Our patient, Kiran, recently had bypass surgery to restore blood flow to his heart. However, there was one big difference in how it was performed – his heart was kept beating. Normally, a heart is stopped during this kind of procedure, but a study at our centre on over 10,000 patients has shown it is safer to keep it working.
Tackling blocked coronary arteries
Coronary arteries are blood vessels that supply oxygen to the heart to keep it beating. However, they can become narrowed and hardened by the build of fatty deposits, resulting in coronary heart disease (CHD).
CHD can cause a type of chest pain called angina, which can prevent patients from taking part in activities they enjoy. It can also increase the chance of a heart attack, making it a leading cause of death worldwide. Certain risk factors can increase the chance of getting CHD, including smoking, being overweight and a high fat diet.
There are a range of treatments to tackle CHD, but if the blockage is large, a coronary artery bypass grafting (CABG) procedure may be needed. Here, blood vessels from other parts of the body (such as the chest, leg or arm) are attached to either side of the narrowed coronary artery to restore blood flow to the heart.
Normally, a bypass procedure is performed using a ‘heart-lung machine’ which takes over the functions of the heart and lungs, so that the heart can be stopped to make the surgery easier. This is currently the gold standard technique. However, using these machines can result in inflammation throughout the body and multiple organs not working as they should. The risk of these complications is also higher for some patients, such as those with kidney problems or diabetes.
Making bypass surgery safer
An alternative type of bypass surgery called an ‘Off-pump CABG’ uses a device to stabilise the heart, enabling it to continue beating whilst the surgery is performed. This more complex approach takes a great level of surgical precision to get right, but can significantly improve surgery outcomes, particularly for high risk patients.
Our consultant cardiac surgeon and internationally renowned CABG expert, Mr Shahzad Raja, recently led a 20-year clinical study on over 10,000 patients at Harefield Hospital to compare the two types of CABG procedure.
The study showed that a beating heart bypass was associated with a lower risk of death during surgery, fewer complications following surgery and a similar chance of surviving after 20 years of follow-up when compared to surgery using a heart-lung machine. This is currently the longest study of its kind.
Successful triple bypass for a high-risk patient
At 57, Kiran had already achieved a great deal in his life. He successfully started and expanded a group of elderly nursing and care homes across the UK, had his first grandchild, and most recently attended the wedding of his youngest daughter. He led a very active lifestyle, regularly travelling for work, as well as swimming 2-3 times a week and going for long countryside walks.
However, he noticed a persistent pain in his shoulder whilst on his walks, particularly when going uphill. He decided to see a doctor about it, but repeat ECG tests came back negative, despite the pain continuing. After struggles booking further heart exams, he decided to seek private care with Royal Brompton & Harefield Hospitals Specialist Care.
“All the tests were done really quickly at Harefield and I met several great cardiologists. They told me that my angiogram showed that three of my coronary arteries were blocked and that I’d need a triple heart bypass,” explains Kiran. “I was absolutely shocked as I was at my daughter’s wedding a few weeks before and was jumping up and down all night. I had no idea there was something wrong with me like this."
“I was scared of surgery initially, but when I met Mr Shahzad Raja who was recommended to operate on me, my heart just said this was the right man for the job – he was just such a positive man to speak to. He encouraged me to do research on him, but I didn’t have to, I just asked him to go ahead."
"When I woke up from the surgery, I saw Mr Raja, who came to check up on me. I couldn’t talk to him at that point, but I just put two hands up to thank him for giving me a new life. And after about 6 weeks I was back to normal really – I was driving again and going on my long walks which I love.”
Mr Raja said:
“Kiran’s case was quite complex, as he had diabetes and multi-vessel coronary artery disease. We recommended an off-pump bypass procedure to ensure the best results as he was a very high-risk patient. We were very pleased with the outcome and would recommend the off-pump procedure to all high-risk patients in centres that have the expertise to perform it.”
Consultant cardiac surgeon