New bypass technique - a breakthrough in heart surgery
Coronary artery stenosis and angina has become one of our most common diseases, due to changes in lifestyle and life expectancy. The prognosis is relatively good, thanks to modern surgical procedures. A new surgical technique for bypass surgery has been developed at Örebro University Hospital, resulting in even better long-term results.
No touch technique
Thorax surgeon Domingos Souza began to question the conventional surgical bypass technique after many years at the operating table. He noticed that vessels moved from the leg to the heart contracted significantly when the surrounding tissue was removed. Leaving the surrounding tissue attached to the vessel — the “no touch” technique — led to many advantages compared to the older technique.
Veins from the leg are used for almost all coronary surgery interventions aimed at bypassing obstructions in the coronary arteries, says Domingos Souza. Previously, almost all tissue surrounding the vessels was removed. The harsh handling led to spastic contractions, which were reversed by passing saline solution through the vessel under high pressure. However, it has now been shown that this process damages the vessel.
One well-known problem after bypass surgery has always been the short functional duration of the new vessels. Maltreatment of the vein lessens the chance of long-term success in its new position. The vein often obstructs after a few years, and further surgical procedures become necessary. Around 30–50% of all patients need a new operation after 10 years.
The tissue protects the vein
The surrounding tissue protects the vessel not only against spasms, but also against damage from surgical instruments. It is therefore important to treat the vessel as carefully as possible and to let the surrounding tissue move along with the vessel to the new location on the heart.
This gentle treatment of the vessel means that we keep the surrounding tissue, the vessel does not go into spasm, and there is need to inject saline. The quality of the vessel improves; the wall remains intact, which prevents calcification and new early obstructions.
Long-term follow-up shows good results
This procedure is a major step forward in coronary surgery, and the long-term follow-up results are much better than expected.
We already have a clinical follow-up with coronary angiography 9 years after the operation, and we are currently carrying out a 15-year clinical follow-up. Preliminary data show significantly lower mortality in patients treated with the "no touch" technique. Results such as these have not been possible to achieve with any other method. More than 90% of patients have well-functioning vessels, compared to slightly more than 50% of patients treated with conventional technique.
The studies have been very important for further research, and the new technique is used routinely at Örebro University Hospital.
-The improved results are important both for patients and for society. If the vessels function longer, we can delay the destructive process of calcification and thrombosis. The patient can avoid further stressful operations, and society gains economically.
