By and bypass

Repeat open-heart surgery, according to experts, should be the last resort.

Long since the days when a bypass surgery was considered a permanent cure for clogged arteries, and definitive insurance against coronary heart disease, coronary “re-operations” have been commonplace. Our very own prime minister Manmohan Singh, recovering now from his second bypass surgery, underwent his first in the UK in 1991, followed by an angioplasty a few years later.

Repeats in bypass surgery, in fact, are now a given in cases of severe artery blockage, with 60-70 per cent of patients undergoing re-operation. Around the time when bypass surgery became popular, a decade ago, many outside medical circles believed it to be a permanent solution.

“When graft failure takes place even after a surgery, another procedure has to be put in place. We can’t have a permanent solution to this medical condition, but what we are working on are ways to prolong the time taken to a re-operation,” says Dr Ashok Seth, chairman, Escorts Heart Institute.

Typically, a patient requires some treatment or other 10-15 years after the first bypass surgery. Doctors prefer to avoid repeat surgeries for as long as possible due to the various risks and complications such a surgery would entail.

“Our first option for a patient who has already undergone a bypass surgery would be to do an angioplasty, which is advanced enough to be a suitable treatment. Especially in older patients, an angioplasty is a better choice,” says Dr Seth. An angioplasty is often less risky than a bypass surgery because it is less invasive, and recovery time is faster.

Other workable alternatives to a re-operation can also be positive — for example, implementing a drastically changed lifestyle pattern based on low-cholesterol food and lowered stress levels. Increased medical intervention following the first surgery and the use of stents to open up the arteries are other ways to avoid severe clogging of arteries. Continuing research on more advanced forms of angioplasty and arterial grafts in future will also be helpful.