Consultant cardiac surgeon Mr Shahzad Raja is internationally renowned for his expertise in performing coronary artery bypass surgery whilst a patient’s heart is still beating. This complex technique requires great precision and skill to get right, but a recent study at our centre on over 10,000 patients has shown it can significantly improve patient outcomes.

Tackling clogged coronary arteries

Coronary heart disease is a leading cause of death worldwide and occurs when the blood flow through coronary arteries becomes interrupted or blocked due to atherosclerosis. Depending on the extent of the blockage, different interventional and surgical options can be explored.

If the plaque is limited in size, non-surgical coronary angioplasty with a balloon and/or stents may be used to widen the narrowed sections of the artery. However, if the plaque is more extensive and/or affects multiple vessels, a coronary artery bypass grafting (CABG) procedure may be needed for revascularisation.

CABG surgery utilising a cardiopulmonary bypass machine which takes over the functions of the heart and lungs (termed ‘on-pump CABG’) is widely regarded as the gold standard surgical approach. It enables the heart to be stopped for the surgery to be completed with greater ease. However, cardiopulmonary bypass machines can result in a systemic inflammatory response, leading to multiple organ dysfunction and morbidity. The risk of complications may be heightened in some patient communities such as those that are older, have renal dysfunction or diabetes.

A safer approach to bypass surgery

Off-pump CABG’ is an alternative approach which enables the heart to continue beating whilst the surgery is performed. The technique was revived over two decades ago and involves the use of a tissue stabiliser to press down around the affected coronary artery to steady the heart, temporarily occlude blood flow and stitch a graft beyond the narrowing – ideally an internal mammary artery.

Although the heart remains perfused by its collateral circulation, the procedure must be performed quickly and requires the skill of an experienced surgeon with exclusive off-pump practice in a high volume off-pump coronary surgery centre for the best results. A recent 20-year investigation of over 10,000 patients at Harefield Hospital, which is one such centre, compared the outcomes of on-pump and off-pump CABG surgery. The study demonstrated that off-pump CABG was associated with a lower risk of operative mortality, fewer postoperative complications and similar 20-year survival and freedom from reintervention when compared to on-pump CABG. This was the longest study of its kind.

Left: Removal of atheromatous material from left anterior descending artery after extensive coronary endarterectomy on the beating heart.
Right: Final result after reconstruction of left anterior descending artery with left internal mammary artery on the beating heart.

Successful triple bypass for high-risk patient

At 57, Kiran had already achieved a great deal in his life. He successfully started and expanded a group of elderly nursing and care homes across the UK, had his first grandchild, and most recently attended the wedding of his youngest daughter. He led a very active lifestyle, regularly travelling for work, as well as swimming 2-3 times a week and going for long countryside walks.

However, he noticed a persistent pain in his shoulder whilst on his walks, particularly when going uphill. He decided to see a doctor about it, but repeat ECG tests came back negative, despite the pain continuing. After struggles booking in an appointment with pain management and further heart exams, he decided to seek private care with Royal Brompton & Harefield Hospitals Specialist Care.

“All the tests were done really quickly at Harefield and I met several great cardiologists. They told me that my angiogram showed that three of my coronary arteries were blocked and couldn’t be stented – that I’d need a triple heart bypass,” explains Kiran. “I was absolutely shocked as I was at my daughter’s wedding a few weeks before and was jumping up and down all night. I had no idea there was something wrong with me like this.”

“I was scared of surgery initially, but when I met Mr Shahzad Raja who was recommended to operate on me, my heart just said this was the right man for the job – he was just such a positive man to speak to. He encouraged me to do research on him, but I didn’t have to, I just asked him to go ahead.”

“When I woke up from the surgery, I saw Mr Raja, who came to check up on me. I couldn’t talk to him at that point, but I just put two hands up to thank him for giving me a new life. And after about 6 weeks I was back to normal really – I was driving again and going on my long walks which I love.”

Mr Raja says:

“Kiran’s case was quite complex, as he had diabetes and multi-vessel coronary artery disease. We recommended an off-pump bypass procedure to ensure the best results as he was a very high-risk patient. We were very pleased with the outcome and would recommend the off-pump procedure to all high-risk patients in centres that have the expertise to perform it”.