Coronary Artery Bypass Surgery

"These days the surgeons should not only offer the best approaches but should tailor them to the patient's needs."

In the era of high technology and web-based information, the patients or in this situation "the customers" are searching the best cost effective way to treat their illness via the internet and e-mail.

The customers learn about the procedures, the risk/benefit and possible complication from surgery; as well as the way the surgeon conducting the procedure. They concern of how they look afterward, how fast they recover, how soon they can go back to work, how they need to take care of themselves afterward more so than before.

It is the duty of the surgeons to become more proactive in adopting new technology and technique in order to provide the patients most satisfaction. The surgeons must tailor the procedures that provide best cosmetic,

With this in mind we are offering these procedures that are being tailored to the need of patients at Bangkok Heart Institute :

1. Off-Pump CABG (Coronary Artery Bypass Graft)
2. Use of all arterial grafts as the conduits
3. Use of small chest incision and eliminate leg incision
4. State-of-the-art cardiac rehabilitation program

OFF-PUMP PROCEDURES

Off-Pump coronary artery bypass (OPCAB) technique or bypass graft surgery without the use of heart-lung machine but with local cardiac stabilizer (Picture I) has been re-introduced in the last six years, and now comprising approximately 24% of all coronary artery bypass surgery worldwide. One of the goals of beating heart surgery is to eliminate the complications associated with the use of cardiopulmonary bypass (heart-lung machine). These complications even are small and occurred only about 2-3% could be serious problem. These include pulmonary (lung) insufficiency, transient renal failure (kidney), stroke and the failure of appropriate blood clotting.

Picture I : Cardiac Stabilizer Off-Pump surgery requires less blood transfusion, shorter operating time, less time on the breathing machine, ICU time and length of hospital stay. The elderly, high risk patients or patients with multiple co-morbidity can do much better when the bypass procedures are carried out without the heart-lung machine.

ALL ARTERIAL CONDUITS

The use of all arterial conduits for coronary artery bypass graft has become more acceptable after gaining experiences and reports of better long-term results. The most common utilized conduits are the left internal mammary artery (LIMA) from chest wall, the right internal mammary artery (RIMA), the left or right radial artery (RA) from forearm and gastro-epiploic artery (GEA) from the stomach . The use of LIMA to the left anterior descending artery (LAD) has been shown to significantly improve long-term survival results. Also, the evidence shows that both mammary arteries could provide better long-term outcomes as well.

The long-term results have shown that the 10 year patency rates of the internal mammary artery are about 90-95% comparing to the 10 year patency rate of the vein graft which is about 60-65%. The 10 year patency rate of the radial artery and gastro-epiploic arteries are about 85% and 80% respectively. In our practice, the saphenous veins (veins from leg) are rarely used unless the arterial conduits are not readily available.

Picture II

Picture III

SMALL INCISIONS

At the Bangkok Heart Institute, we are no longer making one-foot long incision and spreading ten inches wide, like the old day surgery (Picture II ).

We do not need a big opening. With less invasive approach, the less pain occurred after surgery (Picture III). Long-term sternal discomfort from chest wall stretches; nerve and soft tissue damages are nearly eliminated with small incision. Avoiding the use of the leg incision allows the patients to get up and mobilize much sooner than after. Also 3 short (2 cm. long) skip incisions in the forearm used to harvest the radial artery (Picture IV); instead of a full forearm length incision, helping to eliminate the arm pain

Picture IV All of these techniques, as far as we are concerned, will provide ones who need coronary artery bypass graft surgery the best operative approaches which are available at our institution to date.

REHABILITATION

Successful recovery from bypass surgery requires that the patient and the family approach the operation and recovery period wit confidence based on a thorough understanding of the process. Yet recovery may at times be limited by the extent of damage already caused by the coronary artery disease and by the heart's ability to heal. The cardiac rehabilitation team will support the body's efforts to heal its damaged tissues.

After the stay in the CCU, the patient will be moved to cardiac ward. Here the patient will begin a cardiac rehabilitation program with progressive, safe exercise. The cardiac rehabilitation program at Bangkok Heart Institute is well equipped with state of the art technology and US trained physician and full time cardiologist.

Patient and family education is also a part of cardiac rehabilitation program. This will help the patient to understand how the heart works and what the patient can do to improve and maintain an excellent health.