Coronary Artery Bypass Grafting
Coronary artery bypass grafting, also called revascularization, is a common surgical procedure to create an alternative path to deliver blood supply to the heart and body, with the goal of preventing clot formation. This can be done in many ways, and the arteries used can be taken from several areas of the body. Arteries are typically harvested from the chest, arm, or wrist and then attached to a portion of the coronary artery, relieving pressure and limiting clotting factors in that area of the heart.
The procedure is typically performed because of coronary artery disease , in which a plaque-like substance builds up in the coronary artery, the main pathway carrying oxygen-rich blood to the heart. This can cause a blockage and/or a rupture, which can lead to a heart attack.
Preparing For Open Heart Surgery
Heart surgery corrects problems when other treatments dont work or cant be used for some reason. The most common type of heart surgery for adults iscoronary artery bypass grafting. In bypass surgery, arteries or veins are removed from elsewhere in your body and grafted to reroute blood around a clogged artery to supply blood to your heart muscle.
Your health care team which may include surgeons, cardiologists, anesthesiologists, nurses, and therapists will discuss your operation with you. Theyll welcome your questions.
If your heart surgery is planned, and not an emergency, youll meet first with your doctor and health care team. Theyll tell you what to expect and how to prepare. Before your surgery:
A Black Surgeon Performs The First Successful Open
Daniel H. Williams
On this date in 1893, the first successful American open-heart surgery was performed by a Black surgeon, Dr. Daniel Hale Williams.
Dr. Williams completed the operation on a young man named James Cornish. He had been rushed to Provident Hospital in Chicago, a hospital which Dr. Williams had founded and one of the few hospitals that welcomed African Americans–with a stab wound. Williams repaired the wound with the use of sutures.
Sometimes open-heart surgery is referred to as an invasive procedure
Reference:2,000 years of extraordinary achievementby Jessie Carney SmithCopyright 1994 Visible Ink Press, Detroit, MIISBN 0-8103-9490-1
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Before The 19th Century
The concept of surgery was explored well before recorded history with early “surgeons” grasping the basic concepts of the human anatomy and organ systems. Among some of the notable findings:
- 6500 BCE: Skulls found in France show signs of a rudimentary surgery called trepanation, which involves drilling a hole in the skull.
- 1750 BCE: The Code of Hammurabi, one of the earliest Babylonian codes of laws, details regulation governing surgeons, medical malpractice, and victim’s compensation.
- 1550 BCE: The Ebers Papyrus, an ancient Egyptian medical treaty, includes information on how to surgically treat crocodile bites and serious burns.
- 600 BCE: Sushruta, regarded as the “founding father of surgery,” was an innovator of plastic surgery, including rhinoplasty.
- 950: Abulcasis, an Arab physician considered to among the greatest medieval surgeons, apparently learned many of his skills from Greek surgeons.
- 1363: French surgeon Guy de Chauliac writes Chirurgia Magna , regarded as the standard text for surgeons until well into the 17th century.
- 1540: English barbers and surgeons unite to form the United Barber-Surgeons Company. These “barber-surgeons” performed tooth extractions and bloodletting.
- 1630: Wilhelm Fabry, known as “the Father of German Surgery,” is recognized as the first surgeon to employ amputation as a treatment for gangrene.
Celebrating Achievements Paying Tribute To The Past
Cardiac surgery is a complex intervention and success has depended on effective teamwork, both within and between organisations. Patient outcomes have dramatically improved. The days when it was touch and go whether someone would come out of the operating room are long past. This is a very different environment to that of 40 years ago, especially in my field of congenital heart surgery.
The patients who required heart surgery in the early years of the NHS were very, very brave. Of course, as results have improved, so have peoples expectations. Surgeons should be ruthlessly honest about the way that patients are advised about their treatment options. The expectation of many people today is that they can have an operation with a predictably perfect outcome that sadly isnt always the reality.
