HeartPoint: Bypass questions

B Y P A S S S U R G E R Y
(Continuation)

How long do the bypasses last?

I think I've heard more poor information about this than about any other topic in cardiology. Bypass grafts can last for really long periods of time. I have seen many instances where the graft looks almost "brand new" on angiograms done 15-20 years later.

Bypass grafts do close however. About 50% of the grafts placed are closed in 10-12 years ( that means that if four bypasses were placed in a patient, then 2 would be expected to be closed in 12 years). The ones which do close most often are those that supply smallest vessels, or those which supply the heart muscle with the least amount of need for flow. This makes sense to a great degree - veins are soft structures which can collapse, and if the flow is slow, they may do this early. The patient is generally not aware of this when it happens either since there may be enough flow from other vessels to "make up" for the decreased flow through the bypass.
Again, it is important to take good care of yourself and your bypass grafts. You and they will last longer that way! Recent information regarding the use of cholesterol lowering agents stress this: patients who were given cholesterol lowering agents lived longer with more open grafts.

What if I get other blockages? Can I have another bypass?

Other blockages may certainly occur, either in the coronary vessels themselves or in the bypass grafts. These are treated in the same ways as in cases where bypass surgery has not been performed: with medications, with interventional procedures such as PTCA, or with repeat bypass surgery (treatment of CAD). Repeat bypass surgery is generally more difficult than the first time around due to the presence of scar tissue from the first procedure, but is done all of the time with acceptable results.

What vessels are used for bypass grafts?

Most often, veins are used, and most often these are from the legs (the "saphenous veins"). Other vessels such as the "radial" arteries from the wrist can be used just like the veins.
Other arteries, most frequently the artery to the left breast (the left internal mammary artery or "LIMA"), can also be left attached to their usual point of origin and sewn in to the coronary artery, again beyond the point of blockage. The LIMA is the most common vessel used in this fashion and can be attached to the vessels on the front of the heart (the left anterior descending or a diagonal branch). It's counterpart on the right (the "RIMA") can also be used for some branches of the Right Coronary Artery. Finally, some vessels from the area of the abdomen (such as the Gastroepiploic) can be used.

I've heard about the blockage being cut out? I thought you said that this didn't happen, and that blockages were only bypassed?

On some occasions, it is difficult to find a place to sew the bypass graft to the coronary artery beyond the blockage. This is often due to the presence of blockage all the way down the artery. In some cases, it is possible to open the artery and remove some of this plaque so that the graft can be sewn in and adequate blood flow can be maintained. This procedure is called an "endarterectomy".
ŠCOPY;1997 HeartPoint Updated July 1997

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