Heart Bypass Surgery: Say Bye-bye To Bypass Surgery

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Dr. Henry McIntosh was practising cardiology at Baylor College in 1964 when the medical school first started doing heart bypass surgery. Fifteen years later, after years of studying the procedure, he wrote an extensive summary of his observations, and concluded his findings by saying:

'Despite a low operative mortality and rate of graft closure, available data in the literature do not indicate that myocardial infarctions, arrhythmias, or congestive heart failure will be prevented, or that life will be prolonged in the vast majority of patients.'

I think Dr. McIntosh was overly kind in his summary. There is strong evidence that operative mortality is indeed high in many hospitals. But hospitals are very reluctant to release information on the mortality statistics of one of their most lucrative procedures. So even if they have kept records on mortality rates of bypass surgeries, they probably won't release that information to the public. This doesn't just border on quackery - it is quackery.

But with or without the mortality statistics from hospitals, the fact is coronary bypass surgery does not work any better than medical therapy. One study, published in 1984, showed that there was no difference in survival rates between operated and non-operated patients after 11 years.

So how has all this sensational and devastating information affected the bypass industry? It hasn't. It has continued to grow, even though disproved. Heart bypass surgery has truly become a religion - and medicine and religion are often a destructive mix.

Heart bypass surgery offers the same relief as placebo
It's frightening that there is no professional control over heart surgeons and their sometimes-ghastly experiments. Most specialties have peer review groups, which, granted, sometimes are overly zealous and persecute doctors who don't conform to the local standards and prejudices. But these review groups at least serve to keep things within bounds to some degree. Surgeons, though, seem to be able to do outlandish things with little or no criticism. It seems to be their belief that the chest must be opened as often as possible, regardless of whether the surgical procedures really work.

There's an interesting anecdote that's been around for 50 years or so about one of the grimmest and, at the same time, amusing incidents in the history of modern surgery. At the time, 'mammary artery ligation' was the Aztec ritual of choice among the cardiac surgeons for relieving pain in angina patients. Without the slightest evidence of its efficacy, surgeons started punching holes in the chests of cardiac patients and tying off their mammary arteries. (These are prominent arteries just below the ribs in the front of the chest.) The theory was that if you stopped the flow through these 'unnecessary' arteries, more blood would flow through the heart and the pressure and pain would be alleviated. It seemed to work in about 35 per cent of patients.

Somehow, no one really noticed that 35 per cent is within the range of placebo effect.

Then, something worthy of a Monty Python farce happened: An exhausted team of cardiac surgeons performed the operation but forgot to actually tie off the mammary arteries. In effect, they had made two incisions, one on each side of the breastbone, diddled around a bit, and then sewed up the skin. They withheld this interesting information from the patient, and he was sent home feeling quite fit. His angina pain dramatically disappeared - a classic example of placebo effect.

And the proof goes beyond the anecdotal: In 1959, the New England Journal of Medicine published the results of a study on mammary artery ligation. Researchers divided 17 patients into two groups: One group got the mammary artery ligation, and the other got only simple incisions on both sides of the breastbone. The degree of angina relief was the same in both groups.

Now, you might ask, why not do the same test for coronary bypass surgery? In the first place, how many patients would be willing to go through the agony of having their chest split open with a high class can opener, like a pig being prepared for a picnic, and then being told he only had a 'superficial' skin incision? Angina pain is one thing, but people have been brainwashed into believing that bypass surgery is their only chance of survival if the doctor tells them their arteries are clogged. So finding people willing to take the chance on being in the 'placebo' group of a bypass study would be next to impossible.

Unfortunately, things will just keep going on the way they are now. When the first bypass vein graft fails, they go in again and repeat the folly. Some patients have had as many as four bypass operations. That's because changing the flow dynamics of the heart may cause other unaffected arteries to rapidly close following surgery. Plus, the grafted veins placed around the closed artery sometimes rapidly close themselves following surgery, often within two weeks.

It's not too surprising when you consider that you're trying to make a vein - a thin-walled vessel comparable to a strand of spaghetti - handle the pressure of an artery, which, by comparison, is more like a garden hose. I don't understand how they ever thought these thin-walled vessels would hold up. It doesn't take a hydraulic engineer to see that it doesn't make any sense. But by the time the patient figures that out, he's usually run out of veins.

Blood flow to the brain is greatly reduced in the best of hospitals, and no one escapes some loss of mental ability, depression, or both. A Swedish study revealed that 12 per cent of bypass patients had obvious brain damage from the operation and all of the other patients showed marked intellectual aberrations.

