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SURGICAL PROCEDURES OFTEN PERFORMED ON PATIENTS WITH HEART DISEASE
Bypass surgery: Conceptually, bypass surgery is quite simple. It involves the fashioning of “detours” to route blood around sites of blockage in the arteries. Bypasses are made of veins taken from the leg or arteries from the chest wall; these are inserted or sewn into the heart arteries beyond the site of the most important blockages. Although bypass surgery is a fairly major operation, and usually involves placing the patient on a heart-lung machine while the heart is stopped so it can be operated on, the procedure is quite safe. These days, most patients remain in the hospital for five to seven days, unless complications occur, and need a relatively brief period of convalescence (four to six weeks) before resuming previous activities or even more strenuous activities than before, since their symptoms are usually much improved. In very recent developments, this surgery can sometimes be done without the patient being placed on a heart-lung machine, simplifying the procedure and making the recovery period shorter. After the surgery, there is discomfort at the incision sites, some inevitable fatigue, as well as the psychological adjustment of getting used to having had a fairly major heart operation. The risks of bypass surgery are generally quite low, with less than 5 percent having serious complications such as a heart attack or stroke, and no more than 2 or 3 percent with fatal complications.
While bypass surgery is very effective and usually leads to a marked improvement in symptoms, it is not curative, since the original hardening of the patient’s arteries remains. Where veins are used to fashion the bypasses, the bypasses may begin to “give out” (become narrowed or blocked) after eight to twelve years or so, but where arteries are used they appear to last much longer.
The development and perfection of bypass surgery has truly revolutionized the treatment of heart disease. For those patients with severe narrowing of the arteries, especially if they have had prior heart attacks and have several vessels narrowed, the long-term outlook is very much better with bypass surgery than without. Importantly, most patients have an improvement in their ability to perform physical activities, and their general well-being improves after successful bypass surgery.
Coronary angioplasty: Sometimes also known as PTCA (percutaneous transluminal coronary angioplasty), this is a procedure to open narrowed arteries to the heart, by means of a deflated balloon that is threaded into the area of narrowing from a blood vessel in the groin; the balloon is inflated to a fairly high pressure to cause the area of narrowing to expand, thus restoring better blood flow. This procedure is successful in the vast majority of cases, although it does not cure the condition, since the deposits of calcium, scar tissue and cholesterol in the blood vessel wall remain but are displaced so that the opening in the artery is larger. Not all narrowings can be opened, or dilated, because of their dimensions and location, and not all of the attempts to perform this procedure are successful. However, many patients are eligible for this procedure, and when it is successful, it allows better blood flow and improves symptoms. Often chest pain disappears completely. There is a chance of recurring narrowings in the months following the procedure, however, and there are occasional complications. Fortunately, serious complications such as a heart attack or stroke are quite rare.
Coronary stenting: Since narrowing can recur in up to 30 percent of cases following initially successful angioplasty, cardiologists have developed coronary stents?small, delicate, cylindrical wire-mesh objects that can be inserted into an opened-up artery to hold it open, much like scaffolding. They are “folded up,” then passed through the arteries to the site of previous blockage, where they “spring open” and hold the artery walls apart. With these ingenious devices, the chance of a blood vessel remaining open is much better and the long-term results are very good. These days, many patients who have angioplasty also receive one or several stents.
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