Is the Rib Broken During a Closed Bypass?

Closed bypass surgery is a type of surgery performed using the minimally invasive surgical technique. Minimally invasive means accessing the affected area with the smallest incision possible to treat the condition.

In the classic open bypass surgery method, a large incision is made, and the sternum (breastbone) is cut to access the heart. The surgery is typically performed with the heart stopped and assisted by a heart-lung machine. Open bypass surgery usually lasts between 3 to 6 hours. After open bypass surgery, patients are required to lie flat on their back for at least 6-8 weeks because the sternum has been cut.

Closed heart surgery, used in the treatment of vascular diseases, is performed without breaking the ribs and with small incisions. The incisions are made by creating space between the ribs, typically below or above the left breast. No bones are broken or removed. This method, where the heart is accessed through 6-8 cm incisions, can be done either with the heart stopped or, in suitable cases, without stopping the heart. After closed bypass surgery, the patient can return to daily life very quickly.

Who Is Not Suitable for Closed Bypass Surgery?

Whether a patient is suitable for closed bypass surgery is decided by a Cardiovascular Surgeon with extensive experience in this method. Closed bypass is a specialized procedure, and not all cardiovascular surgeons may be able to perform it, or they may have very limited experience. The decision on whether closed bypass surgery is appropriate should be made by a highly experienced heart surgeon who has performed numerous closed bypass surgeries.

From our experience with hundreds of closed bypass surgeries, we can say that the number of patients not suitable for closed bypass surgery is very small, and almost all patients with coronary artery disease can undergo bypass with the closed method. There are exceptions, of course, and each patient is unique. Therefore, a physical and laboratory evaluation of each patient must be conducted before deciding on closed bypass surgery.

Characteristics of patients for whom closed bypass surgery is not suitable include:

• Patients with advanced heart valve diseases requiring intervention, along with multiple vascular problems.
• Patients with morbid obesity.
• Patients with a history of surgical operations on the left lung or chest.
• Patients who are undergoing coronary bypass for the second time.
• Patients with severe narrowing or clots in the aorta or leg arteries that require connection to a heart-lung machine.
• Patients with narrowing extending distally in the LAD (the main artery of the heart).

These conditions are not absolute contraindications but may influence the surgeon’s decision to choose either open or closed bypass surgery.

What Are the Advantages of Closed Bypass Surgery?

Closed bypass surgery has many advantages compared to open bypass surgery, including:

• The surgery is performed through a small incision, causing less tissue damage and bleeding compared to traditional open-heart surgery.
• The small incisions are more aesthetically pleasing for the patient.
• The smaller incisions reduce the risk of infection.
• The recovery process is faster, and hospital discharge times are shorter.
• There is no need to lie flat on the back, and there are no restrictions on using the arms.
• Patients can manage their self-care and daily activities without assistance.
• Faster recovery helps protect the patient psychologically.
• The patient can start driving earlier.
• The return to social and sexual life is quicker.
• The return to work is faster.
• There is no problem with coughing or sneezing.

The many advantages of closed bypass surgery performed with a minimally invasive method stem from the fact that the procedure is done without cutting the ribs. Patients whose breastbone is not cut can return to normal living conditions more easily and feel more comfortable psychologically. You can consult an experienced Cardiovascular Surgeon with extensive experience in closed bypass surgery to determine whether you are suitable for this procedure.