Our Summary

This study looked at the outcomes for patients who had heart bypass surgery and were at high risk of severe bleeding during surgery. The researchers looked at data from 7,352 patients who had this surgery between January 2015 and May 2017. Of these, 3,548 were identified as having a high risk of severe bleeding. The researchers compared the results for patients who had surgery with a heart-lung machine (on-pump) and those who had surgery without it (off-pump). They found that patients who had on-pump surgery needed more blood transfusions, spent more time in intensive care, and were more likely to have irregular heart rhythms after surgery. They also had a slightly higher rate of stroke after surgery. The researchers concluded that patients at high risk of bleeding might have better outcomes if they have off-pump surgery, as long as the surgeon can make sure that all the necessary blood vessels are bypassed.

FAQs

  1. What were the key findings of this study on heart bypass surgery?
  2. How does the use of a heart-lung machine during surgery affect the outcomes for patients at high risk of severe bleeding?
  3. What is the recommended type of surgery for patients with a high risk of bleeding during heart bypass surgery?

Doctor’s Tip

A doctor might advise a patient undergoing heart bypass surgery to discuss with their surgeon the option of off-pump surgery if they are at high risk of severe bleeding. Off-pump surgery may result in fewer complications such as the need for blood transfusions, prolonged ICU stays, irregular heart rhythms, and stroke. It is important for the surgeon to ensure that all necessary blood vessels are bypassed during the procedure.

Suitable For

Patients who are typically recommended heart bypass surgery include those with severe coronary artery disease, which is when the blood vessels that supply the heart muscle with oxygen and nutrients are narrowed or blocked. This can lead to chest pain (angina), shortness of breath, and in severe cases, heart attack.

Other factors that may indicate a need for heart bypass surgery include:

  • Multiple blockages in the coronary arteries
  • Significant blockages in the left main coronary artery
  • Diabetes
  • Previous heart attacks
  • Severe heart failure
  • Unsuccessful previous treatments such as medication or angioplasty
  • High risk of severe bleeding during surgery

It is important for patients to discuss their specific situation with their healthcare provider to determine if heart bypass surgery is the best treatment option for them.

Timeline

Before heart bypass surgery:

  1. Patient undergoes diagnostic tests to determine the extent of blockages in the coronary arteries.
  2. Patient may need to make lifestyle changes, such as quitting smoking or improving diet, to prepare for surgery.
  3. Patient may be prescribed medication to manage symptoms and reduce the risk of complications.

During heart bypass surgery:

  1. Patient is placed under general anesthesia.
  2. Surgeon makes an incision in the chest to access the heart.
  3. Blood vessels from another part of the body are used to bypass the blocked arteries.
  4. Surgeon may use a heart-lung machine to circulate blood during the procedure.

After heart bypass surgery:

  1. Patient is monitored in the intensive care unit for a period of time.
  2. Patient may experience pain, fatigue, and difficulty breathing as they recover from surgery.
  3. Patient undergoes cardiac rehabilitation to improve cardiovascular health and recovery.
  4. Patient may need to make additional lifestyle changes, such as starting an exercise program or taking medication regularly.
  5. Follow-up appointments with the surgeon and cardiologist are scheduled to monitor progress and address any concerns.

What to Ask Your Doctor

  1. What are the potential risks and complications associated with heart bypass surgery?
  2. How will the decision between on-pump and off-pump surgery be made for my specific case?
  3. What are the potential benefits of off-pump surgery for patients at high risk of severe bleeding?
  4. How experienced is the surgical team in performing off-pump heart bypass surgery?
  5. How will my recovery and rehabilitation differ between on-pump and off-pump surgery?
  6. What follow-up care will be necessary after the surgery, and what signs should I watch for that may indicate a complication?
  7. Are there any lifestyle changes or medications I should consider to reduce my risk of future heart issues after the surgery?
  8. How long can I expect the benefits of the heart bypass surgery to last?
  9. Are there any alternative treatment options to consider before undergoing heart bypass surgery?
  10. What is the long-term prognosis for patients who have had heart bypass surgery, particularly in relation to the risk of complications like stroke or irregular heart rhythms?

Reference

Authors: Demal TJ, Fehr S, Mariscalco G, Reiter B, Bibiza E, Reichenspurner H, Gatti G, Onorati F, Faggian G, Salsano A, Santini F, Perrotti A, Santarpino G, Zanobini M, Saccocci M, Musumeci F, Rubino AS, De Feo M, Bancone C, Nicolini F, Dalén M, Maselli D, Bounader K, Mäkikallio T, Juvonen T, Ruggieri VG, Biancari F. Journal: Heart Lung Circ. 2022 Feb;31(2):263-271. doi: 10.1016/j.hlc.2021.06.519. Epub 2021 Jul 28. PMID: 34330630