Bypass Is the Most Effective Method for Diabetic Heart Patients

Prof. Dr. Mustafa Güden states that bypass is the most successful long-term method in treating coronary artery disease, saying "For patients above a certain score and especially those with diabetes, coronary bypass surgery is the first choice." Prof. Dr. Güden explained, "Research shows that in these types of patients, the rate of re-stenosis after stent procedures is quite high. In bypass surgery, if chest arteries are used, stenosis rates are around 10 percent over 10 years, but in leg veins this rate can rise to 50 percent."

What matters is performing the most efficient procedure with the least risk for the patient

Prof. Dr. Mustafa Güden, Specialist in Cardiovascular Surgery at Medipol Mega University Hospital, explained the methods applied in coronary artery bypass surgery. Prof. Dr. Güden noted that there are two treatment approaches for coronary artery disease: surgical and non-surgical, stating "One is surgery and the other is stent procedures performed by the cardiology department. What matters is performing the most efficient procedure with the least risk for the patient. When evaluating the patient, a certain scoring system is applied, particularly by examining the condition of the coronary arteries and whether diabetes is present. For patients above a certain score and especially for diabetic patients, coronary bypass surgery is the first choice. Because research has shown that in those with high scores and diabetic patients, the rate of re-stenosis after stent procedures is quite high. However, sometimes when the patient's score is low and there is no diabetes, very good results are obtained with stent procedures. What is important here is deciding what is most suitable for the patient," he said.

"Chest arteries are more successful long-term than leg veins"

Prof. Dr. Güden, noting that vessels from different parts of the body are used in coronary bypass surgery, continued as follows: "During bypass, chest arteries, arteries taken from the arm, or veins taken from the leg can be used. What matters is preferring chest arteries as much as possible. We want to use 2 chest arteries whenever possible to keep the vessels open for a longer period. In bypasses performed using chest arteries, stenosis rates over 10 years are around 10 percent. However, when leg veins are used, stenosis rates over 10 years can reach 40 to 50 percent. Because there is a significant difference between them, we recommend our patients undergo bypass with arteries."

"Surgery via robotic, endoscopic or direct visualization"

Prof. Dr. Güden, referring to differences in incision size in coronary bypass surgery, provided the following information: "Surgery can be performed standardly by making a 17 to 18 centimeter incision in the breastbone. There are also methods performed with a small incision through the ribs on the left side of the chest, called minimally invasive techniques. Operations with small incisions can be performed robotically, endoscopically, or under direct visualization. The biggest advantage of minimally invasive surgery is the small wound and faster return of the patient to daily activities. If the patient will require bypass from many vessels and the quality of the coronary arteries is not good, the minimally invasive method should not be preferred. However, if there are 2-3 vessel occlusions, the minimally invasive method can be used. Here, our decision is based more on the quality of the vessels rather than the number of vessels. If the quality of the vessels is good and no chest damage such as chronic bronchitis has occurred, surgery can be performed with a small incision using robotic, endoscopic or direct visualization assistance."