Heart Bypass Surgery Is Common
Several hundred thousand patients undergo a bypass operation every year in the US. Although the numbers are not as high as a decade ago (largely due to the number of stent procedures performed by cardiologists) bypass surgery remains the best and safest option for many patients with serious heart artery blockages. So how long does heart bypass surgery last?
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The Different Types of Bypass – Artery vs. Vein
When asking, “how long does heart bypass surgery last?” It’s very important to understand the different types of bypass grafts used. The most important one is called the LIMA (left internal mammary artery) and is an artery that runs on the inside of the chest wall on the left side of the body. This artery is carefully taken down from the chest wall and almost always attached to the main artery that runs down the front of the heart called the LAD (left anterior descending artery / Widowmaker).
The other type of bypass graft we will talk about is called an SVG (saphenous vein graft) that is taken from the leg and is a vein used as a bypass. Although there are other types of artery bypasses (radial, right mammary), for the purposes of this article I will concentrate on the LIMA and the SVG, as they are by far the most commonly used in the US.
The LIMA – The King Of The Heart Bypass Surgery Grafts
We call it the LIMA graft and it’s the gold standard of bypass grafts and almost always attached to main artery that runs down the front of the heart called the LAD (left anterior descending artery / Widowmaker). This is by a mile the most important graft, and in fact many people can simply live off the blood supply they get from this graft. The LIMA graft has superior biological properties to other grafts such as vein grafts and therefore has an excellent chance of staying open.
Now we can start to answer the question “how long does heart bypass surgery last?” Studies have shown that the LIMA graft is around 95-99% likely to be open and working at 1 month after operation, 90-95% likely to be open at 1 year – 5 years, and around 80-90% (even greater in some studies) likely to be open at >10 years. These studies show that the LIMA graft has excellent not only short, but long term results. Unfortunately there is only 1 LIMA graft but often patients have many blockages requiring bypass so we have to use veins or other arteries.
The SVG’s – Vein Grafts
Unlike the LIMA graft, the vein grafts has inferior biologic properties and is prone to degeneration and blockages. The LIMA has a remarkable long patency rate of up to 90% as described above, however studies of vein grafts have shown that up to 40% of vein grafts may be closed at just 1 year after surgery, with longer term studies looking at up to 10 years after bypass also suggesting that around 40-50% of vein grafts will block off, which is remarkably high.
What Do We Do If The Bypasses Close Off?
So far we have said that while LIMA-LAD grafts are an excellent option with great long term results, vein grafts are unfortunately no so good, and have an almost 1 in 2 chance of going down within several years of surgery. The good news is that the LIMA-LAD graft is the most important. And although the vein grafts may go down more frequently, if they do go down the chance of needing another heart operation is very, very low. If required, treatment can typically be undertaken using minimally invasive methods such as using stents.
The decision to treat blocked bypasses depends on many factors. Often the blockage may be silent and without symptoms, in which case no specific treatment is needed. Some bypass graft blockages will present with symptoms such as chest pain, shortness of breath or heart failure, in which case further evaluation can be undertaken and the decision made on the best treatment depending on the results of tests such as stress tests and angiograms. Finally some of these bypass blockages may present as a heart attack in which case often the blockages can be treated through the use of stents and medicines.
So How Long Does Heart Bypass Surgery Last?
Lets summarize the article so far. If a patient has a LIMA bypass, it is almost 90% likely to remain open, even 10 years after the operation, and that is just great. For the other blockages where an SVG graft is used, the bypasses are about 50% likely to remain open at 10 years. If grafts go down its not necessarily a disaster, there are often good treatment options.
How Long Does Heart Bypass Surgery Last? – Don’t Lose Sight Of The Main Issue
Remember that the bypass was done to treat coronary artery disease, but that’s only half the battle. The same disease process still goes on despite the bypass and so the emphasis in these patients should be on treatments that can act to stabilize the heart disease. These treatments include medications, blood pressure control, cholesterol management, avoiding smoke, exercise, diet, and adoption of a healthy lifestyle. Now these are the truly life-saving measures.