But when you think of the great names associated with Royal Brompton, for example Paul Wood, Russell Brock, Magdi Yacoub and Jane Somerville, patient outcomes have improved massively compared to those which could have been anticipated in the 1950s.
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Development Of Open Heart Surgery Techniques
While Harkenâs technique was beneficial to many patients, it could not be used to address more serious conditions such as congenital heart disorders or narrowed heart valves caused by rheumatic fever. This meant that some form of surgery needed to be created that would allow physicians to open the chest cavity without making the patient bleed to death. The main problem was that stopping a personâs heart only gave surgeons four minutes to operate, otherwise the deoxygenization of the blood would result in brain damage.
Dr. Bill Bigelow of the University of Minnesota came up with a solution based on observations he had made about ground hogs. During his studies in the cold Canadian climate, he noticed that the animal would hibernate through winter. The animals’ hearts would slow and they could survive for months of time without eating. He assumed that the cold had something to do with this survival skill. At first, he began to experiment with dogs, lowering their body temperatures and performing open heart surgery. Bigelow found that the surgeries could last much longer than four minutes and the dogs would survive. This proved his theory that cold temperatures caused brain and body tissues to need less oxygen.
Above left: Open Heart Surgery.
Pioneers Of Heart Surgery
For most of history, the human heart has been regarded as an organ too delicate to tamper with. But daring and innovative doctors from WWII onward, aided by advances such as the heart-lung machine and immuno-suppressant drugs, have ushered in a new era of heart transplants and open-heart surgery.
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During World War II military doctors, facing injury and suffering on a massive scale, pioneered advances in antibiotics, anesthesia, and blood transfusionsadvances that would usher in the age of modern surgery. One of the first doctors to use these medical advancements to gain access to the heart was Dr. Dwight Harken, a young U.S. Army surgeon. Many of Harken’s patients were young soldiers evacuated from the European front with shell fragments and bullets lodged inside their hearts. To leave the shrapnel in was dangerous, but removing it was almost surely fatal. Harken began operating on animals, trying to develop a technique that would allow him to cut into the wall of a still beating heart, insert a finger, locate the shrapnel and remove it. All of his first 14 animals subjects died. Of the second group of 14, half died. Of the third group of 14, only two died. Harken felt ready to try the technique on humans. All of his patients survived, proving that the human heart could be operated upon.
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Symptoms Of Coronary Artery Disease
When the heart does not get enough oxygen, portions of it may become ischemic, which results in a type of pain called angina pectoris. This pain is often described as pressure, and it usually occurs over the breastbone. It can feel like a band tightening around the chest. Some of my patients have described it as a pile of bricks or heavy weights that has been placed on their chest. This could be a pain that goes from the chest to the neck and lower jaw or a numbness down the arm, particularly the left arm. Sometimes it can manifest itself as a discomfort in the upper portion of the abdominal wall. It may be mistaken for heartburn, a gall bladder attack, or even an upset stomach.
Chest pain does not always accompany hardened arteries. Some patients have what is called an angina equivalent. This could be a form of shortness of breath or other symptoms that, after appropriate testing, turn out to be caused by a lack of oxygenated blood getting to the heart muscle.
As atherosclerotic material builds up, it may actually starve the heart muscle for blood. Heart attacks occur not only when the plaque on the arterial wall blocks blood flow but also when the artery breaks or ruptures. When this happens, platelets, which are designed to begin blood clotting, attach to the raw surface of the crack and form a growing clump. This further blocks the coronary artery and may result in a heart attack. Even a temporary clumping of platelets can result in a heart attack.
First Human Heart Transplant
On December 3, 1967, 53-year-old Louis Washkansky receives the first human heart transplant at Groote Schuur Hospital in Cape Town, South Africa.
