Moderator: Hello everyone, welcome to the Yahoo Guest Interview Room! Today we have Dr. Zhang Yong, Chief Physician of the Cardiopulmonary Vascular Disease Center at Beijing Military General Hospital, giving a talk on minimally invasive bypass for coronary artery disease. Welcome!
Zhang Yong: Hello, everyone.
Moderator: Minimally invasive bypass is a new technology, right?
Zhang Yong: Yes.
Moderator: How long has it been in use?
Zhang Yong: This concept is rather big, minimally invasive we actually for many years, but this concept is difficult to say exactly what is minimally invasive, for example, our coronary heart disease patients need to do bypass, so from the minimally invasive, one is not to use extracorporeal circulation itself is minimally invasive, in addition to a variety of incision smaller technology are minimally invasive. So this is already a relatively long time ago, but we use it in China in the late 90s. It is not too long. In other words, in our country, bypass is gradually becoming mature, a group of people started to do bypass at the end of 1990s, of course, there is an earlier group of people who are the pioneers in doing bypass, they are the older generation, that is, doing some conventional bypass technology, the volume is not too much, at the end of 1990s, we do this kind of surgery in large quantities in our country, and the technology maturity is also gradually in line with the international, at the same time, that era also quickly did the minimally invasive The technology.
Moderator: Yes. Then this new technology, bypass surgery seems, like I’m not a professional, I’ve heard of bypass surgery seems to be quite common, but minimally invasive bypass said it is a new technology, it will be advanced in what, where is the progress?
Zhang Yong: I will introduce the bypass to you, simply say minimally invasive may be more difficult to understand. Like coronary heart disease to a certain degree, because coronary heart disease treatment now a drug therapy, a stent, medical intervention, and surgery is mainly refers to bypass surgery. Conventional technology, we use extracorporeal circulation, the heart to stop, to use extracorporeal circulation to replace the work of the heart and lungs, the heart in a resting state we do surgery to connect the blood vessels, blood vessels to take their own blood vessels, generally from here to take the artery, from the arm, leg to take the artery, most of the general patients to build three, four bridges, take the blood vessel technology, of course, there is also minimally invasive, that is to say, the original take the blood vessels than to take the thigh, arm are fully cut. Now we can use lumpectomy, for example, a long incision of 30 or 40 centimeters on the thigh, but now it may be two centimeters a mouth, so the whole blood vessel is taken out from here with lumpectomy, which is minimally invasive locally.
Moderator: Localized.
Zhang Yong: Yes, the local incision is minimally invasive. The biggest minimally invasive aspect of the heart is that the extracorporeal circulation is no longer needed, and the heart has to stop, but now it is not needed, and the surgery is done with the heart beating. This has less impact on the patient. The original heart surgery heart to stop, the whole play a lot of heparin, the patient’s average blood pressure on the brain, liver, kidneys are affected.
Moderator: I can understand that the risk factor of doing surgery on the basis of non-stop beating is less?
Zhang Yong: Yes, the risk factor is smaller. The risk is less. The trauma to the patient is less. The technical requirements are more difficult.
Moderator: Oh, the difficulty is higher?
Zhang Yong: Yes, because the original is done at rest, the heart does not move, we do the operation is easier.
Moderator: Right.
Zhang Yong: Now it is beating. The whole heart is beating, depends on the heart to supply blood, to feed, the whole body’s blood pressure to maintain, or rely on its own beating.
Moderator: Does this make the operation time longer?
Zhang Yong: No, it was shortened. Because we have to do extracorporeal circulation on the one hand to do intubation, to stop the bleeding time is long, do not need to use these then these time will be saved. Anastomosis technology has also improved, the original is a few minutes, now is also a few minutes, these are not because of non-stop beating and increased the anastomosis time, so the whole operation time is shorter. The localized ones have the whole heart beating, and we have a fixator to do this locally, so that it will be less beating locally. A small piece of one or two centimeters, we operate as little as possible, the rest of the normal movement, equal to this piece of movement, this piece of movement is not strong. This way the whole technique has less impact on the patient. Then the operation time has not been extended but shortened, which is a big progress.
Moderator: What is the risk of this surgery compared to the previous surgery?
