Heart specialist: a bypass saves the heart and life

Heart specialist: a bypass saves the heart and life

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Bypass - lifeline for the heart
Our heart: the size of a fist, approx. In the course of a human life, this fascinating hollow organ pumps up to three billion beats around 250 million liters of blood through the body. One of the most common heart diseases in western industrialized countries is coronary artery disease (CAD). Cardiac surgeon and managing director of the German Society for Thoracic, Cardiac and Vascular Surgery, Dr. Andreas Beckmann provides answers to coronary artery disease and one of the invasive treatment measures: the bypass surgery of the heart.

Briefly explain coronary artery disease
Coronary artery disease is the disease of the arteries that supply the heart muscle with blood, the so-called coronary arteries. The trigger is often arteriosclerosis, which results in deposits in the vascular walls and plaque formation in vasoconstrictions and ultimately leads to permanent vascular calcification. This jeopardizes the oxygen supply to the heart muscle and creates a mismatch between the supply and demand of oxygen. At the end of this mostly insidious process, the coronary arteries can become life-threatening. Patients with CAD have no symptoms, but often report symptoms such as chest tightness, the so-called angina pectoris, or shortness of breath at rest or during exercise. Other alarming symptoms can range from irregular heartbeats to a life-threatening heart attack. The heart attack is caused by an acute coronary artery occlusion on the floor of a previously existing narrowing of the artery, which then leads to a persistent circulatory disorder in a region of the heart muscle.

What are the purpose, purpose and aim of the therapy?
First of all, it should be mentioned that coronary artery disease is not curable. However, nowadays there are very good therapeutic options available for the affected patients, which offer them excellent chances of being able to live well with the disease in the long term. Depending on the severity of the disease and the degree or type of vasoconstriction, different therapies are indicated, which can be roughly divided into invasive and non-invasive treatment approaches. The main goals of the treatment of CHD are to remedy any symptoms, to minimize the progression of vascular calcification and to completely prevent the negative consequences such as cardiac arrhythmias, heart failure and heart attacks, in order to improve the survival chances of the affected patients. In this context, invasive means an intervention in the body, i.e. in the case in which a purely medicinal treatment of the disease is not or no longer sufficient.

Coronary bypass is an invasive form of therapy. When does the patient need such a vascular bridge?
Guidelines such as the German-language "National Care Guideline - Chronic CHD" or the English-language guideline "Guidelines on myocardial revascularization" of European specialist societies provide recommendations for the treatment of CHD on the basis of recognized scientific knowledge. For example, a complex narrowing of the initial part of the left coronary artery, the so-called main stem stenosis, is a clear indication for coronary artery bypass surgery. This also applies to more complex narrowing of all three coronary arteries. Coronary bypass surgery is also the first recommendation and therefore the primary choice for the patient, both with regard to the expected survival and the quality of life. These recommendations result from the results of various medical studies.

What is the goal of coronary artery bypass surgery and when does surgery make sense?
The coronary bypass surgery is used to transport the oxygen-rich blood behind the narrowing of the coronary arteries and thus to remedy the consequences of reduced blood flow to the heart muscle. The coronary bypass is therefore a bridging of the vascular constriction, a kind of operational bypass or diversion. The primary goal of the operation is to significantly improve the blood flow to the heart muscle with enough oxygen-rich blood.

Whether heart surgery 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 be able to come to a therapy recommendation. This is the only way to choose the therapy that is suitable and the best possible for him. In this context, it is therefore particularly important that the specialists involved (e.g. family doctor, general practitioner, cardiologist and cardiac surgeon) work hand in hand for the benefit of the patient.

What is the coronary bypass made of and how long does it last?
The patient's own blood vessels are used for bypassing the heart; on the one hand, they are large enough to serve as a vascular bridge and, on the other hand, they are unnecessary at the original location of the body. The blood vessel can be an artery in the chest wall or a vein from the patient's leg. The openness and functionality of a coronary bypass depends on various factors, usually the vascular bridges function for about 15 to 20 years.

Which examinations take place beforehand
Before the operation, a general examination and imaging diagnostics take place. This includes laboratory values, X-rays, cardiac ultrasound and an EKG.

How long does a coronary heart surgery last and how big is the surgery team?
Heart surgery takes about 3-4 hours. As a rule, the team consists of an surgeon, i.e. the experienced specialist in cardiac surgery, one or two resident doctors in advanced training, a specialist in anesthesia (the so-called anesthetist), two trained surgical nurses or nurses, a trained anesthesia nurse and a qualified cardio technician.

How long does the hospital stay for the procedure?
Depending on the diagnosis and the general condition of the patient and the course before and after the operation, a hospital stay lasts 14 days. A subsequent rehabilitation makes sense and is usually done.

When are you fit and able to work again, can you lead a “normal” life?
Regeneration and rehabilitation vary 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. Exercise and regular exercise, for example, are sure to have a positive effect on health.

Which risk factors should be minimized - please name them?
First of all, it is important to ascertain that the patient cannot influence all risk factors for heart diseases since these are inheritable or family-related. On the other hand, smoking, high blood pressure, fat metabolism disorders (increased cholesterol), diabetes mellitus, obesity and also lack of exercise as well as stress are known risk factors that can be influenced. In general, a healthy lifestyle is of course a good prerequisite for a healthy cardiovascular system, but this is not a guarantee either.

How often does the patient have to check after the heart surgery?
This also has to be decided individually for each patient. As a rule, a six-monthly examination is sufficient. Here the family doctor and / or the cardiologist looks after.

Can you say how many heart operations or coronary bypass operations are performed in Germany each year?
The German Society for Thoracic, Cardiac and Vascular Surgery collects current figures on all cardiac operations every year. In 2016 around 100,000 heart operations were performed in the 78 specialist departments for heart surgery in Germany. Of these, around 52,000 coronary bypass operations alone or in combination with other interventions were at heart.

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