2022 Southern Medical Research Conference

coronary artery bypass :: Article Creator

UAE: 65-year-old With Multiple Ailments Undergoes Complex Surgery, Gets Discharged In A Week

A 65-year-old male, who had been living with Type 2 Diabetes Mellitus for many years, experienced alarming symptoms, including reduced urine output and breathlessness. He was taken to the emergency department at the RAK Hospital in Ras Al Khaimah, and diagnostic tests revealed that he had suffered a heart attack – further complicated by the adverse effects of long-term diabetes on his kidneys.

Given the extent of his heart disease, traditional methods like stenting were not feasible, and the patient required coronary artery bypass surgery. However, his compromised heart function and renal impairment posed additional challenges for the surgical team.

The doctors at the hospital performed a coronary artery bypass surgery (CABG) on the high-risk patient without the use of a cardiopulmonary bypass machine. The innovative approach, conducted while the patient's heart was still beating, proved to be a game-changer for individuals with complex medical conditions, such as severe heart and kidney damage.

"The patient had both heart and kidney damage due to diabetes. His condition was initially deemed unfit for angiography, requiring multiple cycles of dialysis to improve his overall health before the procedure could be performed," said Dr Adil Rizvi, Chief Cardiac Surgeon and Joint Medical Director at RAK Hospital.

Conventionally, CABG surgery involves stopping the heart and using a cardiopulmonary bypass machine to maintain blood circulation. However, this method requires a significant amount of fluid to prime the machine, leading to potential complications and inflammation.

"Given the circumstances, the surgical team made the decision to conduct the surgery while the heart was still beating, a challenging task that demands specialised equipment and extensive experience to stabilise specific areas of the heart during the operation," said Dr Rizvi.

In a remarkable departure from conventional practice, the cardiac surgeons at the hospital opted for a beating-heart surgery approach. This technique, which requires specialised equipment and extensive expertise, allows surgeons to operate on the heart while it is still functioning. By avoiding the use of a bypass machine, the risks associated with fluid overload and inflammation were significantly reduced, particularly for patients with pre-existing kidney conditions.

The patient experienced a smooth recovery and was discharged within a week, with instructions to prioritise self-care and better management of his health.

Dr Rizvi emphasised the importance of recognising atypical symptoms of a heart attack, particularly in diabetic patients. "Symptoms such as excessive sweating, vomiting, arm or jaw pain, and a feeling of unease could indicate a heart attack, even without the presence of chest pain. Diabetic individuals should be vigilant and not ignore any of these warning signs."

Dr. Raza Siddiqui, Executive Director, RAK Hospital said: "The successful outcome of this surgery reaffirms our commitment to delivering advanced and patient-centric care. By adopting innovative techniques and leveraging our experience, we can provide viable treatment options for individuals who may not have been suitable candidates for traditional procedures", added Dr Siddiqui.

Cardiologists Look To The Past To Create New Heart Bypass Procedure

Henry Ford Health Interventional cardiologists William O'Neill, M.D., and Khaldoon Alaswad, M.D., took a page out of the medical history books by performing a new coronary bypass procedure replicated from one not used in decades to treat a patient living with crippling angina―a severe symptom of coronary artery disease.

Retired painting contractor Fred Casciano, 60, from Traverse City, became the first patient anywhere to receive the life-changing transcatheter procedure on April 12 at Henry Ford Hospital in Detroit. The procedure was re-engineered from an operation first developed in the 1950s.

"This new procedure we specifically engineered for Fred has never been done before but it replicates a bypass operation performed in the 1950s," said Dr. O'Neill, director of the Henry Ford Center for Structural Heart Disease. "It opens the door for non-surgical treatment of thousands of patients who cannot have stents or open-heart revascularization procedures." Each year, hundreds of thousands of patients are treated in the U.S. With coronary bypass surgery―open heart―or stent therapy through a cath lab procedure.

"Coronary revascularization has been a mainstay of therapy for coronary artery disease since the 1960's," said Dr. O'Neill.

Despite these available procedures, many patients are not able to receive the treatments because their coronary arteries are too small or too diseased to achieve effective bypass or stent procedures, he explained.

This medical challenge has led Henry Ford Health investigators to look back at the original operation developed decades ago. The original method required two operations and involved placing a bypass into the main vein in the heart known as the coronary sinus. The advantage of the operation was that the bypass was directed to the large disease-free vein. However, the original method also required two operations about a month apart. This risky method was later replaced by a safer coronary artery bypass procedure also known as coronary artery bypass graft (CABG) that became more common in the 1970s.