Zhang Yong: The risks are the same as those of ordinary small and large operations. For example, during the perioperative period, some patients will have vasospasm and heart attack during the surgery period, which is relatively low, that is 1%-3%. The mortality rate of common major and minor surgeries is 1 to 3 percent. The non-stop rate is around 1%. Of course, the individual may not be exactly the same.
Moderator: The success rate is actually quite high?
Zhang Yong: About 99%. The success rate of ordinary bypass is also in 97%-99%, the whole technology is still quite mature.
Moderator: Just now you mentioned that the coronary heart disease to a more serious degree before you choose surgery, right?
Zhang Yong: Yes.
Moderator: If you have heard that the success rate is so high, then I want to eliminate the pain of taking medication for a long time can have surgery?
Zhang Yong: This treatment should be a comprehensive treatment, you do bypass, put stents have to take drugs, take drugs is the basic treatment. Because coronary heart disease related factors are more, a high blood pressure, high blood pressure, high blood sugar, which is more obvious factors, and obesity, lifestyle habits are also related, and the environment is related, and the family is related, that is, genetic aspects are related.
Moderator: Coronary heart disease is also related to genetics?
Zhang Yong: Yes, now many factors in this, you can not out, you to a good environment may reduce a factor, but there are many factors, your blood pressure, blood sugar, lipid control, these three elements can be removed, which is very useful. The other is obesity, smoking, these two elements to remove and reduce a large number of people. However, to remove these factors, such as high blood sugar, high blood lipid, high blood pressure have to take drugs, so drugs are the basic treatment, you do bypass, stent things, blood sugar, blood lipid, blood pressure still exists, or to take drugs, for example, drugs for hypertension, there are many drugs are repeated. So whether it’s bypass or stenting or medication, it all depends on the patient’s condition. If the patient does not need stenting or bypass, he may only need medication to control the disease. Some patients asked if they could have a second or third bypass, and they did. In foreign countries, second or third bypass is not uncommon, and we have done many second operations.
Moderator: Why would you want to do a second or third time?
Zhang Yong: Some of them are blocked again, some are done in other places may not be particularly mature technical conditions, and problems arise again, of course, there are various factors, there are also with the individual’s constitution, preventive drugs are not used well, or even if you have done everything, preventive drugs are also eaten well, when the surgery was done without problems, but his coronary heart disease progressed also appear narrowing, some patients also need to do a second, or even a third. Even the third time.
Moderator: So whether to do this surgery depends on the severity, there are other requirements?
Zhang Yong: According to the patient’s physical condition and the condition of the cardiovascular lesions. If he does not feel obvious, we should be more cautious in choosing the second surgery, if he feels obvious and the angiogram is really obvious, then we have to do it a second time, or do it again, need to do it again.
Moderator: Hmm. How long would this procedure normally take? It’s a major surgery, right?
Zhang Yong: The first time or the second time?
Moderator: The first time.
Zhang Yong: Generally the specific operation takes three hours. But pre-operative anesthesia, post-operative some… Moderator: recovery?
Zhang Yong: But the operation may take a little longer. The whole from the operating room to come out that 4, 5 hours, or longer, depending on the preparation, some anesthesia preparation time is fast, half an hour to get ready, then we are faster, some preparation is not so fast or is the artery is not good puncture, or tracheal intubation is not good insertion, may have to prepare for a long time, the operation time is long, the specific operation to three hours.
Moderator: How many cases have you done so far? Do you have a calculation?
Zhang Yong: There are more than 2,000 cases of bypass. At least more than 2300. (laughs) Host: That means the population of patients with coronary heart disease is still very large?
Zhang Yong: In fact, we have a lot of domestic coronary heart disease patients, including Beijing, Shanghai, Guangzhou, some major cities and many have not done, including some celebrities, that is, those who died suddenly celebrities, from this point of view of our domestic sudden death of people than abroad, the United States at most a year to do more than 400,000 bypass patients.
Moderator: on this surgery?
Zhang Yong: Yes. We only have tens of thousands, 20,000 to 30,000 in China. Our domestic population is their …
Moderator: The number of people is more.
