Beating-Heart Bypass for Moyamoya Disease

Moyamoya is a disease which causes severe narrowing and blockage of the arteries in the brain, causing patients to face a high risk of strokes and cerebral hemorrhages. This rare and progressive condition greatly affects the internal carotid arteries and their branches and severely reduces blood flow to the brain. Some patients with Moyamoya disease also develop coronary artery disease, causing treatment to become even more challenging, because both the brain and heart circulation must be addressed by doctors carefully to avoid life-threatening complications.

However, there is a unique approach to this development: beating-heart bypass surgery, or off-pump coronary artery bypass grafting (CABG), is a safer option for Moyamoya patients that are in need of heart surgery. Unlike traditional bypass surgery, which stops the heart by using a heart-lung machine, beating-heart bypass surgery allows the heart to keep pumping throughout the procedure. This innovative surgical procedure greatly reduces the risk of brain ischemia, a critical concern for Moyamoya patients whose cerebral arteries are already severely compromised.

A notable case of this procedure occurred in Samsun University Hospital, where Turkish surgeons like Dr. Emrah Ereren performed a beating-heart triple bypass on Murat Şanlıer, a Moyamoya patient with fully blocked carotid arteries. Due to the risks of stroke during surgery, the surgeons avoided stopping the heart to prevent any disruption that could send blockages to the brain, keeping a heart-lung machine on standby incase anything went wrong. The surgery was five hours and was a success, with the patient recovering well after intensive care. This case demonstrated that with skilled teams and careful planning, this surgical procedure can be performed safely even in high-risk Moyamoya patients.

Beating-heart bypass surgery also offers significant benefits for Moyamoya patients with coronary artery disease by reducing the risk of neurological complications, such as perioperative strokes, through maintaining the heart’s natural pumping and stable blood flow to the brain throughout the operation. 

Today, beating-heart bypass surgery is improving care for Moyamoya patients with coronary artery disease. By keeping the heart beating during surgery, doctors can avoid using a heart-lung machine and facing further complicatons, which is especially important for Moyamoya patients who are sensitive to reduced brain blood flow. Although only a few cases have been reported so far, there is growing evidence that beating-heart bypass is a safe and effective option for patients with both blocked heart and brain arteries.

Written by Anonymous at Incisionary

APA References

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