Is the Sternum Cut in Closed Bypass Surgery?
In closed bypass surgery, there is no need to cut the breastbone (sternum). Surgeries where the breastbone is cut are called open coronary bypass surgeries. In open coronary bypass surgeries, the breastbone is cut to access the heart.
There are two methods of performing the surgery. The first method involves stopping the heart and transferring the lung functions to a machine, while the second method is performed with the heart still functioning. In open coronary bypass, the surgery typically lasts between 3-6 hours. However, in closed bypass surgeries, the breastbone is not cut, and all bypass procedures are performed through the space between the ribs under the left breast.
With the advancements in today’s technology, large incisions and cutting the breastbone are no longer necessary in closed bypass surgeries. The surgery is performed through small incisions of about 6-8 cm made under or above the left breast. The surgery can be performed either on a beating heart or with the heart stopped. Through a small incision between the ribs, the internal mammary artery is separated from the chest wall and prepared to be connected to the heart for use in the bypass.
The internal mammary artery is usually preferred because it has a lower risk of blockage compared to other arteries. This method provides significant comfort and advantages to the patient during the recovery period and in terms of physical movement. It is particularly beneficial for elderly patients or those for whom recovery would be prolonged if the breastbone were cut.
How is Closed Heart Surgery Performed?
Closed bypass surgery is increasingly common in modern practice. The procedure is performed through a small incision made under or on the side of the chest. Therefore, instead of calling it closed bypass, it may be more accurate to refer to it as “small incision” or “minimally invasive” surgery.
Before the surgery, the necessary tests are performed during hospitalization, and if the patient is suitable for closed bypass surgery, they are evaluated by an anesthesiologist, and the necessary preparations are made.
On the day of the surgery, after general anesthesia is administered, the surgeon makes a small incision in the predetermined area, usually accessing the internal mammary artery for the bypass. Suitable veins are removed from the arm or leg, and the artery taken from the chest is attached to the coronary artery. Then, veins from the arm and leg are used for the other blocked arteries. Afterward, bleeding is controlled, drains are placed in the surgical area, and the incision made at the beginning of the surgery is closed. The patient is then transferred to the intensive care unit. The surgery typically lasts between 3 to 5 hours, depending on the number of bypasses performed.
