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Would Bypass Surgery Benefit Heart Failure Patients? About two-thirds of the 6 million cases of heart failure in the United States are caused by clogged arteries. People with clogged or hardened arteries (atherosclerosis) are said to develop coronary artery disease (CAD). The fatty deposits or plaques built up inside the arterial wall narrow the artery and can reduce or even completely stop the flow of blood. CAD is the leading cause of death for both men and women in the United States. People with CAD are at risk of getting a heart attack. In general, balloon angioplasty and stenting are offered to patients having coronary atherosclerosis, and coronary artery bypass graft surgery (CABG) is recommended for patients with multiple areas of coronary artery narrowing or blockage. A study, called the Surgical Treatment of Ischemic Heart Failure (STICH) trial, found that patients suffering from heart failure because of blocked coronary arteries appeared to have similar overall survival rate irrespective of whether they have bypass surgery or rely on medication alone. The National Heart, Lung and Blood Institute paid for the study and Abbott Laboratories provided some medicines used in the study. During the presentation at the American College of Cardiology conference Cardiology's annual meeting in New Orleans on April 4, 2011, researchers from Duke University Medical Center claimed that bypass surgery has been overrated for many people with very weak hearts from clogged arteries and previous heart attack. The findings were also published online on the ‘New England Journal of Medicine’.
In bypass surgery, healthy arteries and veins from other parts of the body were taken and used to re-route blood around the blockages. This would restore blood flow and normal heart function. The study involved 1,212 heart failure patients, mostly men around 60 years old, in 22 countries. Most of them had suffered a heart attack before. The participants were randomly divided into 2 groups: half were assigned to medical therapy alone while the other half to medical therapy plus bypass surgery. It was assumed that bypass would cut deaths by 25 percent. But over an average of 5 years of follow-up, patients who underwent bypass surgery reduced their risk of dying by 14 percent, comparing to patients who were on medications alone. The reduction was not statistically significant. However, bypass surgery did significantly lower the risk of dying from cardiovascular disease by 19 percent and the risk of death from any cause and hospitalization for heart disease by 26 percent. The data also showed that in the medication-alone group, 100 people ended up having a surgery bypass and 55 who were supposed to go for the operation never did. After straightening out these discrepancies, it was found that bypass surgery actually reduced the risk of dying from any cause by 30 percent to 50 percent compared with medication alone. Bypass surgery only improved survival for those who had had the treatment they were initially assigned. Meanwhile, more risk from bypass surgery than from medication alone was recorded. There were more deaths among those who were given bypass surgery versus the others for the first 2 years. Researchers felt that surgery is not a good idea if patients could not survive more than 2 years. Data from the study was also used to examine whether imaging could identify patients most likely to benefit from bypass surgery. Scans were given to 601 patients in the study. After almost 5 years of follow-up, it was found that scans did not show how effective bypass surgery would be for each patient. Nevertheless, the scans that identify viable heart tissue could predict long-term survival. Patients with living heart tissues were found to be 40 percent more likely to survive, as comparing with those with irreversible heart damage. According to other cardiac experts, the benefits and risks of CABG in patients with chronic heart failure have so far been uncertain. The new findings, which supported bypass surgery on top of best medical therapy to reduce cardiovascular morbidity and mortality, still suggested that bypass surgery should be considered for patients with heart failure and CAD.
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