What is the ‘bypass’ , the operation that King Juan Carlos underwent?

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This week Don Juan Carlos has had heart surgery, as everyone knows. What perhaps not everyone knows is that the operation that has been performed, a triple bypass – which means bypass or bypass, in Spanish – was not invented by a brave American, German or Japanese researcher, but by an Argentine surgeon, René Favaloro. He made the first operation of this type in 1964 at the Cleveland Clinic in Ohio, USA. During these years it has been one of the most studied surgical techniques in scientific publications.

Why have they had to operate on him?

The arteries that carry oxygen and nutrients to the heart are called coronary arteries. These are several blood vessels and each of them irrigates an area of ​​the heart. They are arteries of very small caliber and can be progressively clogged, usually due to the deposition of cholesterol or other substances. This situation is favored, among other factors, by circumstances such as hypertension, hypercholesterolemia, obesity or smoking, etc.

The arteries are gradually closing and therefore, the nutrients and oxygen that reach the cells of the heart through the blood are insufficient, producing diseases such as angina pectoris or acute myocardial infarction, etc.

When the phenomena described above occur, in addition to medical treatment to lower cholesterol, control hypertension or stabilize angina, etc. Sometimes there comes a time when you have to ‘bridge’ the obstruction of the coronary artery to bring enough blood back to the affected heart area.

This can be done in two ways. The first is through a kind of tiny spring that is placed in the narrowed area of ​​the artery after dilation (stent), is performed without opening the thorax. The second is the bypass, in it the blocked area is bridged with another blood vessel of the body such as a vein in the leg, in this way it is achieved that the blood returns to the area affected by the obstruction.

This operation is performed under general anesthesia and opening the patient’s chest. The intervention is performed by stopping the heart for approximately 60-75 minutes, during which time an extracorporeal circulation machine pumps the blood. After this time of “suspense” in which the heart does not beat, it is put back into operation and everything returns to normal, something that seems like science fiction. This is the operation they have done to the King. Sometimes surgery can be done with the heart beating.

And why open-hearted?

The indications of one technique or another (stent or bypass) are established by multiple studies that compare them. With these studies, clinical guidelines are carried out, which are used by the so-called “heart teams” , which are groups of specialists who review each case individually and decide which is the most appropriate treatment.

The bypass, generally preferred to the stent , in more complicated cases, affecting several coronary arteries when obstructions are long and complex or in diabetics, for example. It seems that the operation has better long-term results than stents and therefore after a few years in which they have been in “fashion” it seems that the number of open surgeries is increasing again.

The Story of René Favaloro, who returned to his native country, did not end well. The doctor ended up committing suicide, paradoxically, shooting himself in the heart for disagreements with the government that led him to ruin. But, along the way, he saved thousands of people across the planet through his technique and will be remembered forever.

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