Zhang Yong: Yes, several times more than them, although our incidence rate is lower than theirs, but every year there should be hundreds of thousands of patients needing surgery, but now, to be honest, many people in China do not realize the seriousness of the disease, the disease is more serious than cancer, I tell you this one point of view, more serious than cancer. Because when you have the disease, it is faster than cancer to die. It’s a disease that can kill you as soon as you say it will. But it is much better treatment, you may have one surgery never need to do surgery again in your life, just take medicine on the line, his recovery may be the same as normal people, climbing, travel, work and normal people as well. But you will need to take some heart rhythm control drugs, blood pressure lowering drugs, to control blood lipids, blood sugar, is conditioning. But if you don’t treat it, you will die soon, such as heart failure, but if you treat it in time, the effect is very good, which I think is in our public health education, we are not doing enough. Because of our health department to do this aspect of publicity less people are not so profoundly aware of this disease.
Moderator: indeed not so much. You just mentioned timely treatment, and you also mentioned sudden death, there are a lot of seemingly, we understand that most of these public figures, they may not know that there is this problem, then in the end to what extent we have to go to the hospital treatment, understanding, and even to understand the surgery related things?
Zhang Yong: This is to say, one of our normal experience, such as 40 or 45 years of age or older, especially men’s annual physical examination to pay special attention to heart problems, blood pressure, blood sugar, lipids, these problems. There are also some obese people, we should pay special attention to whether there are any problems in this area, in addition, that is, whether there are symptoms related to angina, these symptoms, pain or neck and shoulder pain, there are these symptoms it should go to the hospital to see, timely diagnosis, there is no heart ischemia, is not coronary heart disease, if it is after a better doctor to give you a guide, you should do, is to take drugs or do imaging Further how to do, because now coronary heart disease is indeed, we know a lot of people, including their own family members, after the symptoms I told my family that you are very typical, but also to do work, the elderly are also to do work.
Moderator: He will feel the surgery is quite scary?
Zhang Yong: Yes, also have to do work, although I am doing this professional, I have to do work, some say to wait, this is not good.
Moderator: This surgery has to be decided on the spot, right?
Zhang Yong: Yes, this morning we are looking at a particularly serious patient, he is 02 years in our Beijing a relatively large tertiary hospital to do a contrast, he is a very serious disease, but he has not done, and now live in our hospital, the pain many times a day, the whole person is not walking, usually a walk on the pain is not walking, but he himself is still hesitant, I specifically want to talk to this patient today.
Moderator: What is his hesitation? Do not trust this technology?
Zhang Yong: No, he has not yet done the contrast, he is worried about a lot, worried about high blood sugar can do the contrast, worried about my leg is not affected, do the contrast penetration place will have an impact. A few days ago a patient to do bypass, I communicate with him, because he is doing technology, do mechanical aspects of technology, I talked to him and said, I am also engaged in technology, you are also engaged in technology, because he asked me a lot of technical aspects of the problem.
Moderator: Directly asked about the details of the surgery?
Zhang Yong: Yes. I told him, you trust the doctor, we are engaged in technology, you see we are only the surface, you need to understand our profession need to read more than 10 years of books, you must at least understand the disease, understand the full at least half a year to read books, can understand clearly is not bad, so I advised many patients that is not to put the technical aspects of things to dwell too long. The doctor has to tell you that this surgery must be done, and there must be a need for it, so as long as you are in a regular, large hospital if you make this decision, I think there should be no problem. Unless you go to some irregular hospital, I can’t say.
Moderator: The patients you mentioned before have a comprehensive examination was done, the doctor has done so many tests need to do surgery, we just mentioned that there are some people in emergency situations sent to the hospital can do surgery directly?
Zhang Yong: some emergency surgery, we have done a lot of such surgery.
Moderator: emergency cases directly into the operating room?
Zhang Yong: also have to do imaging first. For example, some patients come in a special hurry, some patients are ventricular fibrillation, we recently had a patient who fibrillated 20 times in a row, this patient can only do emergency surgery. Other patients have pain after they come in, and after the angiogram, they look particularly heavy, the blood vessels are particularly heavy, the blood vessels themselves should be 3 or 4 mm, or more than 2 mm, but when they look at his angiogram, they find that his narrowed blood vessels are only as thin as a hair.
Moderator: That’s dangerous!
Zhang Yong: Yes, if the hair is broken, he will lose his life, so this has to do emergency surgery. It is still based on the patient’s condition.
