Bypass operations on beating hearts were first performed in Ukraine at the Amosov National Institute of Cardiovascular Surgery seven years ago. At the time few believed that the new technique would find a place in Ukrainian cardiac surgery. As the years passed, increasing numbers of cardiac surgeons began performing the new procedure. Today, over 4,000 beating heart bypasses are performed in Ukraine every year. Experts say the new technique has reduced the number of surgical failures by dozens of times. Below Anatolii RUDENKO, M.D., head of the Cardiovascular Department at the Amosov National Institute of Cardiovascular Surgery, with a record of over 5,000 operations in 30 years of medical practice, comments on the advantages and features of the new bypass procedure.
Dr. Rudenko, what are the features of beating heart surgery?
Rudenko: This method is used in ischemic diseases of the heart, when the vessels supplying blood are clogged by plaque, when the heart can no longer contract normally because of lack of oxygen. Clogged vessels often cause infarctions in the course of which part of the heart dies, so operations are performed to save the patient’s life. There are two surgical methods: stenting, which is done at an early plaque-forming stage, when the plaques are small, and coronary artery bypass, when the plaques are big. The latter method has been practiced for more than 30 years. As a rule, such operations are done with the aid of a heart-lung machine (the heart is stopped and oxygen is fed through a special device). Ten years ago a new method was developed, involving a special device that allows the surgeon to immobilize the part of the heart where the graft is to be done. In other words, the heart keeps beating except in the part where the stabilizer is placed. This does away with the need for a heart-lung machine.
Did the number of operations requiring the heart-lung machine decrease after this new technique was invented?
Rudenko: Unfortunately, most of these operations are done on a stopped heart. Our institute is the only place in Ukraine where beating heart bypasses are performed in 98 percent of cases. In other medical centers the rate is 70 percent. However, considering that Ukrainian cardiac surgeons were among the first in the world to master this new procedure, our indices aren’t bad at all. We have high hopes for the new generation of specialists because it is much easier to teach them this new method.
What do you mean?
Rudenko: Experienced surgeons are very conservative. After 20 years of using the old method they aren’t likely to discard it quickly. Of course, every method has its pluses and minuses. So far there aren’t enough grounds to talk about the disadvantages of this non-invasive bypass surgery. First of all, this kind of surgery is considerably easier on patients. Stopping the heart for a prolonged period of time can lead to a number of complications, even death. Second, working on a beating heart takes a talented and highly professional surgeon, because the patient’s life depends on the surgeon’s quick and precise movements.
Of course, it is much easier to operate on a stopped heart when the patient’s life is sustained by the heart-lung machine, but in this case the surgeon cannot waste a second because the machine can keep the patient alive for only an hour. Sometimes the surgeon can’t do his main work within this short timeframe.
So what are the advantages of the new bypass method?
Rudenko: In my opinion, the best result of beating heart bypasses is that we have succeeded in reducing the mortality rate by a dozen times. In 2000 the post-operative mortality rate was 13-15 percent. Today it is only 0.5 percent. Incidentally, in the US the post-operative mortality rate has remained at 2.5 percent for the last 10 years. Also, this new method has allowed us to improve the quality of operations and increase their numbers. Between six and eight million people suffer from ischemic heart disease, at least 20 percent of whom (some two million patients) need surgery. So there are long waiting lists. Every year we receive about 25,000 new patients. For example, my work schedule is filled for the next year. The new method makes it possible to perform these operations faster and without serious complications. Our patients are discharged five days after their operation. Vacating hospital beds at this rate shortens the waiting lists. We will soon have another five operating rooms in our ward and this will also shorten the waiting lists.
How do you cope with your tight schedule?
Rudenko: I don’t feel exhausted because I enjoy my work. My greatest reward is when an operation does not lead to any complications and the patient feels well. I stick to a standard work schedule: two operations a day. Sometimes I have to work on weekends. Although every operation lasts about four hours, time passes quickly for me when I’m working. However, I take part in the main stage of the operation, inserting the stent or sewing the graft.
From which country did beating heart coronary bypass come to Ukraine?
Rudenko: It is generally believed to have been invented by two American surgeons, Charles G. Reiter and J. W. Randolph Bolton. [The procedure was invented by an Argentine surgeon named Federico Benetti - Ed.]. They were the first to start performing these procedures in a Texas clinic. Then they started sharing their experience worldwide and inviting cardiac surgeons for internships. That was how this method found its way to Ukraine. I was fortunate enough to work with these gifted surgeons during my on-the-job training in the United States. I also did several internships in Germany where, under the able guidance of Dr. Reiner Koerfer, I mastered the cardiopulmonary bypass technique. I am glad to say that our specialists are way ahead of their foreign colleagues in terms of the quality of beating heart bypasses. So Ukrainians should be in no hurry to get this kind of treatment abroad. Similar surgeries can be done in Ukraine and at a considerably lower price. For example, in Europe a beating heart bypass costs between 25,000 and 40,000 dollars. In Ukraine, it is roughly $5,000. Of course, this is a large sum, but cardiac surgery cannot be cheap because the patient’s life depends on it.
