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Cardiac Surgery

After successful surgery of the heart, whether by-pass operation or the quasi-surgical procedure of angioplasty, the patient feels much better. His angina may be relieved and may even disappear. His need for antianginal drugs may markedly diminish. His exercise tolerance may increase considerably. He may feel that he is back to normal or near normal. Under these circumstances he may be tempted to continue the life-style he was accustomed to - smoking drinking eating.

Can he smoke with impunity? Can he drink alcohol in unlimited amounts? Can he eat as he likes? Can he indulge in sexual intercourse? How much exertion is allowed to him? There are some of the questions to which clear-cut answers are necessary.

To understand this, it is important to know what the operation does and what it does not to do to the disease.

What does the by-pass operation do to the disease process?
It is important to realise that the by-pass operation does not and cannot remove the cause of the disease - the obstructing atheroma in the coronary artery. It merely bypasses the obstruction. The obstructing lesions remain where they were. In fact, with most of the blood now diverted through the bypass graft, the blood flow through the natural coronary arteries is further slowed down. This slowing down of the blood flow only tends to make the obstruction more complete. Secondly the bypass graft, which is usually made out of a vein, is a much weaker structure than coronary artery and consequently more liable to develop obstruction by way of blood clot. The benefit of the operation therefore tends to wane six years or so ( longer with arterial graft) after the operation. This is related to the closure of the bypass graft.

What does angioplasty do to the disease?
The operation presses down the atheroma and thus dilates the lumen of the coronary artery at the point of stenosis. It does not remove the atheroma. While the initial success rate may be as high as 75 to 90 per cent, the predominant problem is of restenosis. Almost one-third of the operated arteries restenose within six months, with return of symptoms needing redilatation or by-pass operation, though position has improved since insertion of stents was started.

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