Washkansky, a South African grocer dying from chronic heart disease, received the transplant from Denise Darvall, a 25-year-old woman who was fatally injured in a car accident. Surgeon Christiaan Barnard, who trained at the University of Cape Town and in the United States, performed the revolutionary medical operation. The technique Barnard employed had been initially developed by a group of American researchers in the 1950s. American surgeon Norman Shumway achieved the first successful heart transplant, in a dog, at Stanford University in California in 1958.
After Washkanskys surgery, he was given drugs to suppress his immune system and keep his body from rejecting the heart. These drugs also left him susceptible to sickness, however, and 18 days later he died from double pneumonia. Despite the setback, Washkanskys new heart had functioned normally until his death.
In the 1970s, the development of better anti-rejection drugs made transplantation more viable. Dr. Barnard continued to perform heart transplant operations, and by the late 1970s many of his patients were living up to five years with their new hearts. Successful heart transplant surgery continues to be performed today, but finding appropriate donors is extremely difficult.
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Education And Early Career
Bigelow acquired his MD from the University of Torontos Medical School in 1938. He was a surgical resident at Toronto General Hospital from 1938 to 1941 and captain in the Royal Canadian Medical Corps during the Second World War. Bigelows residency and military service inspired his research on hypothermia and whether it could be used before an operation to reduce oxygen and slow circulation in the body . Bigelow and his colleague, Dr. John Carter Callaghan, undertook research on hypothermia at the University of Torontos Banting Institute. They presented their research on hypothermia at a meeting of the American Surgical Association in 1950, which contributed to future investigations on the use of hypothermia in surgery.
Did you know?
The first open heart surgery using hypothermia was performed by the American surgeon Dr. John Lewis in 1952.
What Are Some Types Of Heart Surgery
There are many types of heart surgery. The National Heart, Lung, and Blood Institute, which is part of the National Institutes of Health, lists the following as among the most common coronary surgical procedures.
In addition to these surgeries, a minimally invasive alternative to open-heart surgery that is becoming more common is transcatheter structural heart surgery. This involves guiding a long, thin, flexible tube called a catheter to your heart through blood vessels that can be accessed from the groin, thigh, abdomen, chest, neck, or collarbone. A small incision is necessary. This type of surgery includes transcatheter aortic valve implantation to replace a faulty aortic valve with a valve made from animal tissue, MitraClipÂ® placement for mitral valve abnormalities, and WATCHMANÂ® placement for nonvalvular atrial fibrillation patients.
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Williams Rose From Humble Beginnings To Become A Trailblazer
Born in Pennsylvania in 1856, Williams began working by the time he was 10 years old, following his fathers death from tuberculosis. Williams apprenticed for a shoemaker in Maryland and then ran off to join the rest of his family in the Midwest, where he worked in the family barbershop business. When he was 22, Williams was inspired by a local doctor to pursue a career in medicine.
Systemic segregation meant that medical education opportunities were very limited for Black Americans at the time, but after studying for several years with a famed surgeon for two years in Wisconsin, Williams matriculated at Chicago Medical College . He took out loans for his first two years and then was helped along by his brother, a local lawyer. It would prove to be a very wise investment on his brothers part.
Williams established his own private practice after graduating in 1883, but he had to perform care including surgeries on patients inside their homes, as hospitals at that point largely did not allow Black doctors to practice in their facilities.
Daniel Hale Williams
Celebrating Black History: The First Successful Open Heart Surgery
To celebrate, each week throughout Black History Month, Trusted Medical will spotlight an African American medical pioneer whose groundbreaking contributions changed the course of medicine and paved the way for future generations. We begin with a man who performed the first successful open-heart surgery, Dr. Daniel Hale Williams. Keep reading to learn more about Dr. Daniel Hale Williams and his groundbreaking role in the field of medicine.
Born in 1856 in Pennsylvania, Dr. Daniel Hale Williams began his career as a shoemakers apprentice. He then took up barbering, following in his fathers footsteps for a short time. Ultimately, Williams decided he wanted to pursue his education and started an apprenticeship under Dr. Henry Palmer, a highly accomplished surgeon. He went on to complete further training at Chicago Medical College.
