Hi all, my husband had a severe heart attack a few months back. They gotten a stent and we were advised that two of the main arteries were still severely diseased and he would need a bypass with open heart surgery. All the doctors we spoke to agreed that the severity of disease meant a bypass. When we went to see the Thoracic surgeon he advised that he did not think it was necessary as my husband was not symptomatic enough, and that as long as he passed the stress test no bypass would be done. My husband had no symptoms before his heart attack, the only thing that alerted me was his colour and an ache in his arm. The stress test has been passed and surgery refused. Friends that are doctors do not agree, but the surgeon is adamant that as long as blood is pumping freely then surgery is not needed, even though the arteries are severely diseased? Am I being over anxious? Thinking of getting a second opinion as my husband does heavy lifting for work and nervous to return as this is what set of the first heart attack.
Sorry for long post!
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BlueOctopus
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I'm not qualified to pass judgement on your husband's case. I can however understand why a surgeon might well recommend no action. If you look at the "risk versus reward" trade-off, the decision is often far from clear cut.
If you look at the "reward" side of the equation it's important to realise what a bypass can, and cannot, do. There was some research conducted on over 5,000 patents, called the International Study of Comparative Health Effectiveness with Medical and Invasive Approaches (ISCHEMIA). It concluded that stents (although life saving when used during a heart attack) provide almost no protection against further heart attacks, and bypass operations (although very good at relieving the symptoms of angina) give only a small degree of protection.
On the other side of the equation is the "risk" of the operation. The consent form for a bypass operation warns us that we face a 2% chance of a bad surgical outcome, that means either death or a stroke during the operation. To put that 2% figure in context, a bypass operation is the riskiest thing most people will ever do. You'd have to climb Everest three times to expose yourself to a similar degree of risk. What isn't generally realised though is that 2% is just an average, the spread of risk can range from 0.3% for a younger, otherwise fit patient, to as much as 14% for an older patient with multiple health problems who has had previous heart surgery. It might be worth discussing with your surgeon where your husband stands on that risk spectrum.
I appreciate it must be very stressful for your husband and yourself, but it's worth remembering that the majority of people who have had a heart attack can go many, many years on medication and life style changes without ever having a repeat incident.
Thank you so much. My husband is only young, and his father had to go through two separate heart bypasses at 40 and 78 years of age, so believed to be heredity. They have expressed that open heart surgery for him contains less risk than walking across the road. Before his heart attack he was the healthiest man I knew, playing sports daily and lifting/ driving long distances daily. He can not do much at all now. Originally for the last day 18 months we put everything down to long Covid, but now we are not so sure. He can no longer do anything excessive, even a holiday in England for four days meant early return and sleeping for 14 hours daily since . So so hard to know if we trust one doctor from the next in these times. Out of speaking to 6 doctors, 5 say he needs the surgery, but 1 says he doesn’t. We are terrified as if it happened again when he was at work, I am not sure he would survive
Well let’s get to an example of the positive side of a heart bypass. Ranulf Fiennes the explorer ran 7marathons in 7 days in different countries 4 months after his bypass and he is no spring chicken. Without the bypass , which happened as he was to board a plane , he could have died . I had no option and was told I would have to have a bypass age 76 and was also told I would probably have a major heart attack or be dead in 6 weeks. That was nearly two years ago and I am now back to playing tennis and fast walking . I watch my diet and never put on weight. In fact a lot of the Rheumatic pains I used to have plus migraine have practically disappeared . I look at my bypass as a recycling process . I was told it was possibly hereditary. There are thousands of heart bypass people around the world who are leading new active lives years after their bypass . Some discovering sport for the first time
Couldn't help having a chuckle over your "recycling" comment, very good. As to the OP, answer seems simple, 5 to 1 and the good chance of another heart attack?
I am a little bit confused regarding your comment that stents provide hardly any protection against further heart attacks? If I had not had mine fitted to relieve 2 x 96% blockages I would almost certainly have had one, but now I am leading a "normal" life with no obvious likelyhood of having one?
The common description of atherosclerosis as "furring" of the arteries is misleading. A better analogy would be to say atherosclerosis is like acne, a number of puss filled spots randomly scattered throughout the arteries.
If one of these spots bursts then the liquid contents spew out into the bloodstream where they instantly solidify, but in almost all cases they don't break off and whizz around the bloodstream, they remain attached to the spot at that particular location. This can form a blockage which prevents oxygen rich blood reaching part of the heart muscle, which then constitutes a heart attack. A stent inserted in this location opens up a passage for the blood to flow again. In this example the stent has at the very least prevented damage to the heart muscle and quite possibly saved the patient's life.
The other application for a stent is where one of these acne spots has grown to the point where it's materially restricting the blood flow and causing angina. In this case the insertion of the stent relieves the symptoms of angina.
But in both these examples there are still plenty of other "spots" left in the arteries, so even though stenting did a fantastic job it doesn't give any protection against any of those other spots bursting in the future. The better safeguard against that happening is medication (which both stabilises the liquid in the spot, encouraging it to turn into more stable calcified deposits that won't rupture, and also reduces the factors that causes the spots to grow) and life style changes,
There are quite a few studies that explore the effect on patient mortality of stenting. As far as I know they all conclude that stents are incredibly valuable, but don't actually protect against future heart attacks. Here's just one such study,
That is an interesting study, but the outcome is not surprising. I get what you meant in that as is often said by some members on here, the hopeful prevention of further problems is down to medication and lifestyle, but obviously stents get one out of the immediate problem of a blocked artery. What it is saying, really, is that our old friend the Statin will be responsible for stabilising the plaque and also reducing the cause of it. I still think it could be said, particularly in a case like mine, that stents could be said to reduce the likelyhood of a HA, should the drugs/exercise/diet regime not work, for what ever reason and further blockages occur. I find it interesting but a bit frustrating to try and find information on the the possible stable/unstable state of plaque and how it can be predicted, or not? For example in my case I am presuming it had just built up over a lifetime and the "bucket overflowed" rather than a bit breaking off and causing a clot/blockage that may have led to a HA.
Can I ask why a thoracic surgeon weighed in on this issue? Cardiology was in there looking at the entire picture. Should the case be reviewed by a cardiac surgeon?
I would also suggest a second opinion from specifically a cardiac surgeon. Many Drs are able to recommend but specialist knowledge with all tests available is vital. I had a bypass that failed which is something I hadn't thought about prior to my emergency surgery. I wish someone had spoken to me about that risk. I had stents inserted as a result. However I do think that if I had been informed I would have still gone ahead as risks of failure are lower than the risk associated with blocked arteries. Just unlucky. It's very difficult finding your way through all this but I'm sure you will get there. Best wishes.
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