Bypass Surgery

Back to Article

INTRODUCTION

• The Problem
  Cardiovascular Disease – The number one killer of adults in the United States. 12.4 million Patients are suffering from chronic, painful angina pectoris at this very moment. And according to the CDC, nearly 460,000 people died of coronary artery disease in 1998. In the time it has taken to tell you this two more patients have been diagnosed with painful angina. Angina pectoris is a temporary pain or sensation of pressure in the chest which occurs when your heart doesn’t receive adequate levels of oxygen due to critical blockages in its oxygen pipelines, the coronary arteries. Angina then is the debilitating and painful manifestation of heart disease that is commonly brought on by physical or emotional stress. If your angina becomes severe and can no longer be relieved by standard medical therapy, consisting of lifestyle changes and medications, then you may require and in fact I may even recommend myself very expensive and highly invasive therapy, such as angioplasty or coronary artery bypass surgery. In properly selected patients these procedures can be lifesaving but they do come with known risks about which you must be aware. And if you wait too long, you may leave yourself with no other reasonable option other than to submit yourself to the considerable risk of these invasive procedures. When I am forced to recommend these procedures, I consider it a failure either on the part of the physician to outline a comprehensive program to both stabilize and even reverse coronary artery disease or a failure on the part of the patient to follow such a program. So today, I am going to review for you what can be done to avoid finding yourself standing at the precipice or edge of the proverbial coronary cliff. And just as importantly I will also review the details of a revolutionary new noninvasive outpatient procedure that can give your heart the best chance it may have to heal itself in a way not previously possible by aggressively stimulating it to grow its own “Natural Bypasses.”
  
  

  
• The Solution
  So let’s talk now about a comprehensive program designed to prevent, minimize or even reverse coronary artery disease and we’ll start with the basic fundamentals. First, we must identify some of the key risk factors that can cause the development and acceleration of the disease and what you need to do about each one. We will then talk about the indications for invasive procedures such as angioplasty, stents and bypass surgery based upon what the studies have shown as to when they are best utilized. And then I will talk about Enhanced External Counter Pulsation or EECP and what the university based studies across the country have repeatedly shown, with more clear and consistent documentation for its benefits than exists for bypass surgery and angioplasty combined.
  
  

  
• Know and Control Your Risk Factors
  Ah yes, Risk Factors or as we might express it, ‘Know the seeds of thine own destruction. ` Some of these you have already heard about and will require no significant amplification. These include such issues as High Blood Pressure, Elevated Cholesterol, Diabetes or Smoking. But there are a few other nasties out there that you should know about which you should make sure that your doctor checks you for. A few of these I will review for you now. The first is a depressed or low level of a very important protein in your blood called HDL or High Density Lipoprotein. Think of your HDL as acting like a cholesterol garbage collector and of course you want as many cholesterol garbage collectors on duty as you can get. For every one percent that your HDL rises, your risk for developing coronary artery disease goes down by two percent. And of course on the other hand, for every one percent that your HDL goes down, your risk for developing coronary artery disease goes up two percent. By the way, your total cholesterol should ideally be no greater than four times your HDL. Consistent aerobic exercise at least three to five times per week is the best thing that you can do to raise your HDL and so can taking supplements such as fish oil or flax seed oil capsules that are rich in Omega 3 and Omega 6 fatty acids. It just might be for this reason that just one meal of fish per week has been shown to reduce the incidence of heart attacks by as much as 50%.
  
  Have you ever heard of proteins in your blood called Lipoprotein (a), C - reactive protein or Fibrinogen? Each of these, if elevated, can predispose you to developing accelerated coronary artery disease. Elevations in your C - reactive protein and Fibrinogen reflect increased inflammation in your system which can cause stress and damage to your arteries which in turn can promote the development of blockages over time. Lipoprotein (a) acts like the reverse of HDL discussed above. The higher your level, the greater your risk. Effective remedies are available to treat all three of these problems if only we knew that they existed and to know this, you must be checked.
  
  And then there is the chemical in our blood called Homocysteine. This is another bad actor which studies seems to show is an even greater threat, if elevated, than is cholesterol. Fortunately, extra amounts of the vitamins B6, B12 and Folic Acid can usually bring this back into an acceptable range. Oh, and while we’re at it, let’s not forget to mention Vitamin E which can reduce the incidence of heart attacks by as much as 50% and a single baby aspirin per day, which in part through its ability to help thin the blood can do even better.
  
  Are you chronically under a lot of stress? If you are then you possess perhaps the biggest risk factor of all for developing coronary artery disease. The reasons for this are not fully understood but suffice it to say that chronic stress can literally kill you. So if this seems to be one of your problems then make stress management a personal hobby of yours. Make it an ongoing study and figure out what works best for you and then apply it. Remember that the world does not belong to those that merely know what to do but rather to those who actually go out and do it. So learn effective stress management for those areas that trouble you and APPLY them! You cannot become good at the game of golf by simply reading a book about it. You have to get out there and start swinging the club. And so it also applies to becoming good at your own stress management issues.
  
