What is CABG

Coronary bypass surgery

The isolated coronary bypass operation (CABG) is still the most frequently performed cardiac operation at the cardiac surgery department of the Medical University of Vienna at the Vienna General Hospital and is carried out in accordance with recent international guidelines, especially for 3-vascular diseases with or without main trunk involvement. If percutaneous coronary intervention (PCI) is anatomically not possible in 1 and 2 vascular diseases or if there is a better chance of treatment success for other reasons due to the surgery, then a bypass operation is also performed in these patients as an alternative to PCI.

The ongoing endeavor of surgical coronary revascularization is to continuously improve the short- and long-term outcomes in severe coronary artery disease (CHD). The goal of the CABG operation in our department is to use the maximum possible and reasonable number of arterial bypass vessels (LIMA, RIMA, radial artery, and in rare cases gastroepiploic artery), as these vessels show the best long-term durability. The LIMA and RIMA are always removed using the skeleton technique, as this allows the blood flow in the thoracic wall to be better preserved and both vessels to become longer. If the great saphenous vein is harvested, the veins are harvested endoscopically in 80% of patients.

With the exception of patients with severe changes in the ascending aorta, all operations are performed on the heart-lung machine, as this technique produces the same results as the operation without a heart-lung machine, but can be performed with greater certainty.

A high-quality, preoperative CT examination of the thoracic aorta and sonography of the carotids is necessary for all patients with an atherosclerotic profile - and that is all coronary patients - in order to be able to adapt the strategy of the CABG operation and to minimize the risk of insult by recognizing an anatomical risk situation in good time .

Another focus is on avoiding wound healing disorders, which could be reduced to a very low value through the use of special, protective protocols.

The aim of the surgical therapy is the complete revascularization of the myocardium, taking into account the anatomical conditions, in order to be able to guarantee the patient maximum freedom from angina pectoris and a longer survival. All previous studies have shown that in the case of extensive 3-vessel disease, the CABG operation has a clear advantage over PCI in terms of survival and freedom from angina pectoris.

The department also specializes in the care of patients with severely restricted left ventricular function in CHD. Thanks to optimal preoperative, radiological imaging, echocardiography, anesthesiological care and highly specialized intensive care medicine, the extensive experience and technological equipment allow a CABG operation to be carried out safely, even with severely impaired cardiac function. In the case of coronary surgery that is no longer effective, the full range of cardiac replacement therapy with ECMO, VAD and HTX is available. Our department has by far the greatest experience in Austria with short-term and long-term heart replacement procedures, which can then act as a safety net to save patients. For the group of these patients, however, the immediate availability of a specialized cardiologist on the ward, who is responsible for optimizing the preoperative and postoperative drug therapy, is of decisive importance. With OA Dr. Franz Gremmel has an excellent specialist available for this.

Since the Medical University of Vienna has one of the largest and 24/7 emergency units and cardiac catheter facilities in the country at the Vienna General Hospital, a considerable number of acute CABG operations are carried out, sometimes even in the most difficult initial situation.

Scientific activities

The scientific activities focus on further improving the results. Attempts are made to achieve this through perioperative therapy with new platelet aggregation inhibitors (ticagrelor) and our department is a leader in the so-called TICAB study. The administration of ticagrelor versus aspirin is evaluated in a prospective, randomized multicenter study and the number of endpoints (MACCE) is observed after one year.

Another concept will be evaluated in the near future by the VEST3 study, which should improve the long-term durability of venous bypasses. The great saphenous vein, which is still used in most CABG operations, is sheathed with an external, highly flexible metal stent, so that the wall stress caused by the arterialization is reduced and the vein wall is remodeled for a longer period of time.

Further activities concern the long-term analysis of minimally invasive single bypasses in comparison to PCI.

The coordination of the scientific activities in clinical CABG surgery is carried out by
MrsAssoc.-Prof.in Priv.-Doz.in Dr.in Sigrid Sandner directed.