risks vs benefits of bypass surgery

iVillage Member
Registered: 09-08-2004
risks vs benefits of bypass surgery
6
Wed, 09-08-2004 - 3:09pm
An 82 year old woman already suffering from leg pain caused by spinal stenosis, high blood pressure, and high cholesterol informs her doctor during a routine check-up that she recently had a brief episode of tightness in the chest. After a battery of tests, including an angiogram, she's diagnosed with heart disease and an artery too clogged for angioplasty. A cardiologist recommends bypass surgery. What are the risks/benefits of such a procedure for a woman who already has serious medical issues? The literature online tells me that women are at considerably higher risk for heart attack/stroke/complications from bypass surgery than are men, that the recuperative time for elderly patients is significantly longer, that swelling of the legs and feet can continue indefinitely, etc. I'm concerned that, by electing surgery, this woman might risk ending the active life she now enjoys; on the other hand, by not having surgery, she risks a heart attack. My question: are the benefits of the surgery worth the risks to someone not experiencing chronic chest pain or symptoms? I'd like to hear from women who've had to face this dilemma, what choices they made, what resulted from those choices.
iVillage Member
Registered: 04-14-2003
Thu, 09-09-2004 - 1:33pm

Very interesting post.

Hugs,

Cecilia

iVillage Member
Registered: 09-08-2004
Sun, 09-12-2004 - 2:43pm
Thanks for your response. There seems to be very scant literature on this subject, not to mention statistical analysis, that a patient can use to assess her options. That's the reason for my post - in the hope that women who have experienced this dilemma might share their experieces with me.
iVillage Member
Registered: 09-08-2004
Tue, 09-21-2004 - 6:02pm
Unfortunately, there haven't been any replies to my post. Would you perhaps know of a site where there's a "chat-room" for bypass surgery patients and those considering it? Thanks for your interest.
iVillage Member
Registered: 04-14-2003
Wed, 09-22-2004 - 1:25pm

You can go iVillage main, then go to iVillage health, there is a section for chats.

Hugs,

Cecilia

iVillage Member
Registered: 04-21-2003
Thu, 09-23-2004 - 6:07pm
Hi

Interesting post ... at the end of the day, the decision should be one made by the patient in consultation with the medical staff involved. Certainly, it's a good thing to find out all you can about the risks and benefits of all the possible options, and it's interesting to talk with other people who have been through similar, but do bear in mind that everyone's different and sometimes the only people who are vocal about their experiences are those who have had problems!

The following comes from the British Heart Foundation website - I'll put the link at the bottom - summarising the differences between angioplasty and surgery. There's plenty more information on the site regarding angina, heart attacks, and cardiac surgery, if that is of interest to you.



Coronary angioplasty or bypass surgery?

Your coronary angiogram may show that nothing needs to be done. However, if it shows that your angina is caused by one or more blocks or narrowings in the coronary arteries, your specialist will decide whether:

your coronary arteries can be improved by an angioplasty, or

an operation is the best solution, or

either treatment can be used in your case.

If you are suitable for either angioplasty or bypass surgery, you can be offered a choice. There are advantages and disadvantages to both procedures, and in the end it is your decision. You can see what the main differences are in the box on the next page. Angioplasty avoids the need for a major operation. However, people who have angioplasty are more likely to get angina again than people who have bypass surgery, so they may be more likely to need further treatment or heart surgery later.

Angioplasty with stenting:

What sort of anaesthetic is used: Local anaesthetic

How long do you need to stay in hospital? 1 to 2 days

How soon can you return to work? 5 to 7 days

How many people need angioplasty surgery again? 3 in every 100 people within 6 months (Longer-term figures not yet available as angioplasty is a relatively new procedure)

How many people die within 30 days of the operation? 5 in every 1000

Bypass surgery:

What sort of anaesthetic is used: General anaesthetic

How long do you need to stay in hospital? 6 to 10 days

How soon can you return to work? 2 to 3 months

How many people need bypass surgery again? Between 1 and two in every 100 within 6 months. Between 5 and 10 in every 100 people within 5 years

How many people die within 30 days of the operation? About 20 in every 1,000

http://www.bhf.org.uk/hearthealth/index.asp?secID=1&secondlevel=79&thirdlevel=456&artID=2475


Coronary bypass surgery

The aim of coronary bypass surgery is to bypass (get around) the narrowed sections of coronary arteries. The heart surgeon does this by grafting a blood vessel between the aorta (the main artery leaving the heart) and a point in the coronary artery beyond the narrowed or blocked area (see the illustration below).

