Coronary Artery Bypass Surgery in Germany

What is coronary artery bypass surgery? Why coronary bypass surgery is done? Who needs heart bypass surgery, and what are the indications? How is coronary artery bypass surgery performed in Germany? These are the questions we will address in our article.

Coronary artery bypass grafting (CABG), also known as coronary artery bypass surgery, is performed when the coronary arteries of the heart become narrowed or blocked. This major heart surgery improves blood flow to the heart muscle and prevents the development of coronary heart disease (CHD).

During heart bypass surgery, a section of healthy blood vessel is taken from another part of the body (such as the chest or leg) and used to bypass the affected artery, thereby restoring blood flow to the heart.

CABG is recommended when other methods of treating coronary artery disease, such as drug therapy, balloon dilatation or stenting, are ineffective.

What is coronary artery disease?

Coronary artery disease is the most common cardiovascular disease and the leading cause of sudden death worldwide.

It is caused by an insufficient blood supply to the heart muscle through the coronary arteries. Lipid metabolism disorders in the body lead to cholesterol deposits forming atherosclerotic plaques on the walls of blood vessels. Over time, these deposits can cause atherosclerosis, which is the narrowing or stenosis of the coronary arteries. This is when ischaemic heart disease occurs.

According to the International Classification of Diseases (ICD-10), ischaemic heart disease is coded as I25.

Symptoms of coronary artery disease

The symptoms of coronary artery disease do not appear immediately, but may arise unexpectedly as a result of stress or physical exertion. Typical symptoms include:

Burning and pressing pain in the heart area.
Feelings of anxiety and fear.
Increased sweating.

Ischemic disease, which involves significant narrowing of the coronary arteries, can lead to myocardial infarction and sudden cardiac arrest.

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Surgical methods of treating coronary artery disease

These methods aim to increase blood flow to the heart, thereby supplying it with oxygen and nutrients. To achieve this, modern medicine offers two methods:

Percutaneous coronary angioplasty and stenting of the coronary arteries, which is performed directly at the site of the vessel narrowing.
CABG surgery, which involves creating a bypass for the affected arteries.

Percutaneous transluminal coronary angioplasty

Percutaneous transluminal coronary angioplasty has become the standard treatment for coronary artery atherosclerosis in Germany. This minimally invasive procedure is also known as balloon angioplasty. During the procedure, a balloon catheter is inserted through the femoral artery to the site of the narrowing. At the site of the narrowing, the balloon is filled with fluid and inflated, thereby widening the blocked vessel.

Usually, a thin, flexible tube made of metal or plastic mesh, called a coronary stent, is placed in the vessel at the same time. This is done to keep the vessel open for a long time. The stent is coated with a drug that prevents unwanted new deposits and blockages from forming in the stent.

If the coronary arteries are so damaged that it is impossible to restore normal blood flow to the heart using other methods, aortocoronary bypass surgery is performed.

Coronary artery bypass graft surgery (CABG)

This procedure is performed if the coronary arteries are so severely affected that it is impossible to restore normal blood circulation to the heart using other methods.

During this procedure, the patient's own artery is used to create a bypass around the affected area. Most often, the thoracic arteries are used for this purpose. These arteries are a good fit in terms of size, and the body can manage without them as blood continues to supply the chest through other arteries. In order to perform the bypass, the heart is temporarily stopped using a cardioplegic solution and a heart-lung machine takes over blood circulation. The other end of the bypass is then sutured to the aorta. From this point onwards, blood flows through the 'bridge' and circulation is restored.

An alternative method is off-pump coronary artery bypass (OPCAB) surgery, which does not use a heart-lung machine. In this method, stabilisers are used to immobilise the heart relatively, and vascular bridges are placed while the heart is still beating. This type of surgery has several advantages: there is no damage to blood cells and no risk of cerebral embolism or pulmonary oedema. Recovery after surgery is also faster.

Both operations require exceptional skills from not only the cardiac surgeon and anaesthetist, but also the entire team. Coronary artery bypass grafting is only recommended in specialised centres where such surgical procedures are performed frequently and on a regular basis.

Who needs heart bypass surgery?

The indications for coronary artery bypass grafting are determined by the degree to which the coronary arteries are narrowed. According to the recommendations of the German Society of Cardiology, heart bypass surgery is performed in cases of:

Narrowing of the main trunk of the left coronary artery by more than 50%.
Stenosis of all three coronary arteries by more than 70%.
Extensive vascular damage.
Coronary artery aneurysm or coronary fistula.

CABG is also indicated in cases where symptoms persist despite optimal drug therapy or angioplasty, especially if the patient has diabetes mellitus. The same applies to cases where it is impossible to access the affected areas of the vessels with a catheter in order to insert a stent.

Top 10 cardiac surgery centres in Germany.
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The best cardiac surgery clinics in Germany

Heart surgery is performed in certified cardiac surgery centres. The following expert cardiac surgery centres are included in the TOP 10 ranking of the best cardiology clinics in Germany:

The Centre for Cardiology, Angiology and Cardiovascular Medicine at Charité University Hospital. Professor Ulf Landmesser is the head of the clinic.
The Clinic for Cardiovascular Surgery at the University Hospital Düsseldorf. The director of the clinic is Professor Artur Lichtenberg.
Helios Cardiology Center Leipzig. Chief physician is Professor Sergey Leontyev.
The Clinic for Vascular and Endovascular Surgery at Heidelberg University Hospital is directed by Professor Diettmar Böckler.