Consider the choice of heart bypass surgery

Many people with coronary heart disease survive thanks to heart bypass surgery. In this operation, the surgeon uses blood vessels from other parts of the body to create a shortcut around the blocked artery, then returns blood flow to the heart. A report in the American University Journal of Cardiology calls this operation, first pioneered in the 1960s, as "one of the greatest success stories in the medical world".

The award deserves, but not everyone with coronary heart disease requires this operation. Many people are able to control their disease through diet and exercise, and others with drugs, angioplasty, or other non-surgical treatments. After checking all the advantages and disadvantages of each method, you and your doctor can decide which treatment is right for you.

What are the benefits of bypass surgery?

Bypass surgery can quickly cure symptoms of coronary heart disease, including angina (chest pain). Patients can usually return to their usual activities for 10-15 years, after which they may require another bypass surgery if they are blocked again. If you have severe coronary heart disease - for example, some blocked arteries and a weakened left ventricle - bypass surgery can prolong your life.

What are the disadvantages of bypass surgery?

Like other major operations, heart bypass surgery has several risks. A small number of patients do not even survive the operation. The mortality rate is less than 1% in patients under 65 years and is quite healthy, but it increases drastically in elderly patients and patients with a damaged heart, diabetes, or having previous heart surgery.

By slightly blocking normal blood flow, bypass surgery has the potential to cause some severe complications. According to a report in the Journal of Cardiology at the University of America, about 3% of patients will suffer a stroke during another 3% surgery will lose mental acuity. A 2006 study at Duke University Medical Center found kidney damage after increased heart surgery. The Duke researchers analyzed 5 million people who were discharged from the hospital and found a 5-fold increase in kidney failure during the study period. They estimate that around 20,000 cases appear every year. Complications are especially common in elderly patients and with diabetes, hypertension, unstable angina, arrhythmias, heart failure, or previous bypass surgery.

In recent years, more surgeons have performed off-pump surgery, which means the heart continues to beat when a bypass graft is installed. This reduces the risk of bleeding and kidney complications. However, the American Heart Association notes that both techniques can provide perfect results and say that large-scale trials are needed to determine which procedure is better.

Remember that bypass surgery is not a drug. If the patient does not take other steps to control plaque buildup in the arteries, bypass surgery will suffer the same as the original artery. Half bypass veins are blocked by plaques in 10 years. The arterial bypass is now more commonly used for bypass surgery, and arteries are less blocked after 10 years.

What are the alternatives to bypass surgery?

If you have severe coronary artery disease, bypass surgery may be the best hope for survival. However, most patients will consider choosing another method.

Balloon angioplasty is a common alternative to bypass surgery. In this procedure, the doctor installs a tube called a catheter through a blocked artery. After the catheter enters, a small balloon is pumped to dilate the arteries. The doctor then removes a catheter and balloon, but may install a small metal scaffold, called a stent, to keep the arteries from clogging up again. Like bypass surgery, angioplasty restores blood flow to the heart and relieves symptoms of coronary artery disease.

And, like bypass surgery, angioplasty can keep you alive. Researchers at Emory University prove this point in nearly 400 patients with mild to moderate coronary heart disease. With current guidelines, all patients are eligible for angioplasty or bypass surgery. Patients are randomly selected for one of these procedures. According to the April 2000 issue of the Journal of American Cardiology, patients from each group may remain alive 8 years later.

A systematic review of 23 randomized people in 2007 in a controlled trial found that 10-year survival was the same in both treatments. Bypass surgery is more effective in relieving angina and requires less repeated treatment, but has a higher risk of causing a stroke during the procedure.

Drugs that reduce blood pressure and cholesterol are other alternatives. Heart medications such as beta blockers and angiotensin-converting enzyme inhibitors (ACE) can relieve angina and counteract heart attacks. If you have high cholesterol, statins or other cholesterol-lowering drugs can slow down plaque buildup and reduce the risk of many heart attacks. Your doctor may also recommend a daily dose of aspirin. By thinning the blood and preventing blood clotting, this ordinary painkiller provides strong protection to the heart.

Am I able to avoid heart surgery by changing lifestyles?

It depends on the condition of your heart, but some experts believe that many people with heart problems can overcome it with a heart-healthy diet, exercise, relaxation techniques, and other lifestyle changes. For example, a program for heart patients designed by Dr. Dean Ornish - a combination of reducing stress, regular exercise, and a very low-fat diet - has been shown to relieve angina quickly and reduce the risk of a half heart attack. This program has been shown to cure heart disease in some patients by reducing plaque thickening in blocked arteries. Ornish also advocated teaching heart patients the ability to communicate to "open their hearts", citing several studies of the benefits of closeness and intimacy that protect the heart.

To prevent the development of heart disease, or even restore it, heart patients must reduce or avoid saturated fats (in animal products such as butter, fresh milk, eggs and meat) from the diet. Equally important, you must avoid trans fats, which can also add to bad cholesterol.

However, some fat is actually good for the heart. Research shows that some "good fats", such as omega-3 fatty acids in fatty fish such as salmon, may also help reduce cholesterol and help prevent or reduce heart disease. A report in the Journal of the American Medical Association in 2006 noted that normal consumption (1-2 servings per week) of certain types of fish reduced the risk of coronary death by 36%. Another study involving 20,000 US doctors reported that people who ate fish at least once a week was likely to die of a sudden heart attack reduced by 50% then people who only ate fish once a month.

Experts speculate that because omega-3s have anti-inflammatory effects throughout the body, they may relieve arterial inflammation. Omega-3s also appear to increase levels of "good" HDL cholesterol, which helps fight plaques that tend to inhibit arteries. So, while lowering fat in your diet, you may want to talk to your doctor about taking omega-3 fish oil supplements or adding fish to the diet. Remember, fish contain mercury and other pollutants, but enough consumption benefits seem to outweigh the risks.

Of course, a heart-healthy lifestyle makes sense like whatever treatment you receive. If you smoke, eat high-fat foods, and don't exercise, any procedure or medication only temporarily heals.

Do doctors often recommend bypass surgery even though it is not needed?

Many people worry that doctors may recommend bypass surgery quickly without examining other options. However, according to a report in the March 1, 2001 issue of the New England Medical Journal, the opposite is true. The study found that 43% of patients eligible for bypass surgery (meaning patients with severe coronary heart disease) had never had bypass surgery, often because doctors advised other treatments.

Choosing the right treatment for heart problems can be difficult - for you and your doctor. In 2009, a group of heart organizations published guidelines to help doctors determine exactly when heart surgery should be performed. Treatment of coronary heart disease depends on many individual factors, including the place of blockage, whether you have diabetes and overall heart function. That is why you must learn everything you can about your condition and prepare yourself to give lots of questions. You might even want to look for a second opinion. Ultimately, information may be the best medicine.

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