Graft failure after bypass surgery?

MY GUY had 5 bypasses (quintuple?) in April. He was feeling fine and regaining strength. He began having chest pains about two months after the surgery and went to the cardiologist. He has had an upper GI to rule out hernia, reflux, etc., and EKG, which looked ok. His blood pressure has been good and he has been going to Cardiac Rehab, but the pain still comes and goes. A few days ago, he had another angioplasty, and three of the five grafts had failed. (Some kind of occulusion). He even overheard the Dr say that he could not see them during this procedure. What would make the grafts fail? he is scheduled to have a Myocardial Viability Scan in a week or so and possibly have stents put in or at the worst, another open heart surgery. Needless to say, we both are very scared. Is this very common that the grafts would close up?

It happens more than you might think. I worked for a cardiologist who was involved with a study where they did an angiogram on every CABG patient at a one week interval and then a month and then six months. About 20% of the time one or more of the grafts per angiogram had closed at one month. The difference in this phenomenon and that of an acute MI is the graft typically is revascularizing a region that was already being deprived of blood supply prior to the procedure. (So his current situation is no worse than prior to the CABG) In your significant other's case, the fact that the closure is actually causing angina is a good sign that the myocardium is viable. Dead tissue does not hurt.

The sucess rate of stenting grafts is generally very good - especially since these are "new" blocks that have not had years to calcify and harden.

I know this must be very hard for you to swallow but your cardiology team seems to be on top the problem and has a plan to address it. I might suspect that after the stents are deployed then additional anti-coagulation therapy might be added to try to prevent any further blockages.

Good luck.

I had known this could happen but I think it's not very common. My CABG was done in Oct. 2006 and I had 5 done myself. I found the following statement in MedlinePlus:

"A bypass also can close again. This happens in more than 10 percent of bypass surgeries, usually after 10 or more years."

SOURCE: http://www.nlm.nih.gov/medlineplus/coron...

This comes from MayoClinic.com:

"Results
After surgery, most people have improvement or complete relief of their symptoms and remain symptom-free for several years. Over time, however, it's likely that other arteries or even the new graft used in the bypass will become clogged, requiring another bypass or angioplasty."

SOURCE: http://www.mayoclinic.com/health/coronar...

Honestly, I wish I could give you some numbers and more helpful information. It seems that the grafts are expected, in most cases, to last 10-15 years. A lot depends on how advanced the CAD was to start with, the condition of the veins harvested for the graft and how well the patient incorporates the appropriate life-style changes. Perhaps it is influenced by dumb-luck.

Really, your best bet is to ask your cardiologist or cardiac surgeon. Don't let them put you off either. Demand answers. Sometimes they don't want to be real straight forward unless you are persistent and insistent.

If you find further information, I would love to hear about it.

Sincerely,
Terry

c_schumacker

Thanks for your answer. I hope it helped them. I know it gives me a little more information. Keep up the good work!

kmoc...

I had a quadruple bypass almost 3 years ago. It will be 3 years in November. Within six weeks after the surgery I started having reoccuring pressure in my chest. The same that I felt prior to the surgery, just not as intense. My heart surgeon ordered another heart cath to investigate what was causing the pressure I was feeling and it was found that 2 of the 4 grafts they performed had collapsed. Luckilly for me the two that collapsed weren't the two to the main arteries.

The reason for the collapses was because my arteries were not in the best of shape prior to the surgery. One problem is the arteries throughout my body are very small. The other problem is the buildup of plaque in my arteries is throughout my body. So finding "good" arteries was hard to do. My Coronary Artery Disease (CAD) is hereditary.

Since the day they found out that my grafts collapsed they have been "maintaining" my condition with medication. In addition to the Plavix, Toprol, Lisinipril, Lipitor and aspirin I take everyday, I take Isosorbide, 60 mg, so that my heart doesn't have to work as hard to pump the blood. It also helps to "inflate" the arteries so that more blood can pass through them. I also have Nitro Patches that I wear on the bad days.

Up until six months ago I was also taking part in a group where I was taking an experimental drug that was suppose to dissolve the plaque buildup in my arteries. Unfortunately the study group was cancelled because some of the other participants were having serious side effects to the experimental drug.

The day will come when I will have to have another bypass surgery. The reason I haven't had it so far is because of my age. My first surgery was performed when I was 46 years old. I only have one more good "harvesting" of viable arteries/veins left according to the Dr.'s. They are trying to buy me as much time as possible.

I don't normally talk about this side of my condition. Mainly because I don't want to terrify someone who is about to go through the bypass surgery that what happened to me might happen to them. The only reason I am saying this now is so that you know and you can pass onto "your guy" that he is not alone.

I still live my life as normal as possible. If you don't already know I have a heart condition you aren't going to see it. Only indication is the zipper I have on my chest and the seven little zippers I have on my left leg.

I wish I could say some magic words to allieviate your concern and the fear that your guy is feeling. I can't. All I can do is offer to help by being here to answer any questions you may have on how I have learned to live with this condition based on what has happened after my surgery.

c_schumacker above is absolutely correct. The closure rate for vein grafts is around 10% a week after surgery and 20% by one year (after that, the closure rate tails off, so the patency rate is 50% at ten years), so 3/5 grafts being closed counts as unlucky, but hardly rare. (Not everybody has symptoms, which is why this fact isn't more widely known.) In fact, in my opinion, the major reason why patients with more severe disease do better with surgery than with stents is that the *arterial* graft (if he had one), which is usually placed to the most important artery supplying 30-50% of the heart, is very unlikely to close down - patency rates are around 90-95% in ten years.

Occasionally, a patient does have some innate tendency toward clotting off grafts - the truth is, though, that we look for that all the time and rarely find anything.