When Dr. Craig Smith called the quadruple bypass surgery he performed on former President Bill Clinton “relatively routine,” it was a sign of how far heart disease treatment has come in the last fifty years.
Bypass surgery, formally known as Coronary Artery Bypass Graft (CABG), is performed on over half a million people in the United States every year, according to the American Heart Association. Dr. Smith, a cardio-thoracic surgeon at the Columbia-Presbyterian Center of New York-Presbyterian Hospital in Manhattan, told the New York Times that he performs 350 surgeries a year, and about half of them are bypasses.
While heart disease is still the nation’s number one killer, technological advancements have saved millions of lives.
Just look at the example of another former President with heart problems, Dwight Eisenhower. Eisenhower had several heart attacks, beginning in the 1950’s while he was in office, before finally succumbing to the disease in 1969.
Of course, not everything has changed. After his 1955 attack, Eisenhower began following a strict diet and exercise regimen, his main treatment option at the time. That probably extended his life significantly, and Clinton will have to adopt similar lifestyle changes. The cigar-smoker has a well-known passion for junk food and his struggles with weight have been chronicled in many a newspaper. His recent weight loss could not overcome years of bad habits, not to mention a family history of heart disease.
But bypass surgery has given him a second chance, and doctors say that with dietary changes, he can expect a normal lifespan. From his hospital bed, he was healthy enough to spend 90 minutes advising Democratic presidential candidate John Kerry about his campaign. If this surgical opportunity had been available in the 1950’s and 60’s, Eisenhower may have lived longer or at least lived better during his final years.
Recently, new minimally invasive bypass techniques have begun making headlines.
There are two basic types of bypass: conventional open chest surgery, and minimally invasive surgery. Clinton’s procedure fell into the first category. In this surgery, an incision is made above the breast bone to expose the heart. The heart is stopped—Clinton’s was still for 73 minutes—and attached to a heart-lung machine, which takes over feeding oxygen into the blood. Meanwhile, a vein is taken from elsewhere in the body, usually the leg. That blood vessel is attached to the clogged arteries near the heart, creating detours around the obstructed areas.
Minimally invasive techniques generally offer faster recover times and less pain than traditional open heart surgery. It can be done with a much smaller incision, and without stopping the heart. Not all patients are candidates for the procedure, and it carries some risks. But the fact that the heart keeps pumping makes this procedure less stressful on the patient, and eliminates some of the risks of relying on the heart-lung machine.
Newer techniques, some still experimental, have cropped up in the last four or five years. In 2001, cardiologists at Massachusetts General Hospital first performed an experimental technique called percutaneous in-situ coronary venous arterialization, or PICVA. Instead of harvesting a vein in the leg, PICVA uses the veins carrying blood away from the heart. Blood is thus rerouted from the arteries, which carry blood to the heart, into the vein. Other veins then take over the job of bringing blood away from the heart. The procedure is done entirely with a catheter that is fed into the thigh, and the patient does not even have to be unconscious. The procedure is still young, but techniques like this offer great promise for the future of heart health.
