Question: Ten years ago I had a triple bypass. I moved and contacted a new doctor. At my first interview he said that since my bypass is over ten years old, I need to have open-heart surgery again because bypasses begin to fail after ten years. Is this true?

Dr. Hibberd's Answer:

This general statement is definitively incorrect.

Some bypass patients never need another open procedure, and repeat bypass is actually much less frequent than one would expect. Fortunately, many bypass patients with recurring disease can often be treated by a vascular catheter procedure using stents rather than a repeat bypass.

Bypass patients who correct their underlying risk factors such as diabetes, hyperlipidemia (high levels of lipids), smoking, hypertension, and inactivity have excellent outlooks. Some grafts actually stay unobstructed for a lifetime, especially internal mammary grafts.

While vascular disease tends to be progressive in most patients, correcting risk factors will slow the progression of disease. Some studies show the disease actually regresses with aggressive modification of risk factors. Hopefully your doctor was simply trying to tell you that the disease does often progress and that it is time for re-evaluation.

We have excellent ways of evaluating the progression of disease without necessarily subjecting you to invasive procedures such as cardiac catheterization. While it is true that bypasses may fail, the truth is that most patients do very well.

Remember, a bypass is simply a vascular bridge that "jumps over" or "bypasses" a narrowed section of your native vessel. This bridge then allows circulation to get to segments of muscle that would otherwise have remained poorly “fed” had not the blockage been "bypassed." Most often, problems with bypassed patients relate to the development or progression of their vascular disease in vessels that haven’t been bypassed, or poor pump function as a result of underlying or progressive disease.

Stents are now used as a less invasive way to keep open narrowed segments that are accessible to a vascular catheter, but stent failures are commonly seen with re-stenosis (re-clogging), especially when blood thinners such as Plavix are stopped.
This field continues to evolve, with newer stents now remaining open in increasing frequency, often in conjunction with anti-platelet agents such as aspirin and Plavix.

Repeat open chest procedures for repeat coronary artery bypass graft procedures are much less frequently seen since the advent of current aggressive, less-invasive, vascular intervention procedures and devices.