As of: March 1, 2024, 11:49 a.m
By: Andreas Beez
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Heart surgeon Professor Markus Krane from the German Heart Center Munich explains how stents and bypasses save lives when coronary arteries are narrowed.
Either a small prick in the groin or arm artery or major open heart surgery?
Hand on heart: If they could choose, most people would probably rather take a stent than a bypass.
A stent is a vascular support made of plastic and metal.
This mesh tube is transported to the heart using a thin tube (catheter) and unfolded at the narrow point.
The procedure is carried out minimally invasively in the cardiac catheter laboratory and is comparatively gentle.
Heart surgeon Professor Markus Krane © DHM
Heart surgeon Professor Markus Krane: Bypasses are particularly effective and safe in severe cases
However, the second, initially more stressful variant also has decisive advantages: “Bypasses are considered particularly effective and safe, especially when several vessels are affected and the patient also suffers from diabetes.
Studies show that patients survive longer after bypass surgery than with stents,” reports Prof. Markus Krane from the
German Heart Center in Munich
.
He heads the clinic for cardiac and vascular surgery.
Krane's analysis is also reflected in the national care guidelines for narrowed coronary arteries.
According to this, bypass surgery permanently alleviates the symptoms in 94 percent of cases, and the insertion of stents in 80 percent.
One in five patients with a stent needs to be re-stented within four years; after a bypass procedure, only six percent go under the knife again within four years.
The risk of serious complications with both procedures is very low at three percent.
Doctors, technology and aftercare: This is how a bypass operation works
During bypass surgery, heart surgeons work with magnifying glasses.
First, the chest must be opened and the patient connected to the heart-lung machine - if possible not longer than 90 minutes, because the risk of complications then increases.
The operation effort is enormous; there are usually three heart surgeons at the operating table: one doctor sews the bypasses and two colleagues assist.
There are also one or two anesthetists and an anesthesia nurse.
The cardiac surgery team is flanked by a surgical nurse and a cardiotechnician.
How long the procedure takes depends primarily on the number of bypasses required; the heart surgeons need around 15 minutes for each one, plus almost two hours of preparation and follow-up.
As a rule, the patient spends one night in the intensive care unit and around seven to ten days in the normal ward.
This is followed by a three-week rehabilitation stay.
To prevent the bypasses from closing, doctors prescribe three medications for life: ASA (aspirin), a beta blocker and a cholesterol-lowering drug (technical term statin).
The risk of occlusion is relatively low.
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In many cases, bypass surgery saves the lives of patients - such as Werner Stephan Pintér from Munich, whose serious heart disease was discovered just in time at the German Heart Center.
He thought he was in great shape but unexpectedly ended up in the operating room: “That saved my life!”
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The specialists led by Prof. Krane (right) operate on a patient using magnifying glasses.
© Photo: DHM
The chest wall artery is converted into a diversion for narrowed coronary arteries
The left thoracic artery is almost always used for a bypass.
“The body can cope with this well because our chest is supplied with sufficient oxygen through numerous other arteries,” explains heart surgeon Krane.
“If the chest wall artery is used, 90 percent of the bypasses are still open after 15 years.” If several bypasses are needed, the specialists also remove superficial veins from the legs.
Background to the narrowing of the coronary arteries: One of the most important risk factors is high blood pressure.
As is now becoming increasingly clear, hypertension also fuels the development of dementia.
“That's why you should never underestimate high blood pressure,” warn heart specialists such as Professor Martin Halle from the University Hospital Rechts der Isar.
This article only contains general information on the respective health topic and is therefore not intended for self-diagnosis, treatment or medication. It in no way replaces a visit to the doctor. Unfortunately, our editorial team cannot answer individual questions about medical conditions.