Our Summary

This research paper looks at two types of heart bypass surgery and compares which one is better for people in their 80s. The two types of surgery are on-pump and off-pump coronary artery bypass grafting (CABG), and the researchers conducted a comprehensive review of past studies to decide which one had the best outcomes for this age group. The results showed that those who underwent off-pump surgery had lower death rates in the hospital, lower chances of having a stroke, and shorter hospital stays. Other potential complications, like irregular heart rhythm, kidney failure, needing another operation for bleeding, chest wound infection, heart attack, and length of stay in the intensive therapy unit were similar for both types of surgery. These findings suggest that off-pump surgery might be a better choice for people in their 80s, and could also reduce costs for healthcare providers.

FAQs

  1. What are the two types of heart bypass surgeries discussed in the research paper?
  2. For patients in their 80s, which type of heart bypass surgery showed better outcomes in the study?
  3. Were there any differences in potential complications between the two types of heart bypass surgeries?

Doctor’s Tip

A doctor might tell a patient considering heart bypass surgery that off-pump surgery may have lower risks and better outcomes for people in their 80s, such as lower death rates and shorter hospital stays. They may recommend discussing this option with their healthcare provider to determine the best course of action for their individual situation.

Suitable For

Patients who are typically recommended for heart bypass surgery are those who have severe coronary artery disease that cannot be managed with medication or other treatments. This includes patients who have blockages in their coronary arteries that are causing symptoms such as chest pain (angina), shortness of breath, or fatigue. Additionally, patients who have had a heart attack or are at high risk for a heart attack may also be recommended for heart bypass surgery.

Some common risk factors that may make a patient a candidate for heart bypass surgery include:

  • Severe blockages in multiple coronary arteries
  • Diabetes
  • High blood pressure
  • High cholesterol
  • Smoking
  • Family history of heart disease
  • Obesity
  • Age (older adults, such as those in their 80s, may be at higher risk for heart disease and may benefit from heart bypass surgery)

Ultimately, the decision to undergo heart bypass surgery is made on a case-by-case basis by a team of healthcare providers, including cardiologists, cardiothoracic surgeons, and other specialists. These providers will consider the patient’s overall health, the severity of their coronary artery disease, and the potential benefits and risks of surgery before making a recommendation.

Timeline

Before heart bypass surgery:

  1. Patient experiences symptoms of coronary artery disease, such as chest pain, shortness of breath, and fatigue.
  2. Patient undergoes diagnostic tests, such as an angiogram, to determine the extent of blockages in the coronary arteries.
  3. Patient consults with a cardiac surgeon to discuss treatment options, including the possibility of heart bypass surgery.
  4. Patient undergoes pre-operative assessments, such as blood tests and imaging scans, to ensure they are fit for surgery.

During heart bypass surgery:

  1. Patient is placed under general anesthesia.
  2. Surgeon makes an incision in the chest and grafts a healthy blood vessel from another part of the body to bypass the blocked coronary artery.
  3. Blood flow is rerouted through the new blood vessel, bypassing the blockage and restoring blood flow to the heart muscle.
  4. Surgery can be performed on-pump, where the heart is stopped and a heart-lung machine is used to circulate blood, or off-pump, where the heart continues to beat and no heart-lung machine is used.

After heart bypass surgery:

  1. Patient is monitored in the intensive care unit (ICU) immediately after surgery.
  2. Patient undergoes a recovery period in the hospital, where they receive pain management, physical therapy, and education on post-operative care.
  3. Patient may experience side effects of surgery, such as pain at the incision site, fatigue, and difficulty breathing.
  4. Patient is discharged from the hospital and continues to recover at home, following a prescribed medication and rehabilitation regimen.
  5. Patient attends follow-up appointments with their healthcare provider to monitor their progress and address any concerns.

What to Ask Your Doctor

  1. What are the risks and benefits of on-pump versus off-pump coronary artery bypass grafting (CABG) surgery for someone in their 80s?

  2. How will my age and overall health affect the success of the surgery and my recovery?

  3. What is the expected outcome and recovery time for each type of surgery?

  4. How long will I need to stay in the hospital after the surgery?

  5. What are the potential complications or side effects of each type of surgery?

  6. What is the long-term success rate for each type of surgery in people my age?

  7. Will I need to make any lifestyle changes or take medications after the surgery?

  8. How often will I need follow-up appointments or tests after the surgery?

  9. Are there any alternative treatment options to consider instead of bypass surgery?

  10. How many of these surgeries have you performed on patients in their 80s, and what is your success rate?

Reference

Authors: Khan H, Uzzaman M, Benedetto U, Butt S, Raja SG. Journal: Int J Surg. 2017 Nov;47:42-51. doi: 10.1016/j.ijsu.2017.09.054. Epub 2017 Sep 22. PMID: 28951288