Heart Disease: Surgeries and Medical Advances

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A New Bypass Surgery

To create a bypass, the surgeon removes a vein from the leg or an artery from the chest and attaches one end to the aorta, the huge artery at the top of the heart that carries blood to the rest of the body. The other end is attached to the coronary artery below the point where it's clogged, thus rerouting the blood flow so it bypasses the narrowed or blocked area. The number you sometimes hear with this surgery, as in "double bypass" or "quadruple bypass," refers to the number of arteries that get a rescue graft. This surgery has traditionally been done with the heart shut down while a heart-lung machine takes over the blood-circulating duties.

Surgeons have long noted that some patients become confused, forgetful, and even have short-term personality changes (sometimes referred to by surgeons as "pumphead") after undergoing CABG while on the heart-lung machine. It has been estimated, Dr. Oz says, that as many as 20 percent of patients have some short-term cognitive defects, about 6 percent of them serious. This may happen because the microscopic debris and irregular blood flow from the pump may plug tiny blood vessels in the brain and short-circuit the connections between brain cells. It seemed logical, therefore, that keeping the heart beating during surgery would eliminate the problem.

So a few years ago, an exciting new way of doing the surgery "off pump" was developed, in which the surgeon does the operation while the heart is beating, with no need for the heart-lung machine. Last year about 23 percent of all bypass surgeries were done off pump, according to the Society of Thoracic Surgeons' national cardiac database. (Goodreds had this surgery.) Dr. Oz says that, understandably, it's a little more difficult to operate on a slippery, beating heart than a still one. But once learned, it's a quick and efficient procedure that is less traumatic to patients' bodies. Patients bleed less, says Dr. Oz, and they have less risk of heart attack during surgery.

Still, off-pump surgery has not yet been proven in studies to provide a major benefit in the incidence of short-term cognitive problems. "I think that in some categories it is better, in older patients with hardened arteries, for example, and in people who have had prior strokes," says Dr. Oz, who is now performing off-pump surgery in about one-third of his bypass cases. For now, both techniques are viable, but questions remain. The answers may become clearer in 2007, when a large ongoing study by the Department of Veterans Affairs will be finished.

Until then, says Eric Peterson, MD, associate professor of cardiology at Duke University School of Medicine, in Durham, North Carolina, "If you're going to have off-pump surgery, go to someone experienced. There is a learning curve for surgeons -- it's a technical challenge. But once they're good at off-pump surgery, the outcomes can be excellent as well."

Goodreds sailed through her off-pump, double-bypass surgery in March, 2003. "I did not have any noticeable memory loss or confusion afterward," says Goodreds. "But then, I didn't expect to!"

Continued on page 4:  More Medical Advances in Heart Surgery


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