After all that, you wake up feeling like you've been in a head-on collision. Then you're greeted by the unpleasant post-surgical reality that you're at risk of post-operative infection, malunion of the breast bone, chronic incisional pain, abnormal
heartbeat, heart attack, stroke, leaking of the attachments of the vein grafts to the heart arteries, multiple sites of bleeding due to the massive amounts of anticoagulant needed during the operation, transfusion reactions, and infection from blood given during surgery.

It's enough to make anyone opt out.

But if you go to your cardiologist with these concerns, chances are he might recommend angioplasty instead: 'Unblock' the arteries before they close off altogether and avoid 'needing' a bypass in the first place. It sounds logical, but the concept of angioplasty is almost as crude and almost as dangerous as bypass surgery.

A cardiologist passes a catheter up the artery in your groin into the aorta, where it leaves the top of the heart. Then they poke around until they have the end of the catheter (which has an inflatable balloon on the tip) near the plugged area in one of your coronary arteries. The object is to pass the catheter into the partially obstructed area of the vessel and then inflate the balloon in order to press the gook in the artery against its wall. But what most people don't realise is that the artery they're dilating can rupture, which means you'll need an emergency bypass anyway.

Back in the '80s in Atlanta, I had a patient named Lou who came to me for help after this very thing happened to him. He went into the hospital for 'routine' angioplasty. But as the cardiologist was dilating his artery, the artery ruptured and Lou had to have an emergency bypass. He hadn't even been warned of this possibility. So instead of awakening to a little slit in the groin and a nice cup of coffee, he awoke in a sea of plastic tubes, beeping monitors, and a small army of nurses and technicians scurrying about. He looked up and asked: 'Did everything go OK?' 'Yes,' the nurse replied, 'your bypass went well, and everything is going to be just fine.'

Actions to take:
The only real option is to keep your heart healthy now so you won't be faced with any of these barbaric procedures. There are several simple ways to minimise your risk of heart problems.

(1) Let's start with vitamins. First and foremost are vitamin B6, vitamin B12 and folic acid. These nutrients tackle your heart's no. 1 enemy. I'm not talking cholesterol here, I'm talking homocysteine. Homocysteine interferes with your blood vessels' ability to relax, makes your blood stickier, and is a proven precursor of heart disease. I suggest at least 400 micrograms of folic acid, 25 milligrams of B6, and 500 micrograms of B12 daily.

(2) In addition to vitamins B6, B12 and folic acid, vitamins E and C also have proven themselves heart-worthy. Take 200 to 400 IU of vitamin E twice a day and 500 to 1,500 milligrams of vitamin C per day. You can get even more heart benefits from vitamins E and C by taking alpha-lipoic acid (ALA) along with them. When vitamins E and C fight free-radicals, they lose some of their power, but ALA can help recharge them, so you get even more value for your money. Take 100 milligrams of ALA per day.

(3) Now that we've got vitamins out of the way, how about minerals? Magnesium is your best bet. It helps relax blood vessels so blood can flow through your body easier. 50 milligrams of magnesium a day should do the trick.

(4) On to herbs: There are lots of herbs out there that can help your heart function better, but in all the research I've done on this topic, there's one in particular that seems to stand out. It's called Teminalia arjuna (T. arjuna, or just arjuna, for short). Arjuna has been used in Ayurvedic (traditional Indian) medicine for over 300 years, and there are so many clinical trials on it that I can't even begin to go into detail on them here. Basically, if you're worried about your heart, arjuna is a must. Try taking 500 milligrams a day.

(5) Now for the fun part: More and more research is showing that alcohol is good for your heart. So far, beer and wine have the most evidence behind them - so go ahead and tip a glass or two a day.

(6) And, of course, keep on eating a healthy diet that includes lots of protein and animal fat. Any cardiologist would probably have a heart attack if he heard that bit of advice, but, trust me, your heart will thank you for it!

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Sources:
'An evaluation of internal mammary artery ligation by a double-blind technique.' N Engl J Med 1959; 260: 1,115
'Eleven-year survival in the Veterans Administration randomized trial of coronary bypass surgery for stable angina. The Veterans Administration Coronary Artery Bypass Surgery Cooperative Study Group.' N Engl J Med 1984; 311(21): 1,333-1,339
'The first decade of aortocoronary bypass grafting, 1967-1977. A review,' Circulation 1978; 57(3): 405-431
'Brain damage after coronary artery bypass grafting.' Arch Neurol 2002; 59(7): 1,090-1,095
'Racial and community factors influencing coronary artery bypass graft surgery rates for all 1986 Medicare patients.' JAMA 1992; 267(11): 1,473-1,477