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More Older Men Surviving Coronary Bypasses

Surgical techniques get credit for lower risk of death

THURSDAY, Jan. 24, 2002 (HealthDayNews) -- The survival rate for older men undergoing coronary artery bypass surgery is rising, says a new study, even though more patients than ever are undergoing the procedure.

A heart bypass expert says the findings, which appear in the Jan. 26 issue of the British Medical Journal, confirm that the surgery is successful in most patients.

"This is an operation that, with increased experience and improvements in technology and better patient selection, is something that we can do extremely well," says Dr. Jonathan Halperin, director of clinical cardiology at Mount Sinai Hospital in New York City.

Coronary artery bypass surgery uses a blood vessel from another part of the body to reroute blood around narrowed or clogged arteries in the heart. A buildup of such substances as fats or plaque causes this narrowing, known as atherosclerosis. The National Center for Health Statistics estimates, in the latest numbers available, that 571,000 of these procedures were performed on 355,000 Americans in 1999.

In the new study, Scottish researchers compared hospital records for 25,229 coronary-artery bypass operations performed in Scottish hospitals between 1981 and 1996. Of those surgeries, 78 percent were performed on men and 22 percent on women.

"Overall, the total number of operations increased over the period," says Dr. Jill Pell, the study's principal investigator.

While the percentage of bypass surgery increased in younger patients, the greatest percentage increase was in patients older than 65. The percentage of operations performed on men over 65 rose from 2 percent to 30 percent; in women older than 65, it increased from 16 percent to 45 percent.

Pell found that the risk of death in the two years after surgery fell by 37 percent among the men in that age range, while the decrease found in women in the same age range was not large enough to be statistically significant. Pell suspects this was probably due to the smaller number of procedures performed on women.

Pell, an honorary clinical senior lecturer in cardiology at Scotland's Glasgow Royal Infirmary University, says the findings supplement previous research suggesting that fewer patients were dying during coronary bypass surgeries.

"The main improvement has been in cardiac surgery, with the increased use of arterial grafts, particularly internal mammary artery grafts," says Pell. "We know that the use of these grafts has increased over that period."

Also helping to boost the survival rates, according to Pell, are improvements in "secondary prevention," meaning post-surgical drug treatments and changes in diet, exercise and lifestyle, including quitting smoking.

"Even if the surgery has corrected one particular blockage in their system, they nonetheless have coronary disease elsewhere. And the surgery doesn't stop the underlying disease from continuing to progress," she says. "Obviously, these people need to have a change in lifestyle."

Pell adds that other research has suggested that patients requiring coronary bypass surgery today have more severe cardiac disease than patients of a generation ago. And they're more likely to have such concurrent medical problems as diabetes.

"If anything, our study underestimates the improvement," she says.

Halperin notes that by 1996, the use of coronary angioplasty – using a catheter to open narrowed arteries – had become a more common alternative for patients facing the prospects of their first bypass surgery.

He says that the higher percentage of older people undergoing successful bypass surgery could be the result of their having had an angioplasty procedure.

"We're able to forestall the need for [bypass] surgery for a longer period of time by better medication therapies, by perhaps some inroads in prevention, and by having available these devices like angioplasty catheters and stents," says Halperin.

What to Do: For more information on coronary artery bypass surgery, check out the Web sites for Heart-Surgeon.com, the Arnot Ogden Medical Center or the American Heart Association.

SOURCES: Interviews with Jill P. Pell, M.D., honorary clinical senior lecturer, Department of Public Health, Greater Glasgow Health Board, Glasgow, Scotland; Jonathan L. Halperin, M.D., professor of medicine, director of clinical cardiology, Mount Sinai School of Medicine, New York City; Jan. 26, 2002, British Medical Journal; "2002 Heart and Stroke Statistical Update," American Heart Association
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