Moderator: I see some friends asked about the cost, this surgery sounds like it should be a pretty expensive surgery, right?
Zhang Yong: this surgery, generally 60,000, 70,000 bar, some hospitals may be more expensive, our hospital is comparable, 60,000, 70,000 should be considered not too expensive bar, now there are many hospitals is about 100,000. If you want to do it, you have to choose some things, if you use the lumpectomy to take the vein may be 80,000, the conventional is 60,000 or 70,000.
Moderator: Then if you are ready to do this surgery, or this surgery just finished, for example, there are some pre-operative, post-operative care, what are these need to pay attention to?
Zhang Yong: this thing, the family in the hospital to do not too much work, doctors, nurses have helped you do, you will comfort the patient, let him eat normally, do not say do the surgery on a big meal, do not be too nervous, is a normal state of mind, pre-operative doctors will tell you all kinds of conditions, the patient risk level also told you, if the patient is particularly heavy, you will certainly tell you the risk is relatively large, if it is a If it is a routine surgery, the doctor will tell you the routine, and some other preparations, including drugs, will be prepared for you inside the hospital, which patient needs to eat which drugs, according to the situation is in accordance with medical advice, so the family does not have too much work in the hospital, after the surgery is to accompany the bed, that is, to eat and chat with the patient, accompany the patient out of bed.
Moderator: How long does it take to recover?
Zhang Yong: Two days to get out of bed. The day after today’s surgery, he was able to get out of bed and move around.
Moderator: so fast!
Zhang Yong: Generally speaking, after the surgery, you can move to the general ward the day after tomorrow, and then you have to get out of bed.
Zhang Yong: Yes, the wounds are smaller, one is the minimally invasive leg, and the other is the minimally invasive chest incision, which is about one-third to half smaller than the normal incision.
Moderator: How big is normal?
Zhang Yong: about 20 centimeters, right.
Moderator: The incision is open.
Zhang Yong: I started to do small incision in 99 years, from 05 years, the first case in the world to do three branches of the lesion, all done with small incision, the purpose of doing small incision, and we also do minimally invasive venous extraction on the leg, with lumpectomy to do is to encourage the patient to move earlier, less damage to him, early activity, small incision recovery is really faster, on the leg, especially on the leg, like the chest incision we do not cut the top, the whole thorax Although we use steel wire to fix it, but it may move, some of them will not move, of course, there will be, because it may be coughing hard, so there is a certain impact on the wound healing, but if you leave a piece of him how to cough can not cough, which will reduce some risks. Even if the incision below is infected, there is no big risk, but if the whole incision is made, the chest wound infection can sometimes be very risky and even life-threatening. Why should this be minimally invasive? The main reason is to let the patient recover quickly, from early activity, less damage.
Moderator: To encourage patients to exercise as early as possible, even if fully recovered, you should also pay attention to exercise, there are many people I had bypass surgery, so my actions must be how to how to pay attention.
Zhang Yong: In fact, now from every patient we have done, we have to give him an education, before discharge to do an education, that you need to move, after surgery recovery is on their own, the drug is to regulate blood pressure, blood lipids, blood sugar and these things.
Moderator: You can’t go home and stay still.
Zhang Yong: can not regulate physical strength, physical strength is to recover by themselves, so after the bypass surgery patients, need to do as soon as possible to gradually recover physical strength, should be about a month to gradually return to normal physical strength. If you are an elderly person, you will be able to regain your strength in three months at most.
Moderator: To be able to climb mountains, to be able to return to normal strength?
Zhang Yong: Yes. 40, 50 you were able to go to work now can also go to work, we are now asking patients so that you go home without any discomfort to continue to exercise, there is discomfort to the hospital to see, no, then continue to exercise. For example, if you are a valve patient or a patient with a precordial heart, some patients are suitable for exercise and some are not, but all patients who have a bypass are suitable for exercise, most of them, only some of them have obvious heart attacks and poor heart function, so we will tell them not to exercise too much, but to be especially careful and increase slowly. The vast majority of patients with good preoperative cardiac function and good postoperative cardiac function will have to make an exercise program, walking 10 steps today and 20 steps tomorrow. This is how to exercise.
Moderator: Here also want to remind everyone. There are friends say how much it costs to build five bridges?
