Heart attacks caused by hardening of the arteries in the heart muscle (coronary heart disease) are the most common cause of death in industrialised nations.
It is therefore not surprising that the majority of heart surgery procedures are bypass operations. This is always preceded by a discussion in the heart team between the referring cardiologist and heart surgeon to find the optimum therapy for the individual case.
Bypass surgery can be performed in different ways:
- Conventional bypass surgery
This usually involves the combination of various endogenous vessels: the left internal mammary artery (LIMA) and the superficial leg vein (great saphenous vein), which is harvested in our clinic using the keyhole technique wherever possible.
- Complete arterial myocardial revascularisation
In the field of coronary surgery, the use of arterial bypass grafts is being intensified to improve the long-term prognosis. In addition to the left-sided internal mammary artery (LIMA), both the right-sided internal mammary artery (RIMA) and the radial artery of the non-leading hand are used. In the presence of significant comorbidities, however, careful risk assessment and highly individualised surgical planning are required in order to avoid taking unnecessary risks that increase complications in a surgical strategy that is geared towards good long-term results.
- Minimally invasive techniques
Where indicated, we perform bypass operations through small incisions (MID-CAB) or completely endoscopically (TE-CAB) with the aid of a heart-lung machine.
- Off-pump surgery (coronary revascularisation on the beating heart without the use of a heart-lung machine - OPCAB)
The use of extracorporeal circulation poses a particular challenge and risk-increasing burden for older patients or those with severely calcified aorta close to the heart. In such cases, the procedure of direct myocardial revascularisation on the beating heart without the use of a heart-lung machine with the aid of mechanical stabilisers is an option.
