life after Bypass surgery,Black Tea Per Day Can be good for patients with Cardiovascular Disease

By Live Dr - Sun Apr 12, 3:31 pm

Bouncing Back From Bypass — In-Depth Doctor’s


Stephen Ball, M.D., a cardiothoracic surgeon at Vanderbilt Medical Center in Nashville, Tenn., explains a new minimally invasive bypass surgery.What is the new bypass surgery and how does it work?

Dr. Ball: The operation was first performed in the mid 1990’s but did not gain popularity.  It is now enjoying a resurgence.The name of the procedure is minimally invasive direct coronary artery bypass and it’s referred to commonly as MIDCAB. It’s radically different than conventional bypass surgery, primarily because, instead of making a sternotomy, where the sternum is sawed open, we make a smaller incision in the left chest and take the mammary artery from inside  the chest wall and utilize that as a bypass graft to the artery in the front of the heart. The other difference in the way many conventional bypass operations are performed is that typically the patient is put on a heart-lung machine and the heart is stopped during that part of the procedure, but in this procedure, we don’t stop the heart at all.

What are the benefits of this procedure?

Dr. Ball: There are multiple benefits. Some are related to the fact that you’re not on the heart-lung machine, and some are related to the fact that you don’t have a sternotomy. The benefits for not being on the heart-lung machine are somewhat controversial, but we know for sure that patients require fewer blood transfusions and have less overall trauma from surgery so they recover faster. The advantages for it being a thorcotomy approach instead of a sternotomy approach are, with the latter, the bone is actually sawed open, or in two, and it’s wired back together so sometimes there’s some instability to the bone that’s put back together. With this approach, we don’t cut through any bone at all, so there’s no instability in the chest wall. Also, one of the fears in doing a sternotomy is infection. We haven’t seen infections with the minimally invasive approach, but if we were to have an infection, it would not be nearly as serious as it would be through a sternotomy approach. Even though infection is not common in the conventional approach, it’s always a concern. We don’t do any kind of manipulation of the aorta and don’t go on the heart-lung machine, so we feel as though we have much lower risk of stroke and other risks associated with being on the heart-lung machine.

What is the Metronic device that is sometimes used in the procedure?

Dr. Ball: One of the pushes in cardiac surgery over the last ten years or so has been to try to develop a way to do off the pump surgery — to still do the sternotomy and do multiple bypasses, but do it without using the heart-lung machine so the heart is still beating. Only about 15 or 20 percent of conventional operations are done that way. Metronic came up with a way to stabilize portions of the heart and other companies have come up with similar products. In the course of developing that, they realized that technology could be applied to the MIDCAB procedure and in some instances it allows us to make this approach and not only do the bypass I was referring to in the front, but even one or two other bypasses. It’s a fairly simple concept; a device that’s put on the surface of the heart and has small suction cups on the bottom of the device that enables you to stabilize a small portion of the heart so you can work on the artery. The arteries are pretty small; most of them are about two millimeters in size so you have to sew a graft to a small vessel like that and, obviously, you need a stable, still environment to do that.

Is using this device for multiple bypasses a pretty recent approach?

Dr. Ball: It is recent that this approach, through the thorcotomy incision, has been used to do multiple bypasses. In the late 90s, some people started doing the single bypass with that approach and it lost some of its popularity as off-pump surgery started gaining some degree of popularity, but it’s coming back now for several reasons. One of them is that the technology, with off-pump surgery, has really helped this other procedure be extended beyond just the one bypass to multiple bypasses.

Do you think procedures like this will be used more in the future?

Dr. Ball: They’re definitely going to be used more in the future. Cardiac Surgeons have been pushing forward to try to make the operations we do less traumatic to the patient and allow a quicker recovery, but always at the same time, we try to make sure we don’t compromise how well we treat the patient. That’s the rub; that’s the challenge. You don’t want to skimp on how well you take care of the underlying problem just so the patients can recover faster, but as technology continues to come along, we think that the technology associated with the cardiologist, in terms of using stents, will be combined with this approach so the limitations stented arteries have can be overcome somewhat by some of these less-invasive bypass procedures, and vice-versa. Some of the limitations of bypass surgery can be aided with stents and in the course of that, provide complete treatment of coronary disease with minimal trauma and risk.

Is anyone not a good candidate for this procedure?