Doctors can carry out a bypass graft for each of the main coronary arteries affected. Most people have three, four or sometimes more grafts as the surgeon tries to do as thorough a job as possible to make sure that the operation lasts. In most cases at least one of the blood vessels used for the grafts is made using an artery from inside the chest called the internal mammary artery. (The left and right internal mammary arteries supply blood to the breastbones but this area does also have other sources of blood supply.) The internal mammary artery is less likely to narrow over time than a vein graft. Blood vessels from other parts of the body are used for the other grafts - usually from the leg or an artery in the arm, or both.

In most heart operations, the surgeon reaches the heart by making an incision (cut) down the middle of the breastbone. Just occasionally they may use a different approach.

Usually the surgeon uses a heart-lung machine to circulate blood around the body while operating on the heart. In some cases the surgeon may be able to operate on the coronary arteries while the heart is beating, without needing to use a heart-lung machine. But there is always a machine available in the operating theatre in case it is needed.

While the heart-lung machine is doing the work of your heart and lungs, the surgeon can temporarily stop your heart with potassium, or stop its rhythmical beating electrically. The heart starts to beat again as soon as the blood supply is restored.

After the operation, you will have a scar down the length of your breastbone. You are bound to feel discomfort in your chest immediately after surgery, but this usually eases off over the next few weeks. If a vein has been removed from your leg, you will also have some discomfort and swelling there. Most patients are sitting out of bed a day or two after the operation and return home in about a week.

How successful is the operation?

Between six and nine in every ten patients who have a bypass operation get immediate relief from angina, lasting for at least five years. Most of the others find that the bypass improves their angina.

However, the bypass operation does not affect the cause of atheroma. So your angina may return if the atheroma builds up inside the graft. This is more likely to happen if you carry on smoking, or donÕt control your blood pressure or cholesterol. Narrowing of the graft happens in about 1 in every 20 patients each year. If the angina does come back, you will probably need to have another coronary angiogram and, depending on the results, you may be advised to take medicines, or have an angioplasty (see page 9) or another heart operation.

Over 28,000 patients have coronary artery bypass surgery in the UK each year. The risk of dying within a month of a first operation is low Ð about 2 or 3 in every 100 patients. This is the same level of risk as for a major operation on the abdomen.

Keyhole coronary surgery

Instead of using a full incision (cut) through the breastbone, some heart operations can be carried out through smaller and more limited 'keyhole' incisions. Keyhole surgery is only used in special circumstances. It is not suitable for all patients because the surgeon usually needs access to get to all sides of the heart to do the three, four or more grafts that are needed.

Port access surgery

This involves making a series of small incisions (cuts) in the chest. The surgeon then operates using a viewing telescope and special catheters. A specially adapted heart-lung machine takes over the work of the heart and lungs while the surgeon carries out the bypass surgery.

Beating heart surgery

In some centres heart bypass operations are carried out while the heart is still beating, with doctors getting access to the heart through a full chest incision (cut). This means that the doctors do not need to use a heart-lung bypass machine. The results of long-term trials of this procedure have so far been good but more research is needed.

http://www.bhf.org.uk/hearthealth/index.asp?secID=1&secondlevel=79&thirdlevel=456&artID=1591


At the end of the day, only the patient can make the decision about what they feel is best - for both quality and quantity of life - in conjunction with and with the support of the medical staff involved, and family and friends.

Hope that helps and you find answers to your questions

Take care,

xx

iVillage Member
Registered: 09-08-2004
Fri, 09-24-2004 - 1:44pm
Thanks for your thoughtful reply. Unfortunately, angioplasty has been ruled out, so the patient must choose between bypass surgery and a "healthier heart" regimen that doesn't include surgery. The decision is complicated by the fact that she suffers no angina or other symptoms of imminent cardiac arrest, but does have high cholesterol, high blood pressure, and chronic leg pain. Again, many thanks.