Graduating with his M.D. in 1883, Dr. Williams became a surgeon in the Chicago area at a time when there were only three other Black physicians in Chicago. As a practicing surgeon during the segregation era, he was prohibited from being admitted and working at hospitals. In response, Dr. Williams founded the Provident Hospital and Training School, the first Black-owned hospital in the United States and the first medical facility with an interracial staff.
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A Short History Of Heart Surgery
- 10 years agoBy admin VolumeIssue5
IN MAY OF 1975, when I was fortyseven, I developed angina , and about two months later, after a stress test, a coronary angiogram, and various blood tests, I underwent an operation. The operation was a coronary artery bypass in which veins from my leg were used to bypass the obstructed arteries of my heart. For about one hour, while this was being done, my heart was stopped and a heart-lung machine did the work of pumping and oxygenating my blood, work ordinarily performed by rny heart and lungs.
In the eight years that have passed since my operation, I have lived a full life, practicing surgery, writing, playing tennis and racquetball, and, in general, enjoying myself. I have not once had an attack of angina.
Hippocrates, who was born in 460 B.C. and is regarded as the father of medicine, wrote, A wound in the heart is mortal with few exceptions the heart remained sacred territory, outside the bounds of surgery, for centuries. Theodor Billroth, the famous Viennese surgeon who first successfully removed a stomach cancer and who devised the operation still in general use for partial stomach removal for ulcer or cancer, wrote in the 1880s, Any surgeon who wishes to preserve the respect of his colleagues would never attempt to suture the heart. When a man of Billroths eminence spoke, surgeons listened in fact, its probably safe to say that Billroths writings delayed the development of heart surgery for many years.
The First Open Heart Surgery Performed On A Human
The first open heart surgery conducted on a human patient occurred on September 2, 1952. Two surgeons from the University of Minnesota, Dr. Walton Lillehei and Dr. John Lewis, performed the procedure on a fiver-year-old girl with a hole in her heart. The doctors used a specialized blanket that lowered her body temperature to 81 degrees Fahrenheit. However, her body continued to shiver, disrupting the ability of the surgeons to perform their duties. To mitigate this problem, they gave her anesthesia, giving them roughly ten minutes to perform the operation. Lillehei and Lewis opened up her chest, clamped the inflow to her heart and allowed it to empty of blood. They cut the open the girlâs heart and sewed up the hole. The heart was repaired and the girl was immersed in a warm water bath, bringing her temperature back to normal. The girl survived the procedure with no side effects and the first open heart surgery was a success, opening up the concept to new procedures and methods.
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The First Coronary Artery Bypass Surgery
DR. DUDLEY JOHNSON, WHO was one of a handful of doctors who popularized the modern coronary bypass operation, first knew he wanted to practice medicine while in seventh or eighth grade but he didn’t know he wanted to be a surgeon until he got into medical school.
“And then I didn’t really have any illusions about being a heart surgeon,” Johnson said in a 1999 interview. “But I figured if I had experience in the chest, I could get a little better job in a clinic somewhere, so I also trained to do lung surgery along with general surgery. As it turned out, the doctor in Milwaukee, Dr. Derward Lepley, Jr., who was in charge of the heart surgical realm, which was really in its infancy in the middle sixties, asked me to join him in practice, so I ended up staying in heart surgery.”
It was a fortunate decision for the field of heart surgery. At the time, surgical teams across the country were experimenting with various treatments for arteriosclerosis in the coronary arteries. Endarterectomy, or stripping plaque from the coronary arteries, was an accepted treatment. Bypass grafts, which were being placed into the coronary arteries of animals, remained a controversial procedure that many surgeons thought wouldn’t work. Various attempts were made, including one in 1962 by Dr. David Sabiston, who probably performed the first bypass in a human. Unfortunately, his patient died only days later of a stroke.