Our Summary
This research looked at two types of coronary bypass surgeries, off-pump coronary artery bypass grafting (OPCAB) and beating heart on-pump (BHOP) bypass grafting, performed on patients at a Veterans Affairs Medical Center between 2004 and 2015. The goal was to see which type of surgery had better outcomes, particularly for high-risk patients.
The study found that individuals who underwent BHOP were more likely to have certain pre-existing conditions, like COPD. The BHOP surgeries also tended to take longer and use more “conduits,” or vessels used to bypass blocked arteries, compared to OPCAB surgeries.
However, after taking into account the differences in the two groups of patients, the study found that both BHOP and surgeries that revascularized two or three vessels (meaning they restored blood flow to two or three blocked arteries) had a protective effect on patients, reducing their risk of death three and six years after surgery.
In conclusion, the study suggests that BHOP may be a better option than OPCAB for high-risk patients, as it appears to increase long-term survival with no increase in short-term mortality.
FAQs
- What are the two types of coronary bypass surgeries studied in this research?
- According to the study, which type of surgery - BHOP or OPCAB - had better outcomes for high-risk patients?
- What impact did BHOP and surgeries that revascularized two or three vessels have on patients’ long-term survival?
Doctor’s Tip
A helpful tip a doctor might tell a patient about heart bypass surgery is to discuss with your healthcare provider the best option for your specific condition, taking into consideration any pre-existing conditions and factors that may impact the success of the surgery. It is important to follow your doctor’s recommendations for post-operative care and lifestyle changes to ensure the best possible outcome after surgery.
Suitable For
Patients who are typically recommended heart bypass surgery are those with severe coronary artery disease, which is a condition where the blood vessels that supply blood to the heart become narrowed or blocked due to a buildup of plaque. These patients may experience symptoms such as chest pain (angina), shortness of breath, fatigue, and an increased risk of heart attack.
Specific criteria for recommending heart bypass surgery include:
Severe blockages in multiple coronary arteries: Patients with blockages in two or three major coronary arteries may be recommended for bypass surgery to improve blood flow to the heart muscle.
Failed medical therapy: Patients who have not responded well to medications, lifestyle changes, or other treatments for their coronary artery disease may be considered for bypass surgery.
High-risk features: Patients with certain high-risk factors, such as diabetes, advanced age, kidney disease, or other serious medical conditions, may benefit from bypass surgery to reduce their risk of complications.
Symptoms of heart disease: Patients experiencing severe chest pain, shortness of breath, or other symptoms of heart disease that significantly impact their quality of life may be candidates for bypass surgery.
Ultimately, the decision to recommend heart bypass surgery is made on a case-by-case basis by a team of healthcare providers, including cardiologists, cardiac surgeons, and other specialists, taking into account the individual’s overall health, preferences, and treatment goals.
Timeline
Overall, the timeline for a patient before and after heart bypass surgery typically includes:
Before surgery:
- Diagnosis of coronary artery disease and recommendation for bypass surgery
- Preoperative evaluation and preparation, which may include tests, medication adjustments, and lifestyle changes
- Discussion with the surgeon about the procedure and potential risks and benefits
- Consent for surgery
During surgery:
- Anesthesia and incision
- Harvesting of blood vessels for grafting
- Bypass grafting to create new pathways for blood flow around blocked arteries
- Closure of incisions
After surgery:
- Recovery in the hospital, which may include monitoring in the intensive care unit
- Management of pain, incision care, and potential complications such as infection or bleeding
- Physical therapy and rehabilitation to regain strength and mobility
- Follow-up appointments with the surgeon and cardiologist to monitor progress and adjust medications
- Gradual return to normal activities and lifestyle changes to promote heart health
The timeline for recovery and long-term outcomes can vary depending on individual factors such as age, overall health, and adherence to postoperative care recommendations. It is important for patients to work closely with their healthcare team to optimize their recovery and reduce the risk of future heart problems.
What to Ask Your Doctor
Some questions a patient should ask their doctor about heart bypass surgery include:
- What type of heart bypass surgery do you recommend for me, and why?
- What are the potential risks and complications associated with the recommended surgery?
- How long is the recovery process expected to be, and what can I expect during the recovery period?
- Will I need to make any lifestyle changes or take medication after the surgery?
- How often will I need to follow-up with you after the surgery, and what will those follow-up appointments entail?
- What is your experience and success rate with performing heart bypass surgeries?
- Are there any alternative treatment options to consider before proceeding with surgery?
- How will my existing medical conditions, such as COPD, impact my candidacy for heart bypass surgery?
- How many vessels will be revascularized during the surgery, and what impact does this have on long-term outcomes?
- What steps can I take to improve my overall heart health and reduce the risk of needing additional surgeries in the future?
Reference
Authors: Skancke M, Endicott K, Amdur R, Greenberg M, Trachiotis G. Journal: J Cardiovasc Surg (Torino). 2018 Apr;59(2):268-273. doi: 10.23736/S0021-9509.17.10058-3. Epub 2017 Nov 16. PMID: 29145722