Study shows 94% of bypass patients need repeat surgeries

The European Heart Journal published this study of open heart bypass patients looking at the question: "What is the average life expectancy after coronary artery bypass graft (CABG) surgery , and are more surgeries needed afterwards?" Here's what they found:

The average life expectancy after CABG depends on a variety of factors including the patient's age, underlying medical problems, how well the heart is functioning and how well the surgery was performed. This study provided the longest and most complete follow-up of post-CABG patients, following over 1,000 patients for 30 years.

Researchers found that, on average, a patient's life expectancy after a first CABG was 17.6 years. Survival was different depending on how many bypass grafts you received. Patients with one, two or three grafts had respective life expectancies of 21.4, 18.8 and 15.4 years.

In general, bypass surgery will correct a patient's problem for about 10 to 15 years. After that time, heart problems, such as chest pain, may recur and repeat surgeries may be needed. The study also found that a majority (94%) of patients required subsequent repeat surgeries. http://eurheartj.oxfordjournals.org/content/30/4/453.abstract

Average age at first surgery was 53. I do have a couple concerns about the results:

#1: 88% of the subjects were male (surprise! surprise!) so these results may or may not be equal for women.
#2: 30 years ago when these subjects were first selected post-op, was bypass surgery technology as good as it is in more recent years as new developments, devices and skills have been improved?

But overall, these stats - although distressing for some - do make sense to me. The more I read and learn from other survivors, the more I'm convinced that although our docs can patch us up temporarily with stents, bypass grafts, pacemakers, defibrillators, new valves and other miracles of modern technology, they cannot cure what caused our cardiac event in the first place. That damage is estimated to be 20-30 years in the making, so a cardiac procedure can save our lives but is a band-aid solution at best.

XOXOXO

http://www.myheartsisters.org

Edited June 7, 2010 at 10:12 am

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17 replies. Join the discussion

You raise interesting questions. I am also interested in who did rehab and who didn't. What lifestyle changes were made (if any) and did they make any impact? What medicines/supplements were they on and were there multipe regressions done on the data?
Lots of questions.......

The bottom line we need to live everday until we die.

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interesting......i am going on 11 years since cabg fingers crossed have had no more done lots of meds and now and icd trigger to help me but thanks that was interesting




live life love life
surviving heart disease one day at a time
with trigger 04/08
for 10 1/2 years
nanamo

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I am very grateful to be blessed with an additional number of years instead of dying at 47 when I had a triple bypass. Every day is special, I have had stents put in twice since the bypass, and I had to realize that there is not a cure at the moment, but we can take responsibilities for our own actions, such as lifestyle, to improve the quality if not the quantity of our years.

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Another question is what causes them to fail? Typically, as already mentioned, the underlying issue is still there. So in the instance of plaque the bypasses will ultimately become blocked with plaque like the old arteries. I am trying to explain myself through the veil of a migraine here, so bear with me if my comments aren't entirely articulate, but I think if you address the underlying issue, then there is a huge chance your bypass will last a long time. Now the question is what can be done to address the underlying issue. Studies on the extreme Ornish program have revealed that heart disease can be reversed through diet, etc. Other evidence of this has emergerged lately too, so if this is the case, it is possible that the new bypasses aren't fated to become victims of heart disease.

Also, why was the bypass done. For SCAD patients with clean arteries there is no reason to think that they bypass won't last indefinitely according to my cardiologist. This is only one example, but there are others.

Also as science improves, the options available to us increase every day.

But ultimately, taking care of your heart day by day and focusing on the now is something we CABGers know intimately ...

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I am so not believing of this that I don't know where to begin.
Of course they always study men...it's a given. When I was in the hospital having my quad bypass at 44yrs of age one of the main reasons I was so angry were ALL the people in my group for exercise were over 75. Well hello...of course they are going to pass in the next 10-15 yrs.
In my Surgeons office, post op, once again, it was full of people well into their 70's plus who already had symptoms before surgery. I had none.
Also 30 years.....and think about this....would any of us be communicating with each other on a computer? CT scans, MRI's...all new.
They are harvesting veins from your own body now. Veins that are much less likely to hang on to the plaque, ie: The Mammarian vein, the radial veins & still of course the legs. 30yrs ago many were artificial.
I had heard this info and asked my surgeon. He said a strong no. I have the life expectancy of any woman my age. He said he did his job, now it's up to me. I know exactly why my arteries clogged and I had that tiny MI. I was overweight-have been partial to fatty food all my life (I blame it on being Hungarian-grin) I was a heavy smoker & am a high stressed person and I was a total couch potato (except for a stressful job)You can't run or hide from that life style...it's going to get you.
I'm sorry if that sounded harsh....all I'm saying is that I have worked in research. There are too many variables that can never be counted in when dealing with people....we are an imperfect group...smile.

With kind regards

Sam

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I hate it when we aggregate data and draw conclusions that really can't be drawn. Especially in relation to women and heart disease. I have a question every day. Since I have bypasses and 2 stents, do I really have heart disease?

