The heart is actually a hollow muscular organ. It pumps oxygen-rich blood through the body by regularly contracting the heart muscle. The heart has to beat day and night, as otherwise organs that are undersupplied would die within minutes.
But this also applies to the heart itself. The heart muscle needs oxygen in order to function. The coronary arteries are responsible for supplying the heart muscle with oxygen. If not enough oxygen-rich blood reaches the heart, it can no longer beat - the person suffers a life-threatening heart attack.
Such a situation can occur due to a narrowing of the coronary arteries (coronary stenosis) or a sudden blockage.
Bypass surgery is used to create a bypass for narrowed or blocked coronary arteries © lom123 | AdobeStock
Coronary stenosis is usually caused by arteriosclerosis, also known colloquially as "vascular calcification". In the case of narrowing of coronary arteries, the term coronary heart disease is used more precisely.
With increasing narrowing of the coronary arteries, there is an imbalance between oxygen demand and supply (coronary insufficiency). This results in shortness of breath and a feeling of tightness in the chest(angina pectoris).
Arteriosclerosis can also cause the coronary arteries to become completely blocked over time. However, a blood clot can also cause such an important blood vessel to suddenly become blocked.
Heart bypass surgery, also known as aortocoronary bypass surgery, is one of the most common heart surgery procedures. The procedure is used to surgically create a bypass around a narrowed coronary artery in order to ensure a continued blood supply.
As a rule, the operation is preceded by an attempt to widen the narrowed coronary vessel with medication or interventional balloon catheter dilatation.
Depending on the extent and position of the bypass, a bypass operation takes between two and five hours. In most cases, it is performed openly. This means that the surgeon opens the chest and operates on the heart under direct vision. Under certain circumstances, however, minimally invasive bypass surgery is also possible.
Nowadays, pieces of veins or arteries are used as bridging material. Artificial materials are used less frequently.
Several methods are available for bypass surgery:
- In an arterial bypass , an artery running on the inside of the chest is exposed and connected to the coronary artery. The advantage of an arterial bypass lies in its proximity to the heart, the long service life of the bypass and the comparatively low risk of reocclusion.
- In a venous bypass , a small vein of around 5 cm is removed from the fatty tissue of the thigh or lower leg. This vein is sutured to the coronary artery with thin threads above and below the constriction. After some time, it adapts to the new environment and transforms into an artery.
- An artificial bypass is now only used very rarely, as the functionality of the bypass is quickly impaired by deposits. There is then a risk of a new blockage.
Traditionally, aortocoronary bypass surgery is performed on a resting, bloodless heart with the aid of a heart-lung machine . This means that the heart and lungs are stopped for the duration of the operation. The heart-lung machine then takes over the pumping function of the heart and the gas exchange function of the lungs.
Some aortocoronary bypass operations can now also be performed on a beating heart. It is then not necessary to use the heart-lung machine.
However, this procedure is technically more demanding. It requires a surgeon and expert in cardiac surgery with appropriate training.
The patient recovers relatively quickly after aortocoronary bypass surgery. They can get up and walk around after just one to three days. In some cases, transfer to a follow-up treatment program(rehabilitation) is possible as early as ten to twelve days after the bypass operation.
Serious complications from the procedure are rare. In the initial period after the bypass operation, there may be a pulling sensation in the chest and shoulder areas. Physiotherapy can have a soothing effect.
The risk of arteriosclerosis remains even after bypass surgery. After the operation, it is therefore important to eliminate all risk factors for arteriosclerosis. Keeping the bypasses open can also be supported by drugs that inhibit blood clotting.
After aortocoronary bypass surgery, regular (annual) check-ups take place. The doctor checks the bypass(es) and the remaining coronary arteries for narrowing. This makes it possible to treat any problems quickly.
Bypass operations are performed by heart surgeons. Minimally invasive bypass operations in particular require the surgeon to have many years of experience.
