Heart Bypass Without Sawing Open the Chest

Every year 20,000 people have a heart bypass because they have blocked arteries. Traditionally, the surgery involves sawing through the breastbone. FARAMARZ ZARE, 45, a computer engineer from Welling, Kent, was one of the first to undergo a new, much less invasive procedure. Here he talks to CAROL DAVIS…

THE PATIENT

He says… Last spring, I started to get cramping pains all over my chest. I’d only get them every week or so, but they were quite strong and often left me struggling for breath.

After a couple of months of this, I went to my GP. He said he thought I had a heart problem so referred me for hospital tests. To be honest, I wasn’t too surprised, because heart disease runs in my family and my mother had heart bypass surgery.

But doctors couldn’t find anything wrong with me. Sometimes the pains disappeared for a few weeks, then they’d come back for up to an hour. Then in March, I was visiting my sister when I had an attack so bad I collapsed. I could barely breathe – it was terrifying.

My sister rushed me to hospital, and this time scans showed that one of my major arteries, and two smaller ones, had narrowed dangerously.

The doctors said my problem was my diet. I’d always eaten pretty much what I wanted, and the red meat and fatty food had furred up my arteries with cholesterol. The blood couldn’t get through to my heart, which was why I’d been in such terrible pain and so breathless.

The scary thing was I could have a heart attack at any time. I couldn’t believe it – all those tests I’d had the year before said everything had been fine. But I was told the problem can sometimes get really bad, even in the space of a few months.

I spent two nights in hospital on medication to widen my arteries. After that I needed to have a stent – a metal tube – fitted into my arteries to keep them open, but there was a two-month waiting list for the operation. I prayed I’d make it.

weeks before the operation, I got some bad news. A new scan showed my main artery was now so narrow they’d never get a stent in. My only hope was open-heart surgery to create a bypass around that artery.

I felt sick when the doctor said this involved sawing through the breastbone and a six-month recovery period. Not only would I not be able to work or drive, there was a risk that the surgery might cause a stroke.

My wife Parisa was very upset, and I was angry at myself for not looking after my body.

My appointment with the surgeon was scheduled for June. In the meantime, I scoured the internet for an alternative.

I came across a new bypass procedure which sounded hopeful. Rather than sawing you open, surgeons were using a special surgical camera inserted through a much smaller incision. It seemed to mean much less scarring and just a few weeks’ recovery time.

When I saw my surgeon, Mr Deshpande in June, I asked him who could do this procedure. To my astonishment, he said he was just starting to do it and that I was suitable. I was thrilled.

I had the operation at the end of July. When I woke up, there was just a small dressing on my chest and I was on painkillers.

I went home four days later with instructions to rest. For the first month I didn’t even have the energy to play with my two-year old son Arvin.

Six weeks after the operation, I had a stent put in to keep the other smaller narrowed arteries open, too. A week after that, I started working part-time again – I felt so much better.

While I’m not back at the gym yet, I dread to think how much worse I’d have been with full open-heart surgery.

I’m so grateful to Mr Deshpande and his team for saving my life. I’ve been given a second chance to enjoy time with my family and I’m determined to look after my health.

THE SURGEON

MR RANJIT DESHPANDE is consultant cardiothoracic surgeon at King’s College Hospital NHS Foundation Trust. EVERY year, around 94,000 Britons die from a heart attack caused by blocked arteries.

He says… Clumps of calcium and cholesterol build up in the arteries until, over time, they become so narrow they can no longer take oxygenated blood to the heart muscle to keep it beating. When this happens, the patient has a heart attack.

The most common risk factors for heart disease are old age, smoking, diabetes, high blood pressure and being overweight, as well as high cholesterol and family history.

If oxygenated blood can’t reach the heart muscle, it can cause chest pain which can spread to the arms and jaw. This is known as angina and is a common early warning sign that there is a problem with the heart. Losing weight and doing more exercise to keep the heart healthy can help tackle angina. We can also prescribe drugs to lower cholesterol.

Where the arteries are very narrowed and the patient is likely to have a heart attack, we insert a stent to keep the narrowed section open.

Where the blockage is severe, we can bypass the blocked artery altogether using a blood vessel taken from the arm, leg or behind the breastbone. It’s rather like having a motorway jam around junction 28 – you simply create a new ‘road’ to take traffic round it, straight from junction 27 to 29, and leave 28 in place.

While heart bypass surgery is very effective, it’s also a major operation. It means cutting through the breastbone, so there’s a lot of pain afterwards.

The recovery period is up to six months and some patients, such as the elderly and those with osteoporosis, liver or kidney problems, aren’t fit enough for it.

But a new technique means that instead of cutting through the breastbone, we can operate using a special surgical camera. Because we can see where we’re going on a big screen, we don’t need to completely open up the patient.

We work through the space between the ribs, using high definition imaging technology and advanced surgical instruments, so the patient recovers much faster and with less risk of infection.

The procedure is suitable for most heart bypass patients, including older people who are not fit enough for open-heart surgery. Most need only stay in hospital for up to four days, and recover in two to three weeks. It really is a brilliant innovation.

The operation takes around two hours – a similar time to traditional surgery. First, we deflate the left lung so there’s room to pass in the camera in a tube. I then make a 5mm incision beside the left nipple and put in the camera.

For the bypass itself, we use the artery which usually brings blood from the heart to the breastbone. I detach it at one end and pull this loose end to just below the blockage.

I then make a small incision in the main artery and simply stitch the two arteries together – the blood will now be rerouted. Then we take all the instruments out and re-inflate the lung, closing the incisions with soluble stitches, and send the patient off to recovery.

This is a fantastic operation which could help a lot of people. I wish Faramarz many good years.

The operation costs around £20,000 privately, and is a similar cost to the NHS. For more information, call 0300 330 3311; http://www.bhf.org.uk

*****

[http://www.dailymail.co.uk/health/article-1219963/At-heart-bypass-DONT-saw-chest-open.html]

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