Zhang Yong: This is similar to the cost of four bridges, or just a couple of thousand more, because we have not counted, the whole thing is about the same. And the stent is different, a stent 20,000, and then put a stent is 40,000, you do four bridges, we add another one is an extra stitch, it is only a couple of hundred, may be some other increases, such as anesthetic drugs, gauze ah, not much increase in cost.
Moderator: For example, bypass, stent this surgery inside the different categories?
Zhang Yong: stent is internal medicine, internal medicine interventional treatment. Just now we talk about three different treatments, one for coronary heart disease is drugs, one is stent, one is bypass surgery. Both drugs and stents are medical treatment. Drugs are internal medicine, stents are internal interventional treatment, and bypass is surgical treatment.
Moderator: So which treatment I want to use is based on my own situation and also based on the doctor’s examination, right?
Zhang Yong: Yes, according to the doctor’s advice, the doctor said you are suitable for this treatment that you do this treatment.
Moderator: Well, you can’t listen to the bypass surgery treatment is very good and you can’t necessarily use this?
Zhang Yong: Yes. If the doctor tells you that you should do bypass, then you should not consider the stent, the general rule is that bypass is the most complicated, if you tell you should do bypass.
Moderator: That means the situation is quite serious?
Zhang Yong: Yes, there is no need to consider anything else.
Moderator: We just talked about the process of treatment, of course, it seems to notice the trend of coronary heart disease is younger, so please tell us how to prevent these problems arise.
Zhang Yong: Now, as mentioned earlier, certain factors related to coronary heart disease, including obesity, blood sugar, blood pressure, blood pressure, smoking, environmental factors…
Moderator: lifestyle habits.
Zhang Yong: lifestyle habits, and genetics, which things we can master. We can only prevent, what things, these related factors, of course, there is a movement, we can control how much on a large aspect, like we say, the environment, the environment we can change, but we have to change, not a person change, so you can find yourself a small good environment, such as you live in the suburbs, buy a building to live in the suburbs, or you can plant some flowers, trees, which is a small environment. The big environment is to work together to transform the environment. The other is smoking, that you …
Moderator: less exposure to alcohol and tobacco?
Zhang Yong: Yes, quit smoking, because smoking is a relatively clear risk factor for cardiovascular disease. You just mentioned wine, wine in this does not play such a big role, because a small amount of alcohol, especially wine or intentional health. As long as you do not drink alcohol should not be a big problem, so we did not mention the wine, although we mentioned here, that is, we do not drink alcohol, the bad effects of alcohol abuse everyone knows, mainly bad for the liver.
Moderator: Yes.
Zhang Yong: obesity, if you are more obese people should go to lose weight. Obesity increases the burden on the heart, which is one aspect. Obesity tends to increase blood lipids, obesity tends to cause hypertension.
Moderator: If the obese patient surgery is also quite painful, right?
Zhang Yong: Yes, last week I did a 98 kg. (laughs) The oil is very thick.
Moderator: It is also more difficult for him to recover, right?
Zhang Yong: Yes, this kind of surgery is also difficult to do. Obesity is really bad. Should try to lose weight, this is one. Another is exercise, exercise is very important. You have two kinds of obesity, one is false fat, one is real fat, people who do not exercise is false fat, that kind of people are particularly difficult to recover. It is easy to incision infection, prone to some syndrome, prone to other aspects of the problem, anyway, is this kind of people deficient ah, he will do surgery prone to problems.
Moderator: Yes, the whole body is not good.
Zhang Yong: Yes, some people are fat but especially like to exercise, this kind of people are generally not a big problem.
Moderator: This kind of person is not a big problem.
Zhang Yong: Yes, the surgery is not a big problem, but the impact on the body still has an impact, or easy to produce some blood pressure, blood lipid problems.
Moderator: the load is large.
Zhang Yong: Yes, but he exercised, his heart function improved, so this kind of people still have the ability to some emergency, if it is fat and do not exercise people will be in trouble, be careful. These are some of the factors that we can control. As I said earlier, environmental factors try to improve, quit smoking, lose weight, go to exercise and diet regulation, do not eat too fatty, but also do not make the malnutrition, the diet should be well matched. There are also things that we can control ourselves, including hypertension, hyperglycemia, hyperlipidemia, some young people also have.
