Our Summary

This study looked at the use of a new method for performing coronary artery bypass surgery, which is a procedure used to treat heart disease. Normally, this surgery is done as “open surgery” which means the chest has to be opened up. But in this new method, called “totally endoscopic coronary artery bypass”, the surgery is done using small tools and a camera, inserted through small cuts in the chest.

The researchers looked at 18 studies involving 2,774 patients who had this new type of surgery. The average age of these patients was about 63 years, and the majority were men. The surgery took on average about 5 hours, and in about 5% of the cases, they had to switch to open surgery.

After the surgery, about 6% of the patients had complications within the first 30 days, and about 5% had complications later on. However, the overall survival rates were quite good - 95% after one year, 83% after five years, and 82% after ten years. About 3% of the patients had to have another procedure at some point during an average follow-up period of about three and a half years.

In conclusion, the researchers suggested that this new type of surgery could be a safe and effective option for certain patients. However, more long-term studies are needed to confirm its benefits.

FAQs

  1. What is the “totally endoscopic coronary artery bypass” method?
  2. What were the findings of the study regarding the complications and survival rates of the new method?
  3. Do the researchers recommend the use of the new method for all patients?

Doctor’s Tip

A helpful tip a doctor might tell a patient about coronary artery bypass surgery is to follow post-operative care instructions carefully, including taking prescribed medications, attending follow-up appointments, and making lifestyle changes such as quitting smoking, eating a healthy diet, and exercising regularly to improve long-term outcomes. It is also important to report any new symptoms or concerns to your healthcare provider promptly.

Suitable For

Patients who are recommended for coronary artery bypass surgery are typically those with severe coronary artery disease, which is a condition where the blood vessels that supply the heart muscle with oxygen become narrowed or blocked. This can lead to chest pain (angina), shortness of breath, or even a heart attack.

Specific criteria for recommending coronary artery bypass surgery include:

  1. Severe blockages in multiple coronary arteries that cannot be treated effectively with medications or less invasive procedures such as angioplasty or stenting.
  2. Patients with left main coronary artery disease, which is a blockage in a major artery that supplies a large portion of the heart muscle.
  3. Patients with decreased heart function, such as a low ejection fraction, which indicates a weakened heart muscle.
  4. Patients with diabetes, especially if they have multiple blockages in their coronary arteries.

Overall, coronary artery bypass surgery is recommended for patients who have a high risk of complications from their heart disease and who are likely to benefit from the procedure in terms of improving their quality of life and reducing the risk of future heart events.

Timeline

Overall timeline of the patient’s experience before and after coronary artery bypass surgery:

  1. Pre-surgery: Patient is diagnosed with heart disease and recommended for coronary artery bypass surgery. They undergo pre-operative testing and preparation.

  2. Day of surgery: Patient undergoes totally endoscopic coronary artery bypass surgery, which takes about 5 hours on average.

  3. Post-surgery: Patient may experience complications within the first 30 days, with about 6% of patients having complications. Some patients may require another procedure at some point during follow-up.

  4. Recovery: Patient undergoes post-operative care and rehabilitation to aid in recovery and healing.

  5. Long-term follow-up: Patient is monitored over the years to assess survival rates and any potential complications. Overall survival rates are good, with 95% survival after one year and 82% survival after ten years.

  6. Conclusion: Researchers suggest that totally endoscopic coronary artery bypass surgery may be a safe and effective option for certain patients, but more long-term studies are needed to confirm its benefits.

What to Ask Your Doctor

  1. What are the specific risks and potential complications associated with totally endoscopic coronary artery bypass surgery compared to traditional open surgery?
  2. How long does the recovery process typically take for this type of surgery?
  3. Will I need to make any lifestyle changes or follow a special diet after undergoing this surgery?
  4. How often will I need to follow up with you after the surgery, and what will those follow-up appointments entail?
  5. Are there any specific factors or conditions that would make me a better or worse candidate for totally endoscopic coronary artery bypass surgery compared to traditional open surgery?
  6. How experienced are you and your team in performing this type of surgery, and what is your success rate with it?
  7. What are the expected long-term outcomes and survival rates for patients who undergo totally endoscopic coronary artery bypass surgery?
  8. Are there any alternative treatment options available for my heart condition, and why do you recommend this specific type of surgery for me?
  9. How can I best prepare myself mentally and physically for this surgery, and are there any steps I can take to improve my chances of a successful outcome?
  10. Are there any additional resources or support groups available to help me navigate the process of undergoing totally endoscopic coronary artery bypass surgery?

Reference

Authors: Zoupas I, Manaki V, Tasoudis PT, Karela NR, Avgerinos DV, Mylonas KS. Journal: Innovations (Phila). 2024 Nov-Dec;19(6):616-625. doi: 10.1177/15569845241296530. Epub 2024 Nov 20. PMID: 39567250