With this new procedure, Henry Ford Health cardiologists are optimistic about the possibility of positively impacting even more patients.

In Casciano's case, Drs. O'Neill and Alaswad attempted to re-create the original operation without using the open-heart method. A channel between Casciano's circumflex artery and his coronary sinus was successfully created during the cath lab procedure, and the channel is functioning well. Dr. O'Neill added that more testing will be done to assess how well the bypass is working.

"I trust Dr. O'Neill and Dr. Alaswad and their team with my life," Casciano said just one day after the three-hour procedure. Before the Henry Ford cardiologists presented this as an option, Casciano had been told he out of traditional medical solutions and had just one working coronary artery left. "And that's when Dr. O'Neill said, 'We're going to bring the blood in the back door because the front door is closed.'"

Following the successful bypass procedure and a one-day inpatient stay, Casciano returned home with his wife Annette to Northern Michigan, where he has been recovering and getting back to his busy daily routine.

"I don't stop. I just keep going. I can't sit still," said Casciano, who'd initially traveled to Detroit in January to see Dr. O'Neill for any available possible treatments to fix his recurring blockages. Casciano has been under the watchful eye of Dr. O'Neill for years.

This wasn't the first time Casciano received revolutionary treatment. In 2019, Casciano was one of only two patients in the U.S. To receive a coronary sinus reducer implant as part of a Food & Drug Administration (FDA) approved clinical trial led by Dr. O'Neill. A reduced blood flow in his heart had created the angina condition.

"My arteries couldn't feed blood to the heart as fast as it was draining the blood through the veins, so they put a drainer restrictor in me," recalled Casciano.

About two months after receiving the coronary sinus reducer, Casciano felt well enough to try a new bike trail that had opened up from Traverse City to Suttons Bay in northern Michigan. Thanks to the implant, he made the 35-mile roundtrip ride with no problems.

However, when his condition worsened last year, he once again reached out to Dr. O'Neill for answers.

Casciano's coronary arteries previously treated with angioplasty and a stent had narrowed again. The condition known as in-stent restenosis is a blockage or narrowing that comes back in the portion of the coronary artery previously treated with a stent, where scar tissue forms inside the stent.

"Dr. O'Neill told us that we're going to make an attempt to try something else and within a couple of weeks he had a plan," said Casciano's wife, Annette.

During the re-engineered procedure, Drs. Alaswad and O'Neill created a channel from the coronary artery to a vein to bypass the recurring and almost complete blockage that has continued to plague Casciano for much of his adult life. Casciano first experienced heart attacks at the age of 38 while working and was treated with angioplasty and a stent. At 41, he was diagnosed with 98% blockage of all major coronary arteries and underwent quintuple bypass surgery.

Unfortunately, a couple of months later, the blockage was back—and has continued to pose problems.

"It's an exciting breakthrough that we hope will allow us to treat many more patients with this condition in the future," said Dr. Alaswad, medical director of the Cardiac Catheterization Laboratory at Henry Ford Hospital in Detroit.

Provided by Henry Ford Health

Citation: Cardiologists look to the past to create new heart bypass procedure (2023, May 15) retrieved 30 May 2023 from https://medicalxpress.Com/news/2023-05-cardiologists-heart-bypass-procedure.Html

This document is subject to copyright. Apart from any fair dealing for the purpose of private study or research, no part may be reproduced without the written permission. The content is provided for information purposes only.

Henry Ford Health Cardiologists Perform New Coronary Bypass Procedure That Replicates An Old Operation

This new procedure we specifically engineered for Fred has never been done before but it replicates a bypass operation performed in the 1950s. It opens the door for non-surgical treatment of thousands of patients who cannot have stents or open-heart revascularization procedures." Each year, hundreds of thousands of patients are treated in the U.S. With coronary bypass surgery - open heart - or stent therapy through a cath lab procedure.

Dr. William O'Neill, Director of the Henry Ford Center for Structural Heart Disease

"Coronary revascularization has been a mainstay of therapy for coronary artery disease since the 1960's," said Dr. O'Neill.

With this new procedure, Henry Ford Health cardiologists are optimistic about the possibility of positively impacting even more patients.

"My arteries couldn't feed blood to the heart as fast as it was draining the blood through the veins, so they put a drainer restrictor in me," recalled Casciano.

However, when his condition worsened last year, he once again reached out to Dr. O'Neill for answers.

"Dr. O'Neill told us that we're going to make an attempt to try something else and within a couple of weeks he had a plan," said Casciano's wife, Annette.

Unfortunately, a couple of months later, the blockage was back-;and has continued to pose problems.

Peripheral Arterial Insufficiency