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Bypass surgery’