In regards to the lifestyle question/Ornish - I had a 95% lesion in the proximal LAD that was reduced to a 60 % with exercise only. Now - that is my personal case of 1, but we do know exercise works! That is probably better defined than the cholesterol issue. As I have said before - a "normal" cholesterol in pregnancy is 400. We do have women get in real trouble after pregnancy but most women giving birth get through this and the baby grows courtesy of the cholesterol, and we don't necessarily have placque. More research, more research........

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I hate it when we aggregate data and draw conclusions that really can't be drawn. Especially in relation to women and heart disease. I have a question every day. Since I have bypasses and 2 stents, do I really have heart disease?

In regards to the lifestyle question/Ornish - I had a 95% lesion in the proximal LAD that was reduced to a 60 % with exercise only. Now - that is my personal case of 1, but we do know exercise works! That is probably better defined than the cholesterol issue. As I have said before - a "normal" cholesterol in pregnancy is 400. We do have women get in real trouble after pregnancy but most women giving birth get through this and the baby grows courtesy of the cholesterol, and we don't necessarily have placque. More research, more research........

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Re Dotie's question "Since I have bypasses and 2 stents, do I really have heart disease?" the answer of course is YES.

They don't do bypasses and stents on people who don't have heart disease. This is a very common question! When I was at Mayo Clinic two years ago attending the WomenHeart Symposium, we had conversations around the breakfast table about this very question, and the answer was always the same.

Also while at Mayo, I asked cardiologist Dr. Sharonne Hayes, founder of the Mayo Women's Heart Clinic, about whether my high blood pressure was actually a risk factor leading to my own heart attack, given that for my entire adult life (since developing hypertension after a bout of pre-eclampsia during my first pregnancy 30 years earlier) my blood pressure has been well controlled with meds. Dr. Hayes replied: "Oh, no, no, no! You have a CONTROLLED risk factor now! Just means you had your heart attack much later than you would have if you'd had an UNcontrolled risk factor!" And here I thought I had some kind of 'free pass' because with drugs my BP was always 120/80!

Sadie, I wonder if SCAD patients may be the rare heart patients whose bodies don't "behave" like heart attack patients. Same with issues like post-partum cardiomyopathy or other event-specific diagnoses. I know a 24 year old woman with Long QT Syndrome, controlled by her ICD now. Because this defibrillator now prevents her Q and T waves from acting up, does that mean that she now has a "normal" life span?

Dean Ornish is the only credible source I've run across whose diet regime claims to actually reverse heart disease - but you're right. His diet is SO EXTREME that I cannot imagine any regular human I know being able to stick to it longterm (i.e. the rest of your natural life). As my Ukrainian Baba would say - you may live longer, but who wants to live a life like THAT?!?! :-)

Dotie, there's some recent research showing that, amazingly, coronary artery blockages often decrease in size on their own (even short term between the diagnostic angio date and the CABG date for example, due to the body's own natural healing system going into overdrive, plus being on the whack of clot-busting drugs like we are all given in the E.R.

Sam, your experience is a great example of the theory that heart disease takes 20-30 years to make itself known, and as you point out, you had a terrific variety of very very serious risk factors (smoking, high stress, overweight, no exercise) that made you a prime candidate for heart disease. Any one of those factors could have damaged your coronary arteries year after year - and in women especially it would be the endothelial cells lining those arteries that would be permanently damaged by any of those factors.

Trouble is: we have arteries throughout our bodies, not just around the heart, which makes us more vulnerable than the average person to Peripheral Artery Disease or strokes - in which the same plaque that clogged our coronary arteries builds up in other arteries around to the brain or limbs.

Your experience with cardiac rehab is unfortunately very common. In my own cardiac rehab program, I was the youngest by a couple decades! The reality for many younger heart patients I've met is that they are often still in the workforce so do not put a high enough priority on attending cardiac rehab if it interferes with their back-to-work or family plans.

By the way, on this site there are sadly many many women reporting graft restenosis in veins that were harvested from their own bodies, too, so that development is not much of a guarantee of permanence.

I hope your surgeon's prediction turns out to be 100% true for you.

For the rest of us, research like this is not meant to make us upset (we're heart patients after all!!!) but to reinforce the reality that we have all been diagnosed with a CHRONIC AND PROGRESSIVE disease that should remind us to cherish every day we have left on this planet.

XOXOXO


http://www.myheartsisters.org

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Any consolation...a good friend had triple by-pass at the age of 39 in some hospital in Florida, THIRTY YEARS AGO!~! She threw the cigaretts away, started walking and is still alive and going strong today. How much did the cigaretts contribute at age 39 to her HD, God only knows but what she did have was a strong family history of HD. Her father and brother both died at an early age of MI. Thirty years ago they did not have all the latest bells and whistles they have today and she is still alive with a thirty year old Triple Bypass. Go figure. Research can be very misleading!

