Mini By-Pass Surgery
Prof. Dr. BARİS CAYNAK
What is Mini by-pass ?
Mini by-pass is a surgery that is done by the same method as open by-pass surgery but with the small incision which is less traumatic for the patients.
What should be done for a vascular occlusion ?
Cardiovascular occlusion is a condition that is manifest itself after coroner angiography procedure. After angiography if there is obstruction in vessels up to certain stage, it must be unblocked. Otherwise, inevitable patient will at high risk for heart attack. If the opening of the veins is not possible with angio procedure, bypass operation is recommended to the patient.
In the by-pass operation, the occluded vein is intervened differently than the angio procedure.
In angioplasty, blocked artery is inflated with the help of a balloon and a stent is placed. Otherwise, by-pass surgery performed by direction of blood flow with venous taken from chest, leg or arm, that sutured above and below blocked artery.
By-pass surgery is better in a long term for a precaution of occurrence other obstructions in the same artery. Thus, by-pass surgery is golden standard for patients who have multiple vascular occlusion. Patients avoid by-pass surgery because of the burden of postoperative effects. One of the main reason is the long incision, opening of breastbone and complications related to the bone dividing procedure.
Classic by-pass surgery
In case of treatment all of 3 venous system that nourish heart, to perform surgery at first it must be prepared saphenous vein from the patient’s leg. This removal procedure happens with the surgical incision that dependent on the veins length.
Afterward, with incision length of 25-30cm surgeon reaches breastbone, divide it to reach chest cavity for executing procedure.
The artery in the chest wall is prepared from the rib cage cavity and the necessary preparations for By-pass surgery are done. Then patient enter to the heart circulation device and heart is stopped, prepared veins are sutured beyond the occluded part of the blood vessel.
What is the difference of Mini By-pass?
There is no long surgical incision on the patients leg. Graft vein is taken with endoscopic method by assistance of camera and whole vein can be prepared with only 1 cm incision from the knee level, vein is taken from the level between ankle and groin. With the incision of 6 cm in the left part of the chest, surgeon reaches to the chest cavity and from the left side of chest prepare an artery.Heart is entered into the circulation device, and the heart is stopped, same way as in the classical By-pass surgery, new blood vessels are sewn beyond the occluded vessels with the same technique. After the anastomoses (stitches) are performed, the heart circulation device is exited and the operation is completed through the same incision in the left side of chest.
What are the advantages of a Mini By-pass surgery?
Mini By-pass surgery carry same risks as the open heart surgery due to the same procedure is applied to the heart in minimal invasive method. However, recovery process is faster in the postoperative period. Specially, hospitalization in ICU and time of connected breathing apparatus are shortened. Patients taken out of respiratory machine in 4 to 6 hours and transferred to patient service room in 12 to 24 hours. After patient transferred to the service room, because they have not incision in their legs, patients can freely walk. Patients have not any discomfort in chest area during breathing physiotherapy, lung activity, taking deep breath, coughing and other procedures. Breathing physiotherapy effects faster and more easily.
There is no any negative condition for using arms, walking, lying on sides which leads to more comfortable and shorter recovery period. Patients in general discharged after 4 days of hospitalization. They can do walking exercises and stimulated to rise their walking range and tempo.However, 4 days after discharge if doctor examination will not show any problems, patient can turn back to work.
Why Mini By-pass?
Nowadays young people with cardiovascular diagnosis whom suggested to have by-pass surgery avoid this procedure. Patients scare lost their daily routines, stay away from burden of the surgery and not taking into account long recovery period. In inconvenient way patients push cardiology doctors to apply angioplasty for stent application.
Mini By-pass surgery is a huge alternative for multiple artery diseases. This surgery method brings all advantages and prevent patients for multiple obstruction of artery and reapplying stenting procedures.
Specially people who have diabetes, advanced level of obesity, COPD lung disease receives higher benefits with Mini By-pass surgery. Early recovery period and ability to return back to work in short time provides psychological advantages.
With no need to divide breastbone, patients have not only psychological but also aesthetic advantages. Even after years since classic by-pass surgery performed, patients could have complaints about breastbone incision and feel themselves continuously in sick psychological condition.
Therefore, minimal invasive By-pass surgery provides not only short term fast recovery period and aesthetic advantages but social and psychological advantages in a long term, too.