People often wonder as to how long the benefits of ‘Coronary Bypass Surgery’ would last. This is certainly more so for the heart patients who have had a heart bypass operation, angioplasty or stenting. This is also one of the most common queries of patients and relatives prior to any intervention on the heart.
Not many people know the truth, not many are told the truth even when they wish to know and ask. The worst part of this misinformation is that most non-specialist doctors also are unaware as to the medium and long term results of bypass surgery. So the results of bypass surgery first published in literature in the early eighties are dished out as gospel truth by physicians to knowledge hungry patients even today.
Myth: Bypass grafts fail within 5-8 years
Background of this myth:
Early bypass grafts were always vein grafts and by the time 6 years elapsed almost half the grafts would be occluded. This result was first published in 1984. That led to a vigorous search for strategies to improve long term results. As a result and fortunately for all involved the results of bypass surgery have improved during the last three decades because of a combination of the following reasons:
- Better conduits (more arterial grafts, better treatment of venous grafts during surgery)
- Better vision (initially bypasses were performed without magnification, then 2.5 * magnification and now 3.5 -4* magnification)
- Finer and superior sutures
- Better control of risk factors after surgery- like smoking cessation and control of diabetes, hypertension and high cholesterol
- Direct effect of drugs on bypass grafts (especially aspirin and cholesterol lowering agents)
Venous bypass grafts have been studied repeatedly and on an average 71% of the grafts are still functioning well at 10 years. Arterial bypass especially the left internal mammary artery (LIMA) is far superior with 95% and more working perfectly well at 10 years and 88% still working well at 15 years. Radial Arteries and RIMA grafts also perform much better than venous grafts (90% and 85%).
As for the need for repeat surgery, reality is that not all patients who have narrowing in their coronary circulation (whether native circulation or in bypass grafts) require bypass. Currently, with the improvements in techniques and technology as well as medications and devices the short-term and medium-term results of bypass surgery are excellent. Even 20 years after of an initial bypass operation only about a sixth of patients require a repeat bypass procedure. The other five sixths (84%) either lead a healthy life, require some medications or a very small minority might benefit by a coronary stent.
16% of patients that require a second time bypass 15-20 years later can be offered safe redo surgery in most centers with experienced surgeons.