Heart bypass surgery Health Article

Indications

Coronary artery bypass surgery is a treatment option for ischemic heart disease (too little blood reaching the heart muscle). Coronary surgery is recommended when there is disease of the left main coronary artery, disease of three or more vessels (triple vessel disease), or nonsurgical management hasn't worked. Nonsurgical management includes medication and/or angioplasty.

The earliest symptoms of ischemic heart disease include angina (chest pain) and shortness of breath. A person may have no symptoms; have mild, intermittent chest pain; or have more pronounced and steady pain. Still others have CAD that is severe enough to make everyday activities difficult.

Symptoms that usually bring a person to a doctor are a feeling of heaviness, tightness, pain, burning, pressure, or squeezing. This is usually behind the breastbone, but sometimes it is also in the arms, neck, or jaw. Some people have heart attacks without ever having any of these symptoms first.

In cases where there are no symptoms, a doctor may suspect CAD and perform a stress test to determine if it is present. CAD is sometimes suspected if there is a family history of heart disease and a combination of other factors, including high blood cholesterol, diabetes, high blood pressure, cigarette smoking, and being male.

Because CAD varies so much from one person to another, the way it is diagnosed and treated will also vary. Heart bypass surgery is just one treatment.

Risks

When considering the risks of CABG, it is important to remember that bypass surgery has been performed for more than 30 years. Cardiovascular surgeons have received extensive training in bypass techniques.

It is the most frequently performed major surgery in the United States, with over a half million done each year. As with any surgery, the health of the patient prior to surgery is a major consideration in determining risks.

Health conditions that should be considered prior to surgery are:

• Age -- patients over 70 are at a slightly higher risk for complications
• Gender -- women have a slightly higher risk
• Previous heart surgery -- puts a person at a higher risk
• Having another serious medical condition (such as diabetes, peripheral vascular disease, kidney disease, or lung disease)

Possible risks in having CABG are:

• Heart attack, which occurs in 5% of these surgeries
• Stroke, which occurs in 5% of these surgeries (the risk is greatest in those over 70)
• Blood clots
• Death, which occurs in 1 - 2% of those who have the surgery (that means 95 - 98% have no serious complications)
• Sternal wound infection, which occurs in 1 - 4% of these surgeries (this complication is most often associated with obesity, diabetes, or having had previous CABG)

In about 30% of patients, "post-pericardiotomy syndrome" can occur anywhere from a few days to 6 months after surgery. The symptoms of this syndrome are fever and chest pain. It can be treated with medication.

The incision in the chest or the graft site (if the graft was from the leg or arm) can be itchy, sore, numb, or bruised.

Some people report memory loss and loss of mental clarity or "fuzzy thinking" following CABG.

As with all surgeries, there is a risk for heavy bleeding. In case a transfusion is needed during or after surgery, ask your doctor about making arrangements for an "autologous" pre-operative blood donation (banking your own blood for surgery).

You may also have family or friends with a compatible blood type donate blood for your surgery. The hospital, Red Cross, or local blood bank can provide family members and friends with necessary information about blood donation for your surgery.

There are general risks from anesthesia. These include reactions to medications and problems breathing.

Expectations after surgery

Every year over one half million Americans have coronary bypass surgery to relieve symptoms and prolong their lives. In the majority of people who have the surgery, the grafts remain open and functioning for 10 to 15 years.

CABG will improve blood flow to the heart but NOT prevent the eventual recurrence of coronary blockage. Lifestyle changes are necessary -- such as not smoking, improved diet, regular exercise, and treating high blood pressure and high cholesterol.