In 1962, just as America ’s Baby Boom was ending, the first coronary artery bypass graft operation was performed in the United States . Today, the Boomer population has become the primary beneficiary of this life-saving procedure. Almost a half-million bypass surgeries are performed in the U.S. each year.
New advances and minimally invasive techniques are providing bypass patients with options that improve outcomes while decreasing risk and recovery time.
Some of these advances include:
The “hybrid” bypass – A new procedure that uses a combination of “key-hole” surgery and advanced drug-eluting stents to accomplish revascularization of the heart without opening the chest. First, the heart surgeon connects the mammary artery through a tiny chest incision and connects it to the most important of the blocked coronary vessels. Then, the bypass is supplemented in the cardiac catheterization lab by stents placed to other blocked arteries. The procedure eliminates the need for a large chest incision and dividing the breast bone, thereby reducing recovery time and infection risk.
Endoscopic vein harvesting – In this technique, the healthy blood vessel that is harvested from the leg for use as the bypass graft is located and removed using a tiny endoscope-fed camera and just 2-3 one-inch incisions. Without the traditional ankle-to-groin incision, patients have less post-operative pain, a decreased risk of infection, a quicker start to their rehab, and no “tell-tale” scar.
Intra-operative echocardiography – Before and during surgery, ultrasound is used to visualize the affected arteries to identify any cholesterol buildup inside of them. This careful monitoring ensures that identified plaques are not loosened during surgery. (Freed plaque fragments can travel through the bloodstream and cause stroke.) Using intra-operative echocardiography, special measures can be taken to ensure that plaque-laden arteries are not disrupted during the procedure, drastically reducing the risk of stroke (see below).
Neurocognitive monitoring – Surgeons can take steps to carefully monitor and perhaps prevent a period of mental haziness, memory loss and/or emotional change that may occur after heart surgery. Neurocognitive tests before and after heart surgery as well as careful monitoring, such as intra-operative echocardiography (see above) can help to prevent these cognitive and emotional changes. Using these techniques, researchers at NorthShore University HealthSystem recently reported at the national meeting of the Society of Thoracic Surgery that their patients are able to undergo CABG with essentially no change in cognitive function.
Inframammary incisions (for women) – Benefiting from a technique favored by plastic surgeons for breast augmentation, certain women may be good candidates for an inframammary incision that is concealed beneath the breast. The traditional incision is typically 10-12 inches long and the resulting scar is evident in all but the highest of dress necklines. In most women, the inframammary incision is almost completely concealed, while still allowing safe access to the heart.
Bloodless surgery – Patients who have concerns about receiving transfused blood during their heart surgery may seek out a surgeon who performs “bloodless” surgery, in which no additional blood is used during the procedure. Although most commonly requested by those from religious groups, such as Jehovah’s Witnesses, other individuals may opt for this approach because of its lowered risk of complications and reduced recovery times.
Off-pump bypass – A stabilizing device allows the heart to remain pumping throughout surgery, eliminating the need for the heart-lung machine. Off-pump surgery is most often recommended for older or frail patients for whom traditional surgery would pose greater risk.