Surgical Treatment of Ischaemic Heart Disease

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Surgical Treatment of Ischaemic Heart Disease

• Division of Cardiothoracic Surgery
• UWI Mona

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Coronary Arterial Disease

• Atherosclerosis in native coronary vessels
  (multi-factorial)
• Blocks develop
• Partial blocks prone to platelet clots
• Large plaques prone to fracture ?clots form
• ? Myocardial Infarction(MI)

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Angina Chest Pain due to inadequate Blood Flow
? Ischaemia

• Unlike MI, angina may be reversible
• Some form of intervention may alleviate symptoms
• (open or less-invasive surgery angioplasty /-
  stenting)

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Coronary Bypass Bypasses the Block
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How is the occlusion bypassed?

• Most procedures are done on a non-beating heart
• Cardiopulmonary Bypass Machine (CPB) is used to
  take over the pumping function of the heart, and
  the gas exchange function of the lungs
• Cardioplegia is given to stop the electrical
  activity of the heart
• Therefore, the heart is still, and the delicate
  operation can be performed with great precision

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The Cardiopulmonary Bypass Machine
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The CPB Circuitry
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The Appearance of the Heart on Opening the Sternum
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Anastomosing the Internal Mammary Artery to the
Left Anterior Descending Coronary Artery
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The Completed LIMA-LAD Anastomosis
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Saphenous Vein(green arrow) being anastomosed to
Coronary Artery(red arrow)
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Completed SV-Coronary Anastomosis
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CABG can be done on a BEATING HEART
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What are the results?

• Best results are for open surgery using cardiac
  arrest (30 yrs experience)
• Newer techniques such as Beating Heart Surgery,
  Minimal Access CABG, Robot-assisted CABG, are all
  in early stages
• For multivessel disease, surgery still superior
  to angioplasty/stenting

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A Late Complication

• Patent LIMA
• Graft with distally blocked native coronary artery

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Angioplasty and Stenting

• A catheter-based procedure performed by
  cardiologists in the CATH LAB which can dilate
  and maintain the lumen of a partially blocked
  coronary artery through the insertion of a tiny
  metallic mesh tube
• Very good short-term (lt 5 yrs) results, but poor
  longer term results when compared to traditional
  surgical therapy

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Pre- and Post- Angioplasty
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Stent is left inside coronary artery and holds
lumen open
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Conclusions

• CABG is one of the most successful operations
  ever devised
• Hundreds of thousands of procedures worldwide
  yearly
• Surgery has best long-term results, although
  angioplasty techniques are improving long-term
  outlooks
• All of these interventions are PALLIATIVE
  THERAPIES, ie. The underlying disease may
  continue to cause problems post-op