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Coronary bypass is by far the most common type of heart surgery, according to the Society of Thoracic Surgeons. Among the 90 percent of United States facilities that report their data to the STS, nearly 170,000 bypass procedures were performed in 2014.
Unfortunately, most Americans find it easier to make an informed decision about cars and refrigerators than about cardiac surgeons. Most people are referred to a heart surgeon by their cardiologist or primary care physician, but may still wish to explore their options in selecting a surgeon for their procedure.
There are three key questions patients need to ask when considering a cardiac surgeon for a coronary artery bypass operation:
Will their heart be stopped during the procedure and their blood circulated through a cardiopulmonary (heart-lung) bypass machine or will it be performed “off pump”?
The heart-lung machine allows the heart to be stopped so the surgeon can operate on a heart that is blood-free and still. During off-pump cardiac surgery, the heart continues to beat normally. Only the surgical surface is immobilized while the rest of the heart keeps pumping and circulating blood to the body.
At The Valley Hospital, more than 75 percent of cardiac surgeries are performed off-pump. The off-pump procedure reduces the risk for blood transfusions and may help reduce the risk of stroke.
What are the chances the patient will need a blood transfusion?
In 2014, more than 80 percent of patients who underwent coronary bypass surgery at Valley had no transfusions at all. Minimizing the use of transfused blood reduces the risk for infection or inflammatory reactions that may be associated with transfusions.
Will the bypass be performed using veins or arteries?
Arterial grafts are superior to venous grafts because they reduce the risk of a repeat operation and result in better outcomes. Specifically, the use of the internal mammary artery is considered a quality indicator for coronary bypass surgery. At Valley, we use both single and bilateral internal mammary arteries for bypass procedures more frequently than the national average.
The bottom line: Patients should seek out an experienced cardiac surgeon and make sure that his or her results are good. The Valley Hospital has been recognized by The Society of Thoracic Surgeons, who has given us its highest rating — 3 stars — for aortic valve surgery, coronary bypass, and a combination of both procedures. Only 1.8 percent of hospitals nationally have achieved these combined awards.
We are also proud to have been selected by the Cleveland Clinic — the No. 1 cardiac center in the country — to be a member of the Cleveland Clinic Cardiovascular Specialty Network. When seeking a cardiac surgeon, patients should also make sure that the entire program has high ratings and rankings.
By Alex Zapolanski, M.D., Director of Cardiac Surgery at The Valley Hospital in Ridgewood, N.J.
The flaws in this article:
1. While Projecting the arterial rconduits as the best hallmark of surgeons, we should never fail to give the information that at times even when surgeon likes to harvest, the underlying anatomy or disease condition may not allow to place the mammary graft. This should not mean a surgeon of low credits.
At the same time we need to inform that a sizeable number of venous grafts too can stay patent for 20 years.
2. While informing that off pump CABG is superior to on pump CABG, we should also inform that there are well proven scientific studies claiming superiority of off pump over on pump CABG as the anastomotic line remains perfect in on pump as it eliminates the micro movements in the operating area due to the beating heart.