Bypass surgery

If the vessels become narrow and the blood flow is blocked

For the heart to fulfil its demanding task it requires a reliable blood supply. The heart muscle is supplied via the coronary arteries (coronaria) with oxygen-rich blood coming from the aorta. In the course of our lifetime we have to reckon with an increasing calcification of the arteries (arteriosclerosis) and a deposition of blood lipids and cell components (plaque) on the previously damaged vascular walls, which leads to angiostenosis. The narrowed areas impair the blood supply of the heart muscle and lead to an oxygen deficiency of the heart, which will cause, for example, the typical symptoms of stenocardia (angina pectoris).

Arteriosclerosis and angiostenosis

There is a threat of heart attack when the narrowing in the coronary vessels grows to a threatening extent and the blood flow in the narrowed area is shut off completely owing to a tiny blood clot (thrombus). Consequently, the part of the heart muscle that is located downstream of the occluded point is no longer being supplied with oxygen and nutrient media. If the occlusion is not re-opened by medical intervention in good time, the heart muscle tissue will inevitably become necrotic. The area involved loses its pumping capability and scars, which will result in a more or less considerable impairment of the heart performance.

Heart attack

How to ensure the free blood flow by adding a bypass

Where cardiological catheterisation methods cannot be applied for a re-opening of the coronary vessels, a bypass surgery is the last resort for the heart.

A bypass means a route diversion for the blood in that the narrowed areas of the coronary vessels are bridged using own vessels. These vascular bridges consist of one's own arteries or veins. In almost all cases it is possible to use the chest wall arteries to bridge one or more narrowed areas. If further bypasses are required, superficial arteries or veins from the arms or legs of the patient are taken to serve as a vascular bridge.

Bypasses bridge the narrowed areas of the coronary vessels

The taking of the required vessels is performed in the Schüchtermann-Klinik using a particularly gentle method. The so-called minimally invasive removal of the vessels by means of special instruments causes a significantly milder pain after surgery than the conventional method. And, due to the small skin incisions only, the cosmetic appearance is considerably better.

Firstly, the vascular bridges thus taken are connected behind the narrowing with the coronary vessel concerned.
Thereafter, the ends of the vascular bridges are centrally sewn in place at the aorta; here, the natural coronary arteries emanate as well. The small vascular bridges made of veins will very quickly accustom themselves to their new task. The interior walls of the vessels will transform so that within a short time a proper coronary artery will develop.

Thus, the vascular bypasses circumnavigate the narrowed areas and occlusions of the coronary arteries and the blood flow through the heart muscle is reliably restored.

Safety thanks to the most advanced medical equipment

Bypass surgeries are performed under general anaesthesia. The anaesthetist monitors the patient's condition throughout the surgery by means of the most advanced equipment for the monitoring of artificial respiration and circulatory system. On average, a bypass surgery in the Schüchtermann-Klinik takes between 2 and 3 hours.

The majority of bypass surgeries is performed by using the heart-lung machine. While the cardiac surgeon is inserting the bypasses at the arrested heart, the heart-lung machine is keeping up the entire circulatory system.

In certain cases - in the so-called off-pump technique- it is possible to do without the heart-lung machine. In such cases the cardiac surgeon sews the healthy vessels in place on the beating heart. The option to apply this technique, however, depends on the location of the narrowed area or the number of coronary vessels concerned.

Bypass surgery: safe and successful

Bypass surgery performed almost 70,000 times a year is the most frequently provided heart surgery in Germany. Over the past 20 years this intervention has become a routine process with a remarkably high success rate. If the surgery is performed early enough and if the heart is not already impaired by a heart attack, the operative risk will be very small.

If the heart muscle has not already been damaged by a heart attack in the time before surgery, the physical performance capacity will be fully restored after a successful bypass surgery. The life expectancy after surgery will then equal that of a healthy person. The patients will again be able to bear the stresses and strains of their everyday life without feeling heart pain and to continue their life as before. Moreover, the number of drugs necessary after surgery can usually be considerably reduced.

Bypass surgery after an acute heart attack as a life-saver

Bypass surgery in the Schüchtermann-Klinik focuses on the emergency medical aid for patients, who have already suffered an acute heart attack and are therefore threatened by acute cardiac failure. In close cooperation with the rescue team such high-risk patients are stabilised already while being transported to the hospital, by means of a special circulatory support method (the so-called intra-aortic balloon pump).
The subsequent immediate bypass surgery will considerably improve the chance of survival for the patient.