Moderator: These are the risk groups for coronary heart disease?
Zhang Yong: Yes, there are many young people have high blood pressure, these we can control with drugs, the front is not drug control, these many things we can control, there is one can not control, that is, genetics can not be controlled, the front said we can control, so from the prevention or a lot of work can be done, eat less, walk more, quit smoking, limit alcohol.
Moderator: Well, we pay attention from the normal lifestyle. But the doctor still wants to go into the operating room as few times as possible, the better.
Zhang Yong: Yes.
Moderator: Some friends asked whether our hospital is the most authoritative? About the technology of minimally invasive bypass surgery.
Zhang Yong: You can’t say that about yourself.
Moderator: But it is very mature.
Zhang Yong: Yes, the number of minimally invasive bypass cases in China is the largest, but also relatively early. 99 years to do, our entire bypass technology is the end of the 1990s, the whole country began to open. We have done, personally I have done more than 2,000 cases of bypass surgery, the mortality rate is about 1%.
Moderator: The success rate is very high.
Zhang Yong: It should be 0.9 several.
Moderator: From 99 years to now?
Zhang Yong: Yes, in our hospital, including in other hospitals, I used to work in two other hospitals in Beijing.
Moderator: Always heart surgery?
Zhang Yong: Yes, and two other large tertiary hospitals.
Moderator: You’ve seen a lot of real human heartbeats. (laughs) Zhang Yong: Our favorite thing to see is the heartbeat.
Moderator: Right.
Zhang Yong: At that time I chose the department, what to do, because I was already to the surgery, is to do general surgery, orthopedics and so on, I most want to see the heartbeat, the source of life, and this post-operative effect is more satisfactory, unlike tumor patients have to chemotherapy, look very cold.
Moderator: Maybe the surgery process sounds risky, but the post-operative period is still relatively good.
Zhang Yong: Yes, the postoperative period is alive and kicking. We treated some children.
Moderator: Hmm. That’s because of heredity.
Zhang Yong: Yes.
The host: another friend said, he said the viral myocarditis can be cured?
Zhang Yong: this does not belong to our category, is the internal medicine.
Moderator: Another friend said heart bomb can be treated surgically?
Zhang Yong: I don’t know, this may be the wrong fight.
Moderator: Well, after this friend can leave us. This should not be a problem in terms of surgery, treatment, you said the technical issues to the doctor, first do the examination and then determine which method to use.
Zhang Yong: Yes, what should the patient think? Doctors tell you how this disease should be treated, should do surgery or put stents or take drugs, this is difficult if you go to explore the details, you tell your concerns to the doctor, I do not understand this area, to tell you, we will talk about it, we will introduce the patient’s various conditions clearly, this is our responsibility.
Moderator: Risk is also mentioned?
Zhang Yong: Yes, the risk, success rate, how to do, but if you say that the particular details of the problem, you have to go to the words of this there are many patients ask, ask half a day, listen also can not understand.
Moderator: The patient’s mood is still understandable, after all, is worried.
Zhang Yong: Yes, we speak for a long time some still do not understand ah, some delayed the operation, some asked a long time, and then discuss, and then some families are a large number of family members.
Moderator: family meeting.
Zhang Yong: Half a day of discussion, but we still have to explain to the patient, how this should be done, but he also have to consider, in fact, that is to say that many things are not that you can understand, on many of us the more important people to do the treatment is more complicated. In fact, some patients need to do emergency surgery, especially emergency surgery, need to hold many meetings will be a problem, for example, the mayor of a city to do surgery, it will be a problem, hold many meetings, and when all the meetings are finished the time has passed, the doctor told you to make a decision as soon as possible is certainly more urgent, so the majority of patients still need to consider, if the doctor told you that this patient is particularly urgent, should be made as soon as possible decision If the doctor tells you that this patient is particularly urgent, you should make a decision as soon as possible. Coronary heart disease is still not quite the same, sometimes quite urgent, may be after a few hours may not have the opportunity.
Moderator: Yes, a very tense moment. Then we are very grateful to Director Zhang for explaining to us the content and knowledge related to minimally invasive bypass surgery, but also to remind everyone to pay more attention to this disease, right, today’s chat is here, thank you, thank you all!
Zhang Yong: Thank you!