  

  
• Angioplasties and Stents?
  If you are reading this then you have undoubtedly heard about angioplasties and stents for coronary artery disease. These are attempts to open up clogged arteries by crushing the artery from the inside out by inserting a catheter through the artery blockage and then inflating a tiny balloon as in the case of an angioplasty. Alternatively, after opening up an artery in such a fashion, a small metal mesh wire can be placed through a catheter into the area just opened to provide a scaffolding of sort to help keep the artery open. Well, it is an interesting theory that has been in practice for well over a decade now. Unfortunately, 30% of all angioplasties fail and when they do, it is usually within the first six months. And it seems that in spite of their promise, these metal scaffoldings, referred to as stents, seem to fair no better based on current methods and materials. And when they fail, they sometimes fail with disastrous results. The success of the angioplasty or stent depends upon the artery’s ability to heal itself after it has been crushed from the inside out by the balloon. In fact, statistics show that 53% of folks submitting themselves to an angioplasty or stent end up having to go through it again, or worse yet have bypass surgery within the following two years. To make matters worse, 10% of these folks who underwent angioplasty or stent end up dying within those same two years. So it doesn’t seem that angioplasty or stenting is anything more than a stop gap measure for many folks and for some a potential disaster. And would you be surprised to find out that just treating folks with medicines to control their angina and to reduce their risk factors that we mentioned earlier works at least as well as angioplasty both in terms of how long people seem to live as well as the quality of their life for those with chronic stable angina.
  
  

  
• And What of Bypass Surgery ?
  Here is the primary circumstance where I would recommend bypass surgery. If someone came into the hospital with rapidly accelerating angina heart pain and appeared to be threatening to have a heart attack at any moment, I would wish to get an angiogram of the coronary arteries otherwise known as a cardiac catheterization. If it showed critical blockages in all three of the main coronary arteries or in the main artery from which two of the three arteries take off from, then I would have to recommend bypass surgery if the surgeon felt that he could do it. But I would do so reluctantly and consider it a failure either to advise the patient as to how he could have avoided getting himself into such a predicament or a failure of the patient to heed such advise. Bypass surgery for folks who have critical blockages in only one or two of these arteries seem to offer no advantages to treating with medication alone in terms of both how long folks seem to live and the quality of their life. One study even showed that the mere aggressive lowering of cholesterol was at least as effective as bypass surgery even in folks with critical blockages in all three of their main coronary arteries.
  
  And if we decide to do bypass surgery, we must also accept the 3-10% risk of dying as a consequence of the surgery before getting out of the hospital. And if you are over 70 years old or have other significant medical problems then your risk for death, stroke or other major complications goes up dramatically. And oh, let me not forget to tell you that a recent study demonstrated that over 40% of folks undergoing bypass surgery lose about 20% of their mental capacity. This is most commonly reflected in aggravating short term memory losses along with an inability to think and concentrate as well.
  
  If all of this is true, and the studies clearly show that it is, then why are we doing all of this angioplasty, stenting and bypass surgery. Well, let’s just say that it is a multi billion dollar industry that will do whatever it needs to do to maintain and even expand its presence. So don’t expect to hear too much general interest to find or implement better ways of avoiding these invasive and dangerous alternatives. But for many, the safest and most effective way of addressing the problem of progressive blockages in coronary arteries outside of aggressive risk factor modification mentioned earlier is to help the heart to heal itself by considering the “Natural Bypass” alternative.
  
  

  
• EECP, the “Natural Bypass” Alternative
  EECP or Enhanced External Counterpulsation has been discussed in detail in prior articles presented here and will be reviewed now only in summary fashion. It represents however a major shift in our thinking about how to treat the coronary artery disease of stable angina pectoris. With aggressive risk factor modification as the constant cornerstone of our treatment weapons, EECP now offers us an opportunity to literally help the heart to heal itself by stimulating its ability to generate fresh circulation in the heart as it progressively develops so called “Natural Bypasses” around any blockages that might be present. And it is effective up to 85% of the time even in folks who have failed bypass surgery after developing significant angina again. It is totally noninvasive, done typically in a doctor’s office and is certified as being effective by the FDA and Medicare and most other insurance companies through their willingness to help pay for its use. Proof of its effectiveness was established in multicenter studies in the last decade including such prestigious medical centers as Yale, The Mayo Clinic, The University of Pittsburgh and the University of Texas among others.
  
