Download Surgical Treatment of Ischaemic Heart Disease

Surgical Treatment
of Ischaemic Heart
Disease
Division of Cardiothoracic
Surgery
UWI Mona
Coronary Arterial Disease
Atherosclerosis in
native coronary
vessels (multifactorial)
 Blocks develop
 Partial blocks prone
to platelet clots
 Large plaques prone
to fracture clots
form
 Myocardial
Infarction(MI)

Angina: Chest Pain due to
inadequate Blood Flow  Ischaemia

angina
may be reversible
Unlike MI,
Some form of
intervention may
alleviate symptoms
(open or less-invasive
surgery; angioplasty
+/- stenting)

Coronary Bypass: Bypasses
the Block
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

The Cardiopulmonary Bypass
Machine
The CPB Circuitry
The Appearance of the Heart
on Opening the Sternum
Anastomosing the Internal Mammary
Artery to the Left Anterior Descending
Coronary Artery
The Completed LIMA-LAD
Anastomosis
Saphenous Vein(green arrow) being
anastomosed to Coronary Artery(red
arrow)
Completed SV-Coronary
Anastomosis
CABG can be done on a
BEATING HEART:
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

A Late
Complication
Patent LIMA
Graft with distally
blocked native
coronary artery

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 (< 5 yrs) results, but
poor longer term results when compared to
traditional surgical therapy
Pre- and Post- Angioplasty
Stent is left inside coronary
artery and holds lumen open
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 longterm outlooks
 All of these interventions are PALLIATIVE
THERAPIES, ie. The underlying disease may
continue to cause problems post-op
