Bypass Surgery for a 75-Year-Old: Is it Safe?

Most patients after CABG surgery experience improvement or remission of symptoms and remain symptom-free for years.

Over 300,000 people undergo bypass surgery each year, with more than 70 percent being over 70 years old. Surgeons consider age, general health, and underlying diseases when advising bypass surgery.

Survival rates for bypass surgery in people over 80 years old have increased. However, complications may be higher for those over 75. Age is just one factor doctors consider, as advancements in surgical methods, anesthesia, and critical care have improved outcomes.

Other Factors for Bypass Surgery Recommendation

When considering bypass surgery for someone over 75, physicians also assess additional health conditions such as:

• Previous heart surgery
• Wider coronary artery disease
• Lung diseases like chronic obstructive pulmonary disease
• Kidney problems
• Liver cirrhosis

The timing of the operation can impact an older patient’s success. Some preparatory measures before planned surgery may not be possible during an emergency procedure.

Several studies indicate that a patient’s general health and linked difficulties are more important than age in predicting a favorable outcome for senior bypass surgery.

What is Bypass Surgery?

Bypass surgery, also known as coronary artery bypass graft surgery (CABG), reroutes blood around blocked arteries to improve blood flow and oxygenation to the heart.

• Bypass surgery can be performed on any artery in the body, but the coronary arteries are most commonly involved.
• A graft vein or artery from a healthy blood vessel is used to bypass blockages in the arteries.
• The graft allows blood to flow past the obstruction, delivering oxygen and nutrients to the affected tissue.

The most common reason for bypass surgery is to prevent or circumvent blockages caused by clots or plaque in the coronary arteries due to atherosclerosis. Without treatment, blocked arteries can lead to heart muscle damage due to oxygen and nutrient deprivation.

Two Types of Coronary Artery Bypass Surgeries (CABGs)

1. On-pump:
2. Also known as traditional bypass surgery.
3. A heart-lung machine temporarily takes over the heart’s functions, and medications paralyze the heart.
4. The surgeon performs the bypass operation while the heart is at rest.
5. Off-pump or beating heart:
6. Performed without a heart-lung machine and without stopping the heart.
7. The heart continues to pump blood and oxygenate the body as the surgeon operates.
8. The surgeon stabilizes only the portion of the heart that needs bypass while the rest functions normally.
9. Considered as safe as on-pump bypass surgery and may lower the risk of stroke, bleeding, and kidney failure, according to the Journal of the American Heart Association.

Four Sources of Graft Blood Vessels During Bypass Surgery

1. Endoscopic vein harvesting:
2. The saphenous vein in the leg is commonly used as a graft in bypass surgery.
3. Traditionally, it required a long incision from the groin to the ankle, resulting in post-procedural discomfort.
4. An innovative endoscopic approach uses small incisions and a video camera to remove the saphenous vein with less scarring and damage.
5. Arterial bypass:
6. The left internal mammary artery (LIMA) is the most commonly used artery graft.
7. In some cases, the right internal mammary artery (RIMA) and other arteries may be used with separate incisions.
8. Sutureless anastomotic device:
9. Sometimes, surgeons use a device to connect a vein graft to the aorta without sutures.
10. The saphenous vein is placed on the device, which is inserted into a small hole in the patient’s aorta.
11. Pressing a button unravels a web of wires that form a star-shaped rivet.
12. Donor saphenous vein:
13. A cryopreserved vein matched to the patient’s blood type from a tissue bank.

The length of surgery varies depending on factors such as the number of bypassed vessels, graft placement, on-pump or off-pump technique, and the patient’s overall health. Typically, surgery takes three to six hours.

Risks and Risk Factors of Bypass Surgery

Most patients experience symptom improvement or remission after CABG surgery. However, there are risks associated with the procedure.

Six Risks of CABG:

1. Bleeding
2. Infection
3. Stroke
4. Kidney failure
5. Lung complications
6. Death

Eight Risk Factors:

1. Age (over 70 years)
2. Health condition at the time of surgery
3. Emergency surgery
4. Smoking
5. Poor heart muscle function
6. Diabetes
7. Chronic lung disease
8. Kidney failure

Pain after surgery is common, and it takes time for the body to heal. Following the doctor’s instructions, maintaining a healthy lifestyle, and regular exercise are critical for a full recovery, which can take up to 60 days.

When is Bypass Surgery Recommended over Angioplasty?

If medication or catheter-based treatments like angioplasty are ineffective, a coronary artery bypass transplant (CABG) may be necessary for individuals with coronary artery disease, leading to symptoms such as chest pain, shortness of breath, and fatigue.

While the choice of therapy is up to the doctor, it is crucial to understand and consider all available options.

CABG is Commonly Considered for the Left Anterior Descending Artery (LAD):

• Not all coronary arteries are equal.
• The LAD artery supplies blood to a larger portion of the heart than the other arteries.
• A blockage in the LAD is more dangerous, and bypass surgery is often the best treatment.

The mammary artery, positioned near the heart in the chest, is typically used for LAD bypass. Complications are rare, and CABG using the mammary artery can provide long-lasting benefits.

CABG is Best for Patients:

• With diabetes
• With multiple blocked arteries (may improve survival rates)
• Aged 65 years and older

CABG is used to relieve blocked cardiac arteries and improve blood flow to the heart muscle using grafts from other parts of the body. The number of bypass grafts needed depends on the number of narrowed coronary arteries. The procedure typically requires a hospital stay of several days.

Five Benefits of CABG:

1. Treats blockage in the blood supply to the heart muscle
2. Improves blood and oxygen supply to the heart
3. Reduces chest pain (angina)
4. Reduces the risk of heart attack
5. Improves physical activity ability impacted by compromised coronary blood flow