  Basically, the procedure involves stimulating the heart’s circulation by having specialized blood pressure style cuffs that are attached to the legs inflate and deflate while in rhythm with the heart’s own cycle to send perfectly timed pulses of pressure from the legs throughout the body including the heart. This, in turn, effectively increases the pressure in the coronary arteries as such pulse pressures are timed to arrive at the heart exactly when both the heart’s own feeder arteries as well as its pumping chambers are normally filling. Such precise timing effectively both reduces the work load on the heart as well as increasing the circulation in its own feeder artery system. Consequently, while the patient is actively being treated, the heart muscle can be placed at relative rest with an improved blood supply both as a result of this pulse pressure effect. In fact, the research that was done to develop EECP was also applied to develop an important device called an Intraaortic Balloon Pump used commonly in hospital intensive care units to ease the stress and pressure on hearts suffering from either the shock of a major heart attack or bypass surgery. The importance of mentioning this is that many patients mistakenly believe that the rhythmical inflations of these cuffs on their legs actually causes stress to their hearts. However, as I have just explained, the reverse is actually the case. That is, the heart is allowed to rest while working more efficiently whenever the patient is actually on the machine. The procedure typically takes an hour a day 5 days per week for 7 weeks. Patients lie comfortably on a specialized bed while listening to music, reading or simply dozing. Up to 95% of the time over the 35 hourly treatment sessions, angina symptoms progressively reduce and energy levels improve and sometimes dramatically! If because of the severity of the problem, angina symptoms though improved still persist, then additional time can be scheduled. Benefits typically last for two to five years and more if an aggressive approach to cardiac risk factor modification is also used. And if angina returns, why not just open up some more “Natural Bypasses” since treatments, unlike bypass surgery or angioplasty can be repeated as often as is necessary.
  
  In summary, if you have coronary artery disease, identify and aggressively go after any risk factors that we discussed which caused the blockages to occur in the first place. And give your heart the best chance that it has to heal itself with EECP, the “Natural Bypass” alternative.
  
  
• EECP, the “Natural Bypass” Alternative
  EECP or Enhanced External Counterpulsation has been discussed in detail in prior articles presented here and will be reviewed now only in summary fashion. It represents however a major shift in our thinking about how to treat the coronary artery disease of stable angina pectoris. With aggressive risk factor modification as the constant cornerstone of our treatment weapons, EECP now offers us an opportunity to literally help the heart to heal itself by stimulating its ability to generate fresh circulation in the heart as it progressively develops so called “Natural Bypasses” around any blockages that might be present. And it is effective up to 85% of the time even in folks who have failed bypass surgery after developing significant angina again. It is totally noninvasive, done typically in a doctor’s office and is certified as being effective by the FDA and Medicare and most other insurance companies through their willingness to help pay for its use. Proof of its effectiveness was established in multicenter studies in the last decade including such prestigious medical centers as Yale, The Mayo Clinic, The University of Pittsburgh and the University of Texas among others.
  
  Basically, the procedure involves stimulating the heart’s circulation by having specialized blood pressure style cuffs that are attached to the legs inflate and deflate while in rhythm with the heart’s own cycle to send perfectly timed pulses of pressure from the legs throughout the body including the heart. This, in turn, effectively increases the pressure in the coronary arteries as such pulse pressures are timed to arrive at the heart exactly when both the heart’s own feeder arteries as well as its pumping chambers are normally filling. Such precise timing effectively both reduces the work load on the heart as well as increasing the circulation in its own feeder artery system. Consequently, while the patient is actively being treated, the heart muscle can be placed at relative rest with an improved blood supply both as a result of this pulse pressure effect. In fact, the research that was done to develop EECP was also applied to develop an important device called an Intraaortic Balloon Pump used commonly in hospital intensive care units to ease the stress and pressure on hearts suffering from either the shock of a major heart attack or bypass surgery. The importance of mentioning this is that many patients mistakenly believe that the rhythmical inflations of these cuffs on their legs actually causes stress to their hearts. However, as I have just explained, the reverse is actually the case. That is, the heart is allowed to rest while working more efficiently whenever the patient is actually on the machine. The procedure typically takes an hour a day 5 days per week for 7 weeks. Patients lie comfortably on a specialized bed while listening to music, reading or simply dozing. Up to 95% of the time over the 35 hourly treatment sessions, angina symptoms progressively reduce and energy levels improve and sometimes dramatically! If because of the severity of the problem, angina symptoms though improved still persist, then additional time can be scheduled. Benefits typically last for two to five years and more if an aggressive approach to cardiac risk factor modification is also used. And if angina returns, why not just open up some more “Natural Bypasses” since treatments, unlike bypass surgery or angioplasty can be repeated as often as is necessary.
  
  In summary, if you have coronary artery disease, identify and aggressively go after any risk factors that we discussed which caused the blockages to occur in the first place. And give your heart the best chance that it has to heal itself with EECP, the “Natural Bypass” alternative.