Is There a Bypass Surgery Ten Year Curse?
Coronary artery bypass graft surgery (CABG) uses blood vessels taken from one part of your body to be inserted and to go around or “bypass” blocked or narrowed coronary arteries. The procedure allows blood flow and oxygen to continue to reach the heart. It also helps to alleviate the pain that usually accompanies narrowed and blocked coronary arteries (angina).
Bypass surgery also helps to prevent a heart attack. The first bypass surgery was performed in 1960 so it’s been around for several decades.
Open heart surgery possibly entails a range of complications (some more serious than others), but the risk of developing complications is considered low. Prognosis is good if you maintain a healthy lifestyle post- surgery. Research suggests, however, that there may be a bit of a curve ball in year ten post bypass, though.
When you consider a serious surgery or invasive treatment that has the risk of complications, one consideration is the survival payoff. You basically ask yourself, often with a doctor weighing in, whether the outcome is worth the risk you’re taking.
In this case, prognosis after bypass surgery has been considered good. In fact, the probability is that your life will be comparable, after bypass, to that of the population in general. Researchers decided to look at data to see what survival prognosis is after thirty years. The results may surprise you.
The Danish study compiled data on more than 50,000 patients who underwent coronary bypass surgery between 1980 and 2009. The goal was to study short-term and long-term mortality rates among the patients. The subjects were compared to a control group of about half a million people of similar age and gender chosen at random from the general population.
The Danish keep remarkable health records of their populace, tracking them for decades. Data in these types of studies is considered very high quality and very reliable.
Researchers found that survival post-surgery had improved over the last three decades thanks to improved bypass techniques. Somewhere around the eight to ten-year mark after bypass though, prognosis changed. At that point survivors seemed to have a (higher) mortality rate of between 60 and 80 percent when compared to the control group.
The researchers theorize that this may be due to the progressive nature of the atherosclerosis or hardening of the arteries. It may also be due to the implanted material placed during the bypass begins to fail.
The study also confirmed that in the first 30 days post-surgery, patients do have an increased risk of dying, directly due to the surgery itself. Overall, these mortality rates are considered low. The researchers also acknowledge that there are unique and personal differences among patients, which suggests that doctors should assess prognosis and risks after bypass individually.
It’s worth mentioning that a 2016 study found that coronary bypass surgery still outperformed newer generations of stent surgery. Another study showed that bypass surgery effectively extends the lives of patients with heart failure.
The question remains as to whether significant lifestyle change after coronary bypass surgery could have an impact on prognosis and long term survival rates, especially given these new findings regarding the mortality increase at the eight to ten-year mark.
A 2014 study, Diet and Exercise Interventions Following Coronary Bypass Graft Surgery: A Review and Call to Action looked at the impact of lifestyle change, including diet and exercise, on long term outcomes of patients who had CABG surgery. The goal was to see if lifestyle modification after bypass could slow or halt the progression of coronary artery disease, limit hospitalizations, and prevent the need for reoperations.
The researchers reviewed previous studies to develop a consolidated position on lifestyle impact. General findings of the review were that:
- Committing to a regular exercise habit had a positive impact on psychosocial well-being and physical fitness
- Diet and exercise appeared to have short term benefits, but effects fade over time
- More research was needed to isolate benefits and differences between gender and among different age groups
The researchers noted that there is really no downside to following a healthy diet and it is certainly a cost-effective therapy since we all have to eat. Current recommendations to patients with heart disease are to follow a diet program like DASH or a Mediterranean-style diet.
Important diet considerations include reducing the consumption of saturated fat and processed carbohydrates, limiting salt and focusing on plant-based proteins, fish, fruits, vegetables, whole grains and healthy fats like those found in olive oil, nuts and avocadoes. Losing excess weight can also help to improve your cardiac health.
The researchers also found that exercise alone, including low to moderate levels of physical activity, was associated with improved functional status. This finding is important because it suggests that exercise may help to prevent progressive worsening of coronary artery disease (CAD), helping patients to maintain independence and avoid hospitalizations.
The conclusion of this review suggests that healthcare practitioners should be very focused on motivating CABG patients to consider diet and exercise as adjuvant therapies to their surgery, helping to improve prognosis and outcomes. It’s clear that we still need more research to identify specific diet and exercise protocols that may benefit these patients. And there may be a need for personalized diets, based on genetic factors and other personal health considerations.
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