Bypass surgery with total arterial revascularisation

Coronary Artery Bypass Graft (CABG) operations are one of the most commonly performed surgical procedures worldwide. Progressive advances in surgical techniques and perioperative care has led to an increasing number of patients undergoing bypass surgery during the past decade. The saphenous vein graft has been widely accepted as the conduit of choice for myocardial revascularisation, even though it involves excessive surgical invasiveness. 

“Conventional CABG consists of three or four bypass grafts where one graft is the left internal mammary artery (LIMA) and the others usually all come from the saphenous veins in the legs. However, arterial conduits are now being used in suitable patients as choices for the second and third conduits in place of saphenous vein grafts to achieve total arterial revascularization (TAR) of the myocardium due to superior patency and long term survival results,” said Dr. Kesava Dev, Resident Cardiovascular Surgeon at Durdans Heart Centre.

Latest studies suggest that total arterial revascularisation provides better long-term survival than a single arterial graft. Using the right internal mammary artery (RIMA) as a second conduit improves long-term outcomes, especially among diabetic and obese patients. Additionally, the overall repeat procedures are far less in those with TAR.

Dr. Wimal Karandagoda, Director Medical Services and Chief Operations Officer at Durdans said, “TAR has not been widely embraced by cardiac surgeons locally, as many surgeons are not comfortable using the two internal mammary arteries.  With an ambition for globally recognised medical excellence, our cardiac surgeons at Durdans Heart Centre go to the greater extends to perform complicated TAR cases with great expertise. Especially, Dr. Dev has a legacy at Durdans in conducting TAR in bypass surgery and his results are of international standards.” 

Since opening in 1999, the Durdans Heart Centre has pioneered and perfected numerous leading-edge techniques and procedures across a range of cardiac services, including minimally invasive coronary bypass operations performed through small incisions, that are much less traumatic to the body than traditional open heart surgery which requires opening the breastbone through the chest (sternotomy) and the support of a heart-lung machine.