March 29, 1999
Contact: John Pontarelli or Bridget McManamon
(312)942-5949
Rush Cardiologists Using New Alternative to Surgery to Re-Open Blocked Heart Bypass Grafts
A new device that increases the effectiveness of angioplasty procedures to re-open blocked heart bypass grafts offers patients an alternative to open-heart surgery, according to cardiologists at Rush-Presbyterian-St. Luke's Medical Center. Traditionally, 25 percent of all heart bypass grafts that become blocked required additional open-heart surgery to replace the graft.
Rush is the first medical center in Chicago to use the new Guardwire system as part of a randomized multicenter study of 800 patients. The study will examine the effectiveness of the device compared with standard methods of treatment to reopen blocked bypass grafts including the use of existing angioplasty balloons, stents, other interventional medical devices and open-heart surgery.
"About 400,000 coronary artery bypass graft surgeries are performed in the United States each year, and 25 percent of these grafts narrow or become blocked within five years," says Dr. Gary Schaer, director of cardiac catheterization laboratories at Rush. "It is imperative that we identify a safer, less invasive alternative to treat heart disease so fewer patients require repeat surgery." More that 3,000 procedures are performed in the cardiac catheterization labs at Rush each year.
During angioplasty, a cardiologist threads a catheter through the femoral artery -accessed in the thigh -- to the coronary artery in the heart. With the Guardwire system, a small, flexible wire with an inflatable balloon at the tip is advanced through the catheter, past the blockage to the site where the bypass vein meets the coronary artery.
The Guardwire system works by sealing one end of the bypass graft with a balloon to prevent the debris that is produced when an angioplasty balloon is inflated in the bypass vessel from floating downstream into the coronary artery. A second balloon is inflated at the site of the blockage, pressing the material that caused the blockage against the vessel wall within the bypass graft to restore blood flow to the heart. A low-pressure vacuum aspiration catheter is threaded along the guide wire to draw out remaining debris from inside the vessel.
"Physicians have avoided the use of angioplasty in patients with diseased, old, bypass grafts because of the serious complications that can arise when debris dislodges during angioplasty and then blocks a coronary artery downstream," says Dr. Jeffrey Snell, associate director of interventional cardiology at Rush.
"Unlike plaque that narrows or blocks a coronary artery, a combination of easily crumbled (friable) plaque and organized blood clots narrow a bypass graft. This material often breaks loose when an angioplasty balloon is inflated in the bypass vein graft. This complication is rare when angioplasty is performed in a coronary artery for the first time."
A bypass vein graft is a piece of a long vein from the leg, the saphenous vein, thatRush Cardiologists Offer Alternative to Surgery is removed and one end is sewn onto the artery in the heart that is blocked. The other end of the vein is attached or "grafted" to the coronary artery below the blocked area. Blood can then use this new path to bypass the blockage and once again flow freely to the heart muscle.
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