Dr. Ball: Right now, we still have difficulty in people that have a lot of scarring, either around the lung or around the heart that would limit access. Some people, depending on what kind of heart surgery or other types of surgery they might have had in the past, would be a poor candidate for that. Beyond that, we’re in the process of trying to study how we can treat people with multiple vessels involved, because right now, if you have enough arteries involved, we still have to go through the conventional approach to make sure we take care of all the arteries; but that’s under study. Some of us have the theory that we can still treat the important artery in the front with the mammary artery, and perhaps treat the other blockages in different ways, either with stents or with medicines, in order to avoid the more traumatic surgery, the conventional operation. We don’t have enough data to be able to confidently recommend that to all patients, but we’re studying that right now. If you study large numbers of people with coronary disease and those that have the mammary bypass graft — that, as I said earlier, is the artery that runs along the inside of the chest wall. It’s graphed to the artery in the front of the heart — the LAD. That bypass graft is the one that’s associated with prolonging life and has the best long-term outcome. The vein bypasses, which are used typically for the other bypasses performed — for instance, the artery in the back of the heart, the circumflex, or the right coronary artery, typically either a vein from the leg or an artery from the arm  — those don’t stay open as long and are not associated with the benefits that the mammary artery is. We feel that with a minimally invasive approach, we can do the most important bypass and perhaps the other arteries can be better treated in other ways.

Where do you see your practice going in the future?

Dr. Ball: In the near future, I see the minimally invasive procedures as becoming more and more popular. In the intermediate term, I see some other technologies that may be as helpful, such as stent technologies, improving. For some of the technology involved with stem cells, which are used to encourage growth of either muscle and/or blood vessels in the heart, I anticipate that technology would improve in the intermediate term. Long-term, I hope we come up with medicines that would dissolve blockages like Drain-O does in clogged drains. That would have an impact on how we treat coronary disease in the distant future and would help avoid stents or surgery.

Are there any risks with the minimally-invasive technique that would be more prevalent than the conventional operation?

Dr. Ball: I think that’s a great question. That’s what I was getting at earlier when I was talking about the fact that we want to do these less-invasive procedures, but we don’t want to compromise what we do. The obvious question is with this approach, are you risking any compromise for treating the blockage? The answer is yes, and that’s one reason why the procedure has not caught on already. I mentioned earlier that the procedure was done in the late 90s and really didn’t catch on. The popularity was usurped by other techniques like off-pump bypass surgery. The concern has always been that, since you’re working through a small incision and the heart is beating and moving, can you sew the bypass as well? There were some studies that suggested that the patentcy rate — that is to say the bypass staying open — were not as good for this type of approach as for the conventional operation. That prompted some people to stay away from that operation even though it was less invasive. It’s better to have a bigger operation if you can be more certain that your bypass works well. The way we’ve gotten around that is with some of the new facilities we have here, in conjunction with other ideas we have about how to combine approaches with cardiology and surgery, we have what’s called a hybrid operating room, which is essentially an operating room and a cath lab, where the arteriograms are done. We can do multiple procedures in that one room, on the same patient, at the same setting. We can do stents, we can do bypass surgery, we can do valve surgery and stents. One of the things we do when we do the minimally invasive bypass is, once we’ve done the bypass, we then do an arteriogram so we know for sure that that bypass is open and works well. That should eliminate the concern about whether or not it’s done as well. So the one concern is how well the bypass is done and we feel like we’ve got a good handle on that.

How often is this surgery performed?

Dr. Ball: I think it’s probably important to point out that the operation is not done very commonly at all. My estimate would be that there are fewer than 10 centers in the United States that do this, and even in those centers, it’s really an occasional operation that’s performed. There are only, as far as I’m aware, three or four hospitals that have a hybrid operating room set up the way we do, and they don’t all use it the way we are using it, in terms of checking our graphs at the end of a procedure. It’s not done in very many places, and not done very often here, except for the fact that we, over the last 6 months, have really started ramping that up. There’s not a week that goes by right now that I don’t do at least one of those operations and it’s increasing; but the goal is not to try to do as many of them as we can, but to develop the procedure so we’re comfortable that we are helping patients. My hope for the short-term future, perhaps even within the next five years or so, would be that almost all of the bypass surgery can be done with this minimally invasive approach such that we don’t have to do the sternotomy, and can have a less traumatic operation to combine that with other techniques so people don’t need such a big operation to fix coronary disease.

