Giving heart bypass a miss

LAST week was backbreaking but most rewarding as I worked with a team of experts over a two-day period to treat six patients with extremely complex heart artery disease who had refused open heart artery bypass graft surgery. Patience and persistence paid off as we managed to successfully open up the blocked heart arteries for all of them. All of the patients had symptoms related to blockage of their heart arteries and long standing total occlusion (also called chronic total occlusion or CTO) of the main heart artery (also called left anterior descending artery or LAD) to the main pumping chamber of the heart. Ten years ago, it would have been difficult to open their heart arteries which were 100 per cent blocked with minimally invasive techniques and five years ago, the success rate for treating CTO would not have been high. However, the rapid development of better devices and equipment to help doctors assess and treat heart artery disease, and increasing experience in treating complex CTO heart arteries have resulted in high success rates. Highly experienced heart specialists are able to achieve a success rate of close to 90 per cent during the first attempt at opening a CTO and this is achieved with a low complication rate.

Percutaneous coronary intervention

Opening a CTO is the most challenging procedure for heart specialists. The procedure is performed via a small puncture in the groin or wrist artery under local anaesthesia. Special plastic tubings are inserted through these minute millimetre openings and manipulated to reach the opening of the heart arteries. Iodine based contrast media is injected into the opening of heart arteries to visualise the moving heart artery under X-ray imaging. Using very specialised equipment and very special techniques, the completely blocked arteries are crossed with specialised minute wires and opened with balloon tubings and finally dilated with cylindrical meshes (stents) which may or may not be metallic. The procedure is called percutaneous coronary intervention or PCI. An important reason why patients are often referred to open heart bypass surgery is because the presence of CTO in one of their main heart arteries deters many heart specialists from performing PCI as the procedure can be very difficult with uncertainty of success.