February 10, 2023by CubaHeal Research0

Surgical myocardial revascularization is the most frequent cardiac intervention and one of the greatest achievements in surgery. It consists of bypassing the blood flow through native coronary arteries with high-grade stenosis or occlusion that cannot be solved by angioplasty with the introduction of an endovascular prosthesis. 


Cardiovascular diseases can manifest itself in many forms: high blood pressure, coronary artery disease, valvular disease, stroke and arrhythmias. 

Major risk factors for cardiovascular disease include: 

  • High blood pressure; 
  • High cholesterol; 
  • Diabetes; 
  • Obesity and overweight; 
  • Smoking; 
  • Sedentary lifestyle; 
  • Genetic diseases; 
  • Age; 
  • Alcoholism. 

Stress is considered a contributing factor to cardiovascular risk, as stressful situations increase heart rate and blood pressure, increasing the heart’s need for oxygen. At times of stress, the nervous system releases more hormones causing blood pressure to rise, which can damage the inner lining of the arteries. Stress also increases the concentration of clotting factors in the blood, which can lead to the formation of a blood clot. 


The traditional surgical myocardial revascularization consists of a thoracotomy through a midline sternotomy. A pump must be used to maintain extracorporeal circulation between the heart and lung, which allows the heart to be stopped and emptied of blood in order to achieve maximum surgical exposure and facilitate the completion of vascular anastomoses. Stopping the heart also significantly reduces myocardial oxygen demand. 

Before starting cardiopulmonary bypass, the patient must receive a very high dose of heparin to prevent clotting in the circuit through which the blood will circulate out of the body. The aorta is then clamped and the heart is stopped with an injection of cardioplegic solution which also contains substances that help myocardial cells tolerate ischemia and reperfusion. The patient’s temperature is also reduced by a pump-dependent mechanism to achieve the same ends. 

Once the vascular anastomoses are completed, the aorta is unclamped, allowing perfusion of the coronary arteries with oxygenated blood, which restores cardiac activity. Heparin anticoagulation is reversed with protamine. Despite cardioprotective measures, stopping the heart is not without risk; these events are treated with conventional measures, such as pacemaker placement, defibrillation, and administration of inotropics. 


The main complications and disadvantages of traditional myocardial revascularization are: 

  • Sternotomy; 
  • Extracorporeal circulation. 

The median sternotomy is fairly well tolerated, however it takes 4 to 6 weeks to heal. Infections of the incision can cause mediastinitis or sternal osteomyelitis, which can be very difficult to treat. 

Extracorporeal circulation causes several complications, such as: 

  • Hemorrhage; 
  • Organ dysfunction; 
  • Neuropsychiatric effects; 
  • Stroke. 

Post-pump bleeding is a problem caused by a variety of factors, including hemodilution, heparin use, platelet dysfunction generated by pump exposure, disseminated intravascular coagulation, and induced hypothermia. 

Organ dysfunction may be due to a systemic inflammatory response caused by the heart-lung machine. This response may cause organ dysfunction in some system or apparatus such as the lungs, kidneys, brain, among others.  

Other frequent complications related to surgical myocardial revascularization include: 

  • Focal myocardial ischemia; 
  • Global myocardial ischemia; 
  • Arrhythmias. 

The mortality rate depends mainly on the patient’s previous state of health, but the experience of the medical staff and the conditions of the institution are very important.  Newer techniques attempt to limit the complications of traditional surgical myocardial revascularization by: 

  • Avoiding the need for cardiopulmonary bypass, i.e. surgical myocardial revascularization without a heart-lung bypass pump. This pump can be avoided in selected patients by means of techniques that allow the surgeon to revascularize the heart without stopping its beating. 
  • Avoiding median sternotomy (minimally invasive myocardial revascularization surgery). This technique is somewhat difficult and may not be possible when several anastomoses must be performed, particularly when they involve vessels behind the heart.  

Coronary revascularization is a therapeutic intervention that, although not without risk, is fully established and therefore included in all treatment strategies for patients with coronary artery disease. 

You may need this procedure if you have a blockage in one or more coronary arteries. The coronary arteries are the blood vessels suppling the heart with oxygen and nutrients carried in the blood. 

When one or more of the coronary arteries become partially or completely blocked, the heart does not receive enough blood. This is called ischemic heart disease or coronary artery disease and can cause chest pain (angina). 

Coronary artery bypass surgery may be used to improve circulation to the heart, although  specialists usually first try to treat it with medication, dietary changes or angioplasty and stenting. 

Coronary artery disease is different for everyone. The way it is diagnosed and treated also varies. 

Recovery from surgery takes time and in some cases the full benefits may not be felt until 3 months after surgery. In most cases, patients who undergo coronary artery bypass surgery, the grafts remain open and work well for many years. It is recommended to take measures to reduce the risk of a relapse for example: 

  • Not smoking; 
  • Eating a healthy cardio diet; 
  • Control arterial hypertension; 
  • Control glycemia and cholesterol. 

Among the risks that a person may have for needing long-term cardiovascular surgery are high blood pressure, smoking, diabetes mellitus and dyslipidemia (elevated lipid levels).  

Risk factors: 

  • High blood pressure; 
  • High cholesterol; 
  • Diabetes; 
  • Obesity and overweight; 
  • Smoking, alcoholism, drug addiction; 
  • Sedentary lifestyle; 
  • Inherited genetic diseases; 
  • Age 

It is never too late to start improving your cardiovascular health. Some risk factors can be controlled but others cannot, but if you eliminate bad habits and start living a healthy lifestyle, you are likely to reduce your risk of heart disease.  

If you suffer from high blood pressure, obesity or any of the risk factors mentioned above, we recommend you to visit a specialist immediately so that you can prevent cardiovascular disease. CHMT offers you the possibility of accessing innovative medical methods through which you will be able to obtain a safe, effective and personalized treatment. 

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