This heart surgery consists of removing part of the saphenous vein, which is in the leg, to reconnect heart arteries obstructed by fatty plaques. With the new connection, called a bridge by doctors, it is possible to normalize blood circulation in the area and avoid a fatal heart attack. The development of this surgery can be considered a multinational achievement: it was performed for the first time in the United States (in 1967), by an Argentine physician (Renné Favaloro). Since then, the saphenous vein bypass has undergone several improvements. Before it was common, for example, that during the operation the patient’s blood pumping was done by a machine outside the body, as the heart stopped beating completely. Today, there are several techniques that only reduce the heartbeat, making the surgery less invasive and risky.
People typically find out that they need to have a heart bypass in one of two ways: when they show physical symptoms of heart problems (such as chest pain) or after undergoing routine tests that can indicate obstructions. If lesions in the arteries are identified, saphenous vein bypass is not the only treatment option. In some cases, it is possible to reverse the situation with just the use of medication. Another way less traumatic than surgery is angioplasty, in which a long and very thin tube is introduced into the person’s body – from the arm, for example.
He is then directed to the artery and clears it. “Angioplasty is more recommended if the obstruction is in an easily accessible location. If this is not the case or the patient has lesions in several arteries, surgery is more indicated”, says cardiologist Luís Alberto Oliveira Dallan, from the Heart Institute (Incor), in São Paulo. A heart bypass operation takes three to five hours and up to five reconnections can be done at once.
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The oxygenated blood that comes from the lungs needs to be distributed by the heart through arteries that are called coronary. These arteries can accumulate fatty plaques that obstruct the passage of blood. As circulation in the region is difficult, the patient begins to experience chest pain (angina). When 70% or more of the coronary is obstructed, bypass surgery is recommended. If not done, the patient could have a fatal heart attack.
2. Vital shortcut
To prevent the heart from running out of the necessary oxygenation, it is necessary to find a new way for the circulation to return to normal. A piece of a leg vein called the saphenous vein is extracted and grafted into the heart. A bridge, that is, a new connection, is made between the aorta (the main artery of the body) and a region of the coronary artery that is after the part obstructed by the fatty plaques. The blood then begins to use the new path and oxygenation of the heart is guaranteed.
For patients aged up to 60 years, instead of a saphenous vein bypass, surgery can be performed using one of the two mammary arteries, which are located in the chest. In this operation, the route of a mammary gland is diverted to reach the heart, serving as an alternative path to the obstructed coronary artery.
2. Arm wrestling
Bridges made with the radial artery, removed from the arm, began to be used in Brazil in 1993. The problem is that this artery can show spasms that reduce blood flow. To avoid involuntary contractions, the patient uses medication
3. Strong stomach
Another option is the use of the gastroepiploic artery, which is below the stomach. In a delicate surgery, it is taken to the blocked artery in the heart, passing through a small hole opened in the diaphragm, the muscle that separates the chest from the abdomen.
4. Well of the legs
In each leg, we have two saphenous veins that run through the entire limb. The one most used in cardiac surgery is the great saphenous vein, on the front of the leg, which is easy to extract.
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