Coronary surgery

"To prevent heart attack, it is necessary to change the lifestyle: not to smoke, to have a healthy diet, to practice regular exercise and to treat both hypertension and high cholesterol".

DR. JUAN JOSÉ GAVIRA GÓMEZ
SPECIALIST. CARDIOLOGY DEPARTMENT

Coronary by-pass surgery consists of diverting the blood flow interrupted by the obstruction of a coronary artery (bypass) using the patient's own vessels (grafts), either from a leg (saphenous graft) or from the chest (mammary artery).

The most frequent intervention is performed in the following cases:

  • Patients who have obstruction of the left coronary trunk (main vessel that gives two branches and irrigates the entire left ventricle).
  • In cases of proximal obstruction of two or three coronary arteries (right coronary, circumflex or anterior descending).
  • In situations of proximal obstruction of the anterior descending one in which a coronary angioplasty is impossible.

By making this connection below the obstruction, we manage to bring blood to the poorly irrigated areas of the heart, and thus allow the heart to recover correctly. This operation to place a bypass is carried out without touching the narrowed area.

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When is coronary surgery indicated?

Coronary artery diseases and their complications represent the leading cause of death in the West.

The obstruction is produced when accumulations of fat, called atheroma plaque, are deposited, which can prevent the heart from obtaining enough blood and oxygen.

This plaque is composed of cholesterol, fatty compounds, calcium and fibrotic material. It forms in the arteries, over the years, by a process called atherosclerosis. Tobacco, cholesterol, hypertension and diabetes are risk factors.

When the coronary arteries are partially or totally blocked, the blood lacks sufficient oxygen to allow the heart to perform its function properly. This is when the symptoms of chest tightness, choking sensation, etc. appear.

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Most frequent indications of this treatment:

  • Angina pectoris
  • Acute myocardial infarction

Do you have any of these diseases?

It may be necessary to perform a coronary by-pass

How is coronary surgery performed?

The operation, which usually lasts several hours, is performed under general anesthesia and through an incision in the front of the chest. It may require the help of extracorporeal blood circulation.

With the heart stopped, the graft is sutured to the coronary vessel. After the connections are made, blood circulation is restored and the chest is closed.

Among the advances that have improved the effectiveness and safety of our interventions in recent years are:

  • Medical team trained in performing off-pump coronary surgery, which is done without interrupting circulation, with the help of a device that partially immobilizes the heart and allows sutures to be made.
  • Use of arterial-only grafts: technique in which only the internal mammary arteries are used (which are located on both sides of the sternum), with better long-term results and a decrease in complications in diabetic patients, since leg veins are not used.
  • Extraction of venous grafts (saphenous) by videoscopy: a method by which the patient's own leg vein is removed through a small incision, with significant reduction of pain and faster recovery.

Most patients will be admitted to the hospital the day before the procedure or, in some cases, the morning of the procedure itself.

You will be asked to shower the night before in order to reduce the amount of germs on your skin. After you are admitted to the hospital, you will be washed, disinfected with an antiseptic and, if necessary, shaved.

The risk of complications from anesthesia is less if the patient is fasting. That is why you will be asked not to eat or drink anything after midnight the day before the operation. If you do eat or drink anything, it is important that you notify the anesthesiologist and the surgeon.

If you smoke, your doctor will ask you to stop smoking at least two weeks before your surgery. Smoking before surgery can lead to problems with blood clotting and breathing.

The hospital stay usually lasts approximately one week. After the operation, the patient usually stays one day in the intensive care unit, where heart function will be monitored. In total, the patient will have to stay between 5 and 7 days.

After a bypass operation, the patient will have to limit his fat and cholesterol intake. The doctor may advise walking or swimming to regain strength. He may also recommend a cardiac rehabilitation program. These programs can help you make lifestyle changes, such as adopting a new diet, starting an exercise plan, quitting smoking and learning to better manage stress.

The purpose of this intervention is to allow an adequate supply of blood and oxygen to the heart in order to prevent angina and decrease the risk of heart attack. In any case, the intervention does not prevent the coronary blockage from occurring again. To avoid it, it is necessary to change the style of life: not to smoke, to take a healthy diet, to practice exercise regularly and to treat, as much the hypertension, as the elevated cholesterol.

If the patient's work does not require great physical effort, he or she can return to work after 4 or 6 weeks. If, on the other hand, you are in a physically demanding position, you may have to wait longer.

Between 70 and 80% of the patients operated on are symptom-free 10 years after the operation.

Where do we do it?

IN NAVARRA AND MADRID

OUR MEDICAL TEAM

Specialists of the Department of Cardiac Surgery

The Cardiac Surgery Department of the Clinic is backed by its extensive experience of more than 50 years. It is a pioneer in the introduction of the most complex procedures and the most avant-garde techniques.

Our surgeons are specialists trained in international reference centers, which combine the application of the latest techniques with personalized treatment to our patients.

We also have a team of highly specialized nurses, both in surgical and clinical aspects.

Treatments we perform

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Why at the Clinica?

  • Pioneers in advanced procedures and techniques.
  • Implantation of the first total artificial heart in Spain in 2016.
  • Specialists trained in international centers of reference at national level.

Safer than ever to continue taking care of you

We update safety protocols weekly with the latest scientific evidence and the knowledge of the best international centers with which we collaborate.