Mini by-pass operation is a method of performing all the same procedures as in an open by-pass operation, but with smaller surgical incisions and less traumatic to the patient.

What should be done in vascular occlusion?

Cardiovascular occlusion is a condition that becomes apparent after coronary angiography. If there is a blockage in the vessels after coronary angiography and this blockage is above a certain degree, the vessels must be opened. Otherwise, a heart attack is inevitable. If it is not possible to open the vessels with angiography, by-pass operation is recommended to the patient. In by-pass operation, the blocked vessel is opened by inflating the blocked vessel with the help of a balloon and then placing a stent. In the by-pass procedure, the blocked section is bridged by sewing a new vessel beyond the blocked vessel. The advantage of the by-pass procedure is that in the long term, precautions are taken against stenoses that may occur elsewhere in the vessel. For this reason, especially in people with multivessel disease, the vessel is intervened in a different way from the angioplasty procedure.

In angioplasty, the blocked vessel is inflated with a balloon and then a stent is inserted. In the by-pass procedure, the blocked section is bridged by suturing a new vessel beyond the blocked vessel. The advantage of the by-pass procedure is that in the long term, precautions are taken against stenoses that may occur elsewhere in the vessel. For this reason, especially in people with multivessel disease, the vessel is intervened differently from the angioplasty procedure. Aortic By-pass Grafts Coronary Artery By-pass surgery is the gold standard treatment method. Many of the reasons why patients avoid by-pass surgery are not the surgery itself, but the burden of the surgical procedure on the patient. The main reasons are large surgical incisions, especially opening of the sternum and bone-related complications.

Classical By-pass Operation

In the classical by-pass operation, especially if all 3 vascular systems supplying the heart are to be intervened, the vein in the leg is first prepared (saphenous vein). In order to prepare this vein, a long surgical incision is made between the ankle and groin junction, depending on the length of the vein to be used, and the vein is removed with the classical method.

The artery in the chest wall is prepared through the thoracic cavity and the necessary preparations for bypass are made. The heart is then accessed, the heart is stopped by entering the cardiovascular device and the prepared vessels are sutured beyond the blocked part of the vessel.

The sternum is then accessed through a 25-30 cm long incision in the midline of the chest. The sternum is separated and the thoracic cavity is accessed.

What is the Difference of Mini Bypass?

In a mini bypass surgery, the leg vein is prepared without making a long surgical incision in the leg. A 1 cm incision is made at the knee level, and with the help of a camera, the entire vein between the ankle and groin can be prepared. Then, a 6 cm incision is made below the left breast, and access is gained to the left chest cavity. From there, the artery in the chest wall is prepared. Afterward, the heart is accessed, and the heart-lung machine is used to stop the heart, just like in a traditional bypass surgery. New vessels are sewn in place beyond the blocked arteries, using a technique similar to an open surgery. Once the anastomoses (stitches) are completed, the heart-lung machine is turned off, and the operation is completed through the same incision.

What are the Advantages of Mini Bypass Surgery?

The surgical risks for the patient in mini bypass surgery are no different from those in open surgery, as the same procedure is performed in both types of surgery. However, the recovery process after the surgery is significantly faster. In particular, the duration of intensive care and the time needed to be weaned off the ventilator are shorter. Patients are typically removed from the ventilator within 4 to 6 hours and are transferred from the intensive care unit to the general ward within 12 to 24 hours. Once in the general ward, patients can walk comfortably since there are no incisions in their legs. They do not experience any pain or problems related to the sternum during respiratory physiotherapy, lung exercises, deep breathing, or coughing. Respiratory therapy is much faster and more effective.

There are no restrictions regarding turning to the right or left side, walking, or using their arms after surgery. This leads to a quicker recovery period. These patients are usually discharged after 4 days in the hospital. They can start walking outside immediately after discharge. Patients are especially encouraged to increase their walking distance and pace. About 4 days later, when they come for a follow-up appointment and no problems are observed, they can return to work. There are no restrictions on driving or lifting weights after discharge from this surgery.

Why Mini Bypass?

Today, patients with coronary artery disease, especially younger individuals, often avoid surgery due to the desire to maintain their daily routines, avoid the burdens associated with surgery, and the long recovery period. Although it may not always be suitable, some patients may push for stent placement using somewhat forceful methods, possibly even convincing their cardiologists. Mini bypass surgery, in this regard, serves as a serious alternative for patients with multiple vessel disease. It offers all the advantages of bypass surgery while sparing the patient from the burdens associated with traditional bypass surgery.

Additionally, it prevents the need for repeated interventions, such as angiograms, due to the recurrent blockage of stents over time. This surgery particularly benefits patients with diabetes, those who are severely obese, and individuals with chronic obstructive pulmonary disease (COPD). Early return to work provides a psychological advantage for patients.

The absence of opening the sternum provides not only cosmetic benefits but also avoids potential psychological trauma. The opening of the sternum in traditional surgeries can lead to psychological distress, with patients feeling unwell even years after the procedure. However, with mini bypass surgery, since the sternum is not opened, patients experience not only a cosmetic advantage in the early stages of recovery but also a long-term improvement in their psychological well-being and quality of social life.