calcifications and to completely prevent the negative consequences such as cardiac arrhythmia, heart failure and heart attacks, thereby improving the chances of survival of the affected patients. Invasive means in this context an intervention in the body, ie in the case in which a purely medical treatment of the disease is not or no longer sufficient.
An invasive form of therapy is the coronary bypass. When does the patient need such a vessel bridge?
Guidelines such as the German-language "National Treatment Guideline - Chronic CHD" or the Guideline on "Myocardial Revascularization" from European specialist societies provide recommendations for the treatment of CHD based on recognized scientific findings. For example, a complex narrowing of the initial part of the left coronary artery, the so-called major stenosis, is a clear indication for coronary bypass surgery. This is also true for more complex constrictions of all three coronary arteries, and coronary artery bypass grafting is the first recommendation, and thus the first choice for the patient, both in terms of expected survival and quality of life. These recommendations result from the results of various medical studies.
What is the purpose of coronary artery bypass surgery and when is surgery useful??
The coronary bypass operation serves to transport the oxygen-rich blood behind the constriction of the coronary arteries and thus to remedy the consequences of reduced blood flow to the heart muscle. The coronary bypass is thus a bridging of the Gefassengstelle, quasi an operatively created bypass or detour. The ultimate goal of the operation is to significantly improve the circulation of the heart muscle with enough oxygen-rich blood again.
Whether a heart operation makes sense depends on various factors. Therefore, each patient must be individually interviewed, examined and advised on the basis of medical facts and personal circumstances in order to arrive at a therapy recommendation. Only then can the most suitable and individually best possible therapy be chosen for him. In this context it is therefore particularly important that the specialists involved (for example family doctor, general practitioner, cardiologist and cardiac surgeon) work hand in hand for the benefit of the patients.
What is the coronary bypass made of and how long will it last?
For the bypass at the heart of the patient's own blood vessels are used, which are both large enough to serve as a vessel bridge and on the other hand are dispensable in the original location of the body. The blood vessel may be an artery of the chest wall or even a vein of the patient's leg. The openness and functioning of a coronary bypass depends on a variety of factors; usually the vascular bridges function for about 15 to 20 years.
Which examinations take place beforehand
Before the operation a general examination takes place as well as diagnostic imaging. These include laboratory values, x-rays, heart ultrasound and an ECG.
How long does a coronary heart operation take and how big is the surgical team??
A heart surgery takes about 3-4 hours. As a rule, the team consists of a surgeon, ie the experienced specialist in cardiac surgery, one to two assistant doctors in further education, a specialist in anesthesia (the so-called anesthetist), two trained surgical nurses, a trained anesthetic nurse and a qualified perfusionist.
How long does the hospital stay for the procedure last??
Depending on the diagnosis and the general condition of the patient as well as the course before and after the operation, a hospital stay lasts 14 days. A subsequent rehabilitation makes sense and is usually done as well.
When will you be fit and able to work, so you can lead a "normal" life?
Regeneration and rehabilitation varies from patient to patient. After the hospital stay and the subsequent measures a normal life is usually possible. Existing risk factors should be minimized as far as possible. Sport and regular exercise, for example, certainly have a positive effect on the state of health.
Which risk factors should be minimized - please name them?
First, it should be noted that the patient can not influence all risk factors for heart disease as they are inheritable or familial. Smoking, high blood pressure, lipid metabolism disorders (elevated cholesterol), diabetes mellitus, obesity, lack of exercise and stress are known risk factors that can be influenced. In general, of course, a healthy lifestyle is considered a good condition for a healthy cardiovascular system, but this is not a guarantor.
How often does the patient need to go to the heart surgery for control?
This must also be decided on a patient-specific basis. As a rule, a semi-annual examination is sufficient. Here the family doctor and / or the cardiologist looks after.
Can you tell how many heart surgeries or coronary bypass operations are performed each year in Germany??
Every year, the German Society of Thoracic and Cardiovascular Surgery collects up-to-date figures on all cardiac operations. In 2016, around 100,000 cardiac surgeries were performed in the 78 specialist departments for cardiac surgery in Germany. Of these, around 52,000 coronary artery bypass grafts were important, alone or in combination with other procedures.