Anthea Hospital, part of GVM Care & Research, has been recognized as an international center of excellence in the treatment of coronary heart disease, in particular heart attack. The high volume of myocardial revascularization operations performed every year and the high specialization achieved by the operators, has allowed the Cardiac Surgery of Anthea Hospital – directed by Prof. Giuseppe Speziale – to be part of an important multicenter study “Trial Roma” of Cornell University of New York, aimed at identifying the best conduit to be used for coronary surgery and in particular for bypass surgery. Trial Roma is the first study with a high statistical power to demonstrate and / or refute the importance of the double breast artery in patients with coronary artery disease under the age of 70.

Coronary artery bypass surgery is the most commonly performed surgical procedure in cardiac surgery, as it is linked to the ever increasing spread of coronary heart disease, including heart attack. As the term “bypass” suggests, it is an operation in which a stenosis, or a coronary obstruction, is “overcome” through the use of a venous and / or arterial conduit, with consequent reperfusion of the downstream vessel.

Patients who are candidates for coronary artery bypass grafting are generally affected by: diabetes, impaired ventricular function, coronary stenosis or a complex coronary situation.

Technically, the bypass surgery is performed in a standard manner, that is, with the opening of the sternum. Even with a classic approach, the surgery is extremely safe and low-complication with validated results.

It is performed under general anesthesia. The surgeon makes a 10-12 cm incision of the sternal bone, then the conduits, the left internal mammary artery of the chest or the right internal one, and a portion of the saphenous vein of the leg are taken, then arterial and venous conduits are used to bring the blood downstream of the stenosis, of the diseased coronary artery.

The operation can be performed with extracorporeal circulation using the heart lung machine or off pump, without stopping the heart. There is also an intermediate variant, according to which the patient is connected to the heart lung machine without stopping the heart, that is, it is an intermediate method, between the on pump and the off pump.

“The choice of the conduits that will be used for the bypass is of fundamental importance, since the remote results largely depend on the type of conduit used – explains Prof. Speziale – in the past mainly venous conduits and more precisely the great saphenous vein were used. Later over the years we have moved towards a mixed revascularization, which involved the implantation of at least one arterial conduit, such as the internal mammary artery, and the grafting of venous conduits on the other coronary branches. Today the technique has evolved even more: the Trial Roma study will allow us to scientifically understand which conduits to use, whether two mammary arteries, or also a venous conduit“.

Currently the surgery is performed at the surgeon’s discretion, but in relatively young patients, under 70, it may be more appropriate to use the double mammary artery inside the chest, as the arterial conduit tends to last longer, granting an advantage for long-term bypass patients, by allowing them to live longer, and to avoid events such as a heart attack and angina, and therefore a high quality of life.

Bypass surgery tends to be a definitive intervention: it aims to achieve a series of medium-long term objectives, mainly represented by the improvement of the quality of life and the reduction of the incidence of ischemic events (myocardial infarction and heart failure).

The bypass – unlike coronary angioplasty which very often requires further or repeated revascularization – in the vast majority of cases does not require further interventions.