Coronary Artery Disease and Cardiac Infarction

The coronary arteries supply the heart muscle with blood. These arteries arise close to the heart, leading from the main artery of the body, the aorta. When deposits accumulate in the coronary arteries and partially or completely block the flow of blood, this is known as coronary artery disease.
The symptoms are known as angina pectoris. If part of the heart no longer receives enough blood, the consequence can be the death of heart muscle tissue, leading to myocardial infarction (a “heart attack”). Infarction reduces the pumping capacity of the heart; it can also lead to life-threatening heart rhythm disturbances and dangerous malfunction of the heart valves.

When is a Bypass Operation Necessary?

In many cases, narrowing of the coronary arteries can be solved by using balloon catheter. A stent (a metal mesh) is implanted in the artery to keep it open. We perform the procedure by puncturing the groin artery and advancing the catheter through the body to reach the coronary arteries. This makes an operation on the heart unnecessary. Read more here.  Only when several of the patient’s coronary arteries are affected or when treatment by catheterization is not possible, must a bypass operation be conducted.

The Bypass Operation

During the bypass operation the narrowed coronary arteries are replaced by vessels from the patient’s own body. The doctor decides which vessels will be used. The body can compensate well for the loss of a vessel that is removed. At our institution it is mainly chest wall arteries that are used. The left chest wall artery is diverted to the anterior wall of the left ventricle.
Further, a vein may be removed from the leg or an artery from the lower arm; these are then sewn on as bypasses to other arteries around the heart. We usually remove the lower arm artery through a small incision at the wrist. This reduces pain and the risk of wound healing disturbances and means that there is only a small scar.

Modern Variations of the Bypass Operation at the German Heart Center Berlin

Bypass Operation on the Beating Heart

Bypass operations used to be possible only when the heart had been stopped, using the heart-lung machine to maintain the circulation. Today, many procedures can be performed on the beating heart. The area around the narrowed coronary artery is held still with a stabilizer, while the heart itself continues to pump. Avoiding use of the heart-lung machine reduces the risk of complications, such as a stroke. The bypass operation on the beating heart contributes to more rapid recovery and shorter hospital stays.

Minimally Invasive Bypass Surgery

For a bypass operation the breastbone usually has to be divided. At the German Heart Center Berlin, however, the procedure can often be performed through a small skin incision below the left nipple. This minimally invasive, “direct” coronary artery bypass operation reduces the risk of complications during surgery, partly because the heart-lung machine is not necessary. However, we can only use this minimally invasive method for patients who do not need bypasses at the back wall of the heart, as that area cannot be reached in this manner.