EECP

Alternative to Bypass Surgery

COMPLICATIONS OF CABG September 12, 2008

HOW TO AVOID  Heart Bypass Surgery

Since the last 20 years or so Bypass Surgery has come a long way in treating patients with heart attacks & blocked arteries of the heart.Since the last 2 years there has been a lot of negative reports about stents,especially drug eluting stents in that they are inferior to AMT(aggressive medical treatment) and that stents may actually increase the chances of a heart attack.The death rate in patients who had stents was higher than those who chose to do nothing.With this information the use of Bypass Surgery increased even more.Surgery has become much safer today than it was a decade earlier.

Even then is it as safe as professed? Should we just jump into surgery as if were a walk in the park? Is there nothing else we can do?

The risk of complications generally depends upon age, general health, smoking history, specific medical conditions like diabetes,thyroid,high blood pressure,obesity,very weak and frail patients,kidney disease,diseases of the lung,previous stroke and heart function.

 

1.Death

Bypass Surgery is one of the biggest and the most dangerous planned surgeries that a human being has to undergo.So don’t take it lightly.It takes upto six hours,involves blood transfusion,the patient is put on a ventilator and has no breathing of his own and sometimes his heart is stopped completely.In the best of centers the death rate is from 2 to 20% depending on how serious the patient is before the surgery and his risk factors.So if a 75 year old man,with a previous CABG,in failure with an EF of 25%, Creatinine of 2.5 will have a more than 10% chances of dying on the table.So a patient must clearly discuss with his surgeon the actual percentage risk of death he is facing.Only then should he take an informed decision.

 

Even if all goes well with the surgery and the patient is lucky to be alive,there can be a lot of major complications immediately post operatively.

2.Bleeding-

There can be major bleeding inside the body which may need further blood transfusions or in 3% of the cases,repeat surgery to stop it.

3.Heart attack

The patient may get a heart attack during surgery or immediately thereafter.He has a 9% chance of heart failure.

4.Infection

The wound can get infected especially in diabetics and may not heal,can even lead to death a few months later.

5.Complications of blood transfusion like Hepatitis B, C or HIV can surface many months later.

6.Stroke and mental problems

The most disturbing complication is Stroke or paralysis in 2-3% of the patients.Dr Frank M Sellke who is the vice chairman of American Heart Association says that after Bypass Surgery upto 20% of patients have some degree of mental impairment in the form of recognition,memory and higher functions. Tiny fragments of blood clots travel to the brain and block small arteries, reducing mental function. (BBS – Cognitive Study)2006.

7.Kidney failure

Another life threatening complication is kidney failure needing dialysis for life.This is more likely in patients with diabetes aged 70 yrs or more with a Creatinine of more than 2mg.Once kidney failure sets in,these patients have a 25% risk of dying from such kidney failure.

United States the National Cardiovascular Network

Between October 1993 and December 1999 there were complete data on just over 51,000 CABG patients;

 

Percentage with complication

Complication

Men
(36,009)

Women
(15,178)

Bleeding requiring reoperation

3.0

2.9

Postoperative MI

1.3

1.7

Neurological complication

3.8

5.3

Renal failure

4.0

5.0

 

A very important fact not known to patients is that in most cases Bypass Surgery does not prolong life .It only relieves pain.So a patient must ask himself the question “Is my pain so severe that I MUST undergo such a major surgery?”

Can my medical treatment be improved so that I can avoid surgery?Is there something else that I can do?

The first thing to do is ask the question “Is my medical treatment adequate”?

In more than 90% of the cases the answer is NO.Most doctors for fear of complications,outdated knowledge,catering to patient whims and fancies do not use adequate doses of drugs.The concept of AMT or Advanced Medical Treatment is very new in Punjab.Properly implemented with a weight loss of 1Kg per week and a LDL target of less than 70mg, the success rate of AMT is better than Stents and equal to Bypass Surgery .So with an initial expense of Rs 3500 (for tests) and a recurring expense of about Rs 2000 per month (for medicines) more than 80% of heart patients can avoid Bypass Surgery and Stents and save from 2-3 lacs .In a poor country like ours this is a blessing.We at Randhawa Hospital,Amritsar,have been implementing AMT during its evolution in various forms since 1995.Today we are the only center in Punjab combining AMT(Aggressive Medical Treatment) with EECP(since 2003) with a view to avoid Bypass Surgery and stents.The cost of EECP,35 one hour sessions is Rs 60,000.Compare this with the cost of two stents (DES) of about Rs 3.5 lacs.So Rs 60,000 will get you better results than Rs 350,000.

The best thing about EECP is that it can be used for almost every patient.No matter how sick or how many diseases he has.It is completely painless and has no major side effects.It requires no anesthesia,no cutting,no blood transfusion,no stitching,no hospitalization.The patient can continue with his daily routine as before.

Benefits of EECP+AMT for the patients

1.Releif of chest pain and difficulty in breathing.

2.Increased walking distance.

3.Feeling fresh and energetic.

4.Most patients return to work

5.Increase in quality of life.

6.Reduced chances of heart attacks and heart failure.

7.Reduced chances of future Bypass Surgery and stents.

9.Prolongation of good quality life.

10.Patients with failed or reblocked Bypass Surgery can benefit.

11.Patients whose stents have got blocked can also benefit .

12.It can be repeated as often as necessary during the entire life of a patient.Bypass surgery can be done only once or twice.

13.When a patient has had one failed Bypass Surgery ,two to four stents,is in heart failure and all treatment has failed,EECP+AMT can still provide him substantial benefit.

Further details at my website www.randhawahospital.com

Dr SJS Randhawa MD DNB, Randhawa Hospital,12 Mall Road,Amritsar.

Tel 98140 52303.

 

 

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