Coronary artery disease: surgical solutions

Coronary artery disease (CAD) is the most common type of heart disease and can be potentially lethal. It can cause a number of symptoms, such as chest pain (angina), shortness of breath, and even heart attacks. However, there are options for treatment. Leading heart surgeon and CAD expert Professor Olaf Wendler explains the surgical options to combat this condition and potentially save your heart.

What is coronary artery disease?

Coronary artery disease is where the arteries that supply blood to the heart muscle become narrowed and hardened due to atherosclerosis – a build-up of cholesterol and plaque on the inner walls of these blood vessels. Atherosclerosis develops over time and means that less blood can pass through these arteries, thus depriving the heart muscle of sufficient oxygen.

Coronary artery disease is one of the most devastating heart conditions in the Western World and leads to heart attacks (myocardial infarctions), which destroy heart muscle. Over time, this puts the patient at risk of dying from heart rhythm problems or heart failure. In addition, patients are affected by chronic chest pain and very often shortness of breath on exertion.

Modern treatment of coronary artery disease – complete arterial coronary bypass grafting

While stenting of the coronary arteries is established as an interventional treatment of coronary artery disease, coronary bypass grafting (CABG) is the treatment of choice for patients with severe disease affecting the left main stem or multiple heart arteries.

Originally, operations on the heart were done using one artery from the chest wall and venous blood vessels from the legs. However, it has been known for a long time that venous blood vessels degenerate (calcify and occlude) much faster over time and therefore, many patients suffer from repeat symptoms soon after CABG surgery.

The solution to coronary artery disease?

Complete arterial revascularisation is a technique which was introduced more than 20 years ago by myself and others, in which only arteries from the chest wall and the forearms are used to bypass the diseased blood vessels on the heart. While it does not pose any higher risk in terms of surgery, recent research has shown that it improves outcomes of patients in terms of freedom from chest pain, shortness of breath, heart attacks and freedom from bypass failure, as the arterial blood vessels do not calcify as easily as veins.

In my practice I offer complete arterial revascularisation to all patients 70 years and younger, as they should benefit from the improved long-term outcomes, approximately 10 years after surgery.