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Common Heart Bypass Surgery May Have Great Risks

Posted on: Thursday, 16 July 2009, 11:10 CDT

A disturbing new study has revealed a common method used in heart bypass surgery may relieve some symptoms related to coronary artery disease, but may cause them to be more likely to die from a heart attack in the following three years.

Approximately 450,000 bypass operations are performed each year in the U.S. and 70% of those operations use the method in question, which makes this an issue of great importance.

Bypass surgery entails cutting a vein from the leg and moving it to the chest to provide a detour around clogged heart arteries. It is the manner in which this is done that makes the difference.

For many years, the operation was done with an incision as long as from groin to toe, but it was very painful, often led to infections and lengthy hospital stays, and left a huge unsightly scar.

Then, about 13 years ago, doctors developed a new way where they could make very small “porthole” incisions with a tiny scope to tunnel along the vein and pull it through small openings. Without realizing that this method could be too rough on the vein to the point of causing it damage, it quickly became popular in a big push toward less invasive surgery.

Study leader, Dr. John Alexander of Duke University Medical Center calls the new study a “wake-up call” to re-consider the current approach.

People receiving the small-incision method had a significantly higher chance of dying, suffering a heart attack or requiring another artery-opening procedure in the following three years. It seems that the vein is damaged from being pulled out and in turn does not hold up very long.

"This is a very worrisome finding," said Dr. Timothy Gardner, a heart surgeon at Christiana Care Health Services in Wilmington, Del., and former American Heart Association president.

In order to confirm the results, it will require far more research, but doctors ought to use the technique less often or give greater care to the way they handle the vein when pulling it out, according to Gardner.

Results were published Thursday in the New England Journal of Medicine.

Since the main objective of the study was not to evaluate the leg artery removal technique, the results are not considered definitive. 3,000 patients at over 100 sites around the country who had been part of another study testing an experimental drug were involved in the research.

The study should still be taken seriously. It is the largest study on the issue, with the longest follow-up in observing this method that yielded results that doctors called surprising.

Over 9% of people who had their veins removed with the newer small-incision method died or suffered a heart attack in the following three years, as opposed to the less that 8% of those who had the traditional big incision.

Cardiothoracic surgery chief at Emory University Hospital in Atlanta, Dr. Robert Guyton, had a few patients participating in the study. He commented that the results should serve as a warning for doctors not to rush into adopting new approaches that may seem better for the patient but carry hidden risks.

"There is a big push, both from patients and from cardiologists, for small incisions, minimally invasive techniques," he said. "That push sometimes pushes surgeons to adopt these types of procedures that have not been vetted as well as they might be."

Two years ago, a very small study revealed that that by giving patients a blood thinner before pulling out the leg vein, the chances of a clot forming later in the vein were dramatically cut.

After such a finding, "many of us changed our techniques," Guyton said. However, there is no research showing whether that has improved results, or how it compares to the traditional big open incision to remove the vein.

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On the Net:

• Duke University Medical Center
• New England Journal of Medicine

Source: redOrbit Staff & Wire Reports

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