Coronary artery disease: bypassing to beat CAD

Coronary artery disease (CAD) is on the rise. Plaque builds up in the arteries entering the heart, narrowing them, and decreasing blood flow. Chronic angina (chest pain) is a frequent symptom of severe SAD, but more worrying are the risks of heart failure and heart attacks. Expert heart surgeon Professor Olaf Wendler specialises in treating CAD, and helped to pioneer arterial coronary artery bypass grafting (CABG) – a surgical technique to treat this condition.

Coronary artery disease, also known as coronary heart disease or ischemic heart disease, can be brought on by lifestyle factors, such as smoking and high levels of cholesterol in the diet, and can also be affected by conditions like diabetes and hypertension. Severe CAD can lead to chronic chest pain and potentially fatal heart attacks.

One of the ways to treat the condition is coronary artery bypass grafting (CABG). CABG is particularly useful for certain patients, e.g. those with complex disease and diabetes.

CABG aims to bypass the areas blocked with plaque by taking blood vessels from another body part and grafting it to the coronary artery above and below the blockage. This improves blood flow and oxygen to the heart.

CABG has long been the gold-standard surgical technique to treat patients with CAD. In its early years, it was performed with venous (low-pressure) blood vessels from the legs of patients. However, it was found that these can also become blocked in time, as they are unused to the high pressure they have to endure following the operation. Later, surgeons began to use arteries (which are used to dealing with high pressure), such as the internal thoracic artery (ITA), also known as the ‘mammary’ artery, and the radial artery (RA), and long-term success of the procedure improved.

Complete arterial CABG is the most advanced type of heart bypass surgery. Developed by myself and others, it is the culmination of the various CABG techniques that have been tried over the years. By only using arteries such as the ITA and RA during the bypass operation, we can avoid the negative side effects suffered by venous blood vessels.

As the operation is more complex, it often takes longer to complete, as most surgeons would harvest multiple arteries during one operation, which can increase the trauma for the patient. However, some surgeons, including myself, have further developed the arterial revascularisation technique. As a result, it is nowadays feasible to perform complete arterial CABG using only two arteries – most of the time the left ITA in combination with the RA from the non-dominant forearm.

Complete arterial CABG performed by an experienced and skilled surgeon is the best option for patients under the age of 70, and should be offered to patients who need coronary bypass surgery.