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Hi Kennarina, that was an interesting read. The thing about averages is that they don't actually fit anyone, it's just number crunching. From the point of view of a 70 year old having a bypass, 15 years is very good news, not so if you happen to be 40. But it's not written in stone, the 70 year old could die within 5 years, the 40 year old could live to see 90, who really knows?
Life is terminal, so everyone should cherish every day on the planet whether they have heart disease or not, nobody knows what's around the next corner, unfortunately we've all just had a reality check to wake us up to the fact. ;-)
Lidia xx

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Dear Kennie,

I no longer have access to the article, but I read a similar study comparing the rate of coronary restenosis at 5 years in both stented and CABG patients. It turned out that CABG patients actually had a slightly higher rate of restenosis.

They attributed this to the fact that CABG patients are less likely to make the necessary lifestyle changes that led to their heart conditions in the first place. 1) They generally feel so much better after recovering from a CABG and 2) because they have new pipes they assume they are "fixed." Many CABG patients don't seem to understand that their bypasses can become just as clogged as their arteries, and YES! they MUST adapt the same lifestyle changes as anyone else with CAD.

May the Blessings Be!

Sherrie

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I am 47 and a two year survivor of quad bypass surgery. Well all I can say about this is we must live each day like it is our last. No one on this earth knows when it is their last day. It is up to the guy upstairs when he calls our number. My husband is a seven year survivor of stage three colan cancer. His oncologist recently suggested that he should have genetic testing done. If he tested positive he could have his colan removed just to be safe. At age 49 he would have to live the remainder of his life with a colostomy. What kind of quality of life would we have then? I keep in the back of my mind that I must eat well, exercise, keep my stress level in place and enjoy the special things in life. My husband is doing the same. We have went on some great vacations since my surgery and I have done some really fun things "Bucket List" items. I recently went jet sking for the first time and it was on the Gulf of Mexico! I made it up to 38 MPH. When the wind and salt water was blowing in my face and the beautiful sunshine was warming my skin, I thanked God for giving me the second chance on life for however long it is. We enjoy our family and friends and thank God for every day we have. Hugs to all of you heart sisters!

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Dear TooYoung,

Beautiful post.

May the Blessings Be!

Sherrie

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Read some of Joe Piscatella's writing. He was 32 when he had bypass surgery; now 60-something. He has effectively reversed his heart disease with diet and exercise. His diet is not nearly as severe as Dr. Ornish. He made major lifestyle changes in his own life and now shares his experiences -- I am following his type of diet. He was told he wouldn't live to see his 40th birthday. I'm so thankful he "showed them!" I highly recommend his books!

Dana

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I am also for diet and exercise but I am not sure if it is the only way to keep the bypasses open. I had my triple bypass 1983. Till 1998 I did not eat diet, did not take any blood thinners, not even aspirin, did not exercise more than before and the bypasses remain open. I must tell you I have always had 45-46 kg and I am 165 cm tall. I got my first stent 1999 in one of the bypasses. Up then I had to take bloodthinners, aspirin and Plavix. Nevertheless one of the bypasses began to close several times in the last 11 years. There are now 5 stents in this bypass and 2 stents are in my legs. And I have even eaten diet the last years. What shall I think about this. I could not go back to my previous way of life, even if I wanted. I mean to eat everything, to do everything as if I had not any bypasses. That is what I did for 16 years. Skiing in high mountains, walking. Nobody regarded me as a patient with heart disease. I did not tell it everybody. I did not like to tell it. When I had angina pectoris by doing something (even sex) I took a nitro and that was it. One doctor told me being crazy as I told him from our skitours in St. Moritz (1800 m)with chest pain an hour long. I would not do it any more. Now I know more and I have had my first heart attack 2 years ago. I am more afraid now than I was after my bypass operation for years. Before the bypass operation I had 3 mute heart attacks.

Believe me your heart is stronger than you think.

That is my experience in 27 years with triple bypass.

Piscatella has had a new bypass operation 15 years after his first operation. I know it, because he has written it to me. I had asked him how dangerous a repeat bypass operation were. I have not had it done, because the circumstances were against it. Now I am glad that it was not done. My bypass could me dilatated 8 months after the heart attack 2008. I am wondering how it was possible. During the heart attack it was not possible to do it. I went home and had terrible chest pain by my first walking but I did not give up and it got better by every walk. I did not like to go to the hospital again. I even prefered to die than go back.

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What an interesting post thread! I am sitting here at work - should be doing an continuing medical education article but this is so much better!

I have to believe that the lifestyle issues are critical. Quitting smoking is so important. Exercise is important and watching the diet. Those of us that are too young to retire still have some significant social and work issues that continue to put us at risk. But - if there isn't distress, you don't know eustress either.

Anyhow, the comments about enjoying every day are so very poignant and important. I wish I could get it through my thick skull.......

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Hi Dotie

"...if there isn't distress, you don't know eustress either...."

I think there's a whole new post topic there! Tell us more about this "eustress" theory please!!

Personally, I'm all for reducing as much distress as possible, at all times.... :-)

XOXOXO

http://www.myheartsisters.org

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