If a replacement artery is put in to bypass the existing blocked / dodgy artery what happens to said blocked / dodgy artery?
Is it removed, does it just stay there? Redundant?
What makes it not try to keep working while the new one takes over? Does it stop working because it’s blocked off either end by the bypass?
there is a serious side to the question, surgery if an option would probably be a bypass for me (although cardiologist says unlikely to benefit me) but I understand that the new artery can fail due to competitive flow as my existing artery is not blocked in the traditional sense but does restrict blood flow and as a result will keep trying to work. It’s my LAD in my case.
I am no expert but Coronary artery bypass surgery creates a new path for blood to flow around a blocked or partially blocked artery in the heart
The surgery involves taking a healthy blood vessel from the chest or leg area sometimes it has been known if the leg veins are not good they try the arm ones
The vessel is connected below the blocked heart artery
The new pathway improves blood flow to the heart muscle and so I believe takes over from the ones that are not working well
This is as much as I know even though I have had a triple Bypass I never really asked but others maybe able to answer you better than I can x
I never knew that I just knew they always used that one no matter how many Bypasses you are having and they called it the Gold standard one when I was in thought why does it seem so special and it took all this time to find out why
Now having 3 I am sat wondering where did they use the best Gold standard one x
The existing, blocked artery is left in place. Even though it's blocked the heart has an amazing facility where it can grow additional small capillaries that branch around the blockage. These won't be enough to deliver the huge amount of oxygenated blood that the heart requires to pump at maximum rate during exercise. But it's often enough to supply sufficient oxygenated blood to allow the heart to tick over provided you're sedentary.
This is why some people can survive for many years with extremely high levels of blocked arteries. They may be unable to walk far or carry heavy loads without angina pain, but they can still live as long as they stay seated or walk slowly.
The bottom line is that a bypass doesn't remove blood supply from your heart, it only adds to what was there before. So even if you're unfortunate enough to find yourself with failing grafts, you can at least console yourself with the knowledge that you're never worse off than you were before.
thanks for the explanation- now I know what happens to the original artery. I’m in that stay seated category, I walk very slow but the pain still comes on. But that’s an interesting way of looking at surgery - no worse than before (unless surgery causes complications I guess - I’ve been advised by cardiologist it’s not going to be of enough benefit). 👍
You're right, there are two parts to the calculation, risk and benefit.
Cardiologists usually avoid discussing the risk dimension. If you're mathematically inclined you can explore the EuroSCORE II tool which cardiologists and surgeons use to predict the risks of open heart surgery, it's not an easy read without some knowledge of stats, but it's all public domain.
Even with a cursory read you'll quickly see that age and co-morbidities are the main risk drivers. The risk that's used for the legal requirement of "informed consent" is 2%, in other words going into open heart surgery there's a 2% chance of a bad outcome, such as death or a stroke. To put that in context, 2% is by far the biggest risk that the average person will ever face unless they've led an exceptionally exciting life. 2% is far higher than all the risk you'd experience in an entire lifetime of motoring, cycling, and being a pedestrian. Put another way, you'd have to climb Everest three times before you'd have a cumulative risk of 2%.
But 2% is just the average. The real world spread is much wider. A young person with no other medical issues can go through open heart surgery with just a tenth that level of risk. An older person with multiple health problems might experience a risk nearly ten times that level.
A British cardiologist, Samer Nashef, wrote a fascinating book, "The Naked Surgeon", about the development of this quantified risk approach to heart surgery.
Some of the old school heart surgeons really hated this approach. Their patient survival rates became a matter of record, and they argued this meant they no longer accepted high risk surgery patients. They also pointed to evidence that "bad outcomes" are more likely due to poor post operative care, which in turn generally occurs following surgery at night or at weekends, or with temporary staff on the wards.
It's a complex issue, but there's no denying that open heart surgery has become a lot safer since this high level of transparency and quantified objectivity was introduced. Given that you're in the thick of the issue I thought you might be interested in some of the background.
thank you so much, I will have a look at the EuroScore. Yes I’m definitely interested in knowing more / understanding more (well as much as I can).
yes I guess I am in the thick of it (my gut told me I’d get to this point) - surgery if an option appears to be only option to exhaust now (meds haven’t worked) and I have an appointment with a surgeon to discuss in a couple of weeks. 👍
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