What is the normal recovery time for the minimally invasive procedure compared to the traditional procedure?

Dr. Ball: It’s quite variable. Most of the people I’m performing the surgery on are ready to go home on day three. Most of the people that get a sternotomy are here for five days and some of them up to seven, even with everything going well. With a sternotomy, it takes about three months for the patient to heal, although most of them at about six or eight weeks are able to resume most normal activity.


New research reveals that drinking just one cup of regular, black tea per day may help to protect against cardiovascular disease. The research, conducted at the University of L’Aquila in Italy and supported by the Lipton Institute of Tea, is the first study to show that black tea consumption does – depending on dose – improve blood vessel reactivity, reduce both blood pressure and arterial stiffness, indicating a notably better cardiovascular health profile.

Using a cohort of 19 healthy men (mean age 33), the researchers assigned participants to one of five prescribed intakes of black tea over five periods lasting one week each. The caffeine level of each dose was standardized but the dose of tea flavonoids was controlled at levels of 0 (the control dose), 100, 200, 400 and 800 mg of tea flavonoids per day. A standard cup of black tea contains approximately 100-200 mg of flavonoids, depending on the individual preference of tea making. During the course of the research, participants avoided naturally flavonoid-rich food and drink such as red wine and chocolate to ensure that the results were a true reflection of flavonoid-rich black tea consumption only.

Professor Claudio Ferri, the principle investigator of the study and one of the lead researchers in this field, explained: “Our study demonstrates that commercially available black tea can affect vascular function in normal individuals. We clearly demonstrated that vascular function improvement exerted by black tea starts with one cup per day and further improves by increasing the number of daily cups of tea.

“We used the gold standard technique to assess the dilation of the brachial artery in response to black tea and observed a significant improvement in arterial dilation. Simultaneously, we also observed that black tea consumption lowered blood pressure and reduced arterial rigidity, thereby improving the elastic capacity of the blood vessels.

“Protection of vascular properties, starting with drinking even a single cup of regular, black tea, suggests that black tea can exert cardiovascular benefits in common tea drinkers.”

Dr Paul Quinlan, Research Director at the Lipton Institute of Tea, added: “In recent years, a growing volume of scientific research has pointed to there being significant mental and physical health benefits to be gained from regular tea consumption. This new study takes this one step further; demonstrating that tea flavonoids play a role in maintaining healthy blood vessel function, which in turn can contribute to cardiovascular health. This adds to recent evidence that regular tea-drinkers have a lower risk of heart disease, and can have as much as a 21 per cent reduced risk of stroke.

“We are delighted to have helped fund this study and helped further our understanding of the role of tea in physical wellbeing – and particularly in maintaining good cardiovascular health.”

Tea is the second most consumed drink in the world after water, and is a major source of dietary flavonoid intake in Western countries and in the Middle and Far East. The benefits to cardiovascular health that this study reveals are therefore relevant to millions of tea-drinkers globally.

A full copy of the research, Black tea consumption dose-dependently improved flow-mediated dilation in healthy males, will be published in The Journal of Hypertensionin April 2009.

The Lipton Institute of Tea is Unilever’s dedicated tea research facility, headquartered at Sharnbrook, just outside London in the UK. It is entirely Unilever funded, and works with both its own in-house experts and external tea researchers to uncover new physical and mental health properties pertaining to tea.

The Lipton Institute of Tea publishes regular academic papers, aimed at uncovering and sharing the physical and mental health benefits of tea. It is responsible for publishing The Lipton Institute of Tea Quarterly Tea Science Review, a quarterly overview of key tea science research developments from both internal and external sources and compiled to share recent studies and findings to a broader, non-specialist audience.

The Lipton Institute of Tea also operates the world’s most northerly tea ‘plantation’ at its Sharnbrook headquarters. This facility enables tea to be studied in a controlled environment, as representative samples of tea from around the world are grown. Here, the journey from bush to cup – through drying and processing – can be very much shorter than usual.

Lipton Institute of Tea

This information is intended for additional research purposes only. It is not to be used as a prescription or advice from Ivanhoe Broadcast News, Inc. or any medical professional interviewed. Ivanhoe Broadcast News, Inc. assumes no responsibility for the depth or accuracy of physician statements. Procedures or medicines apply to different people and medical factors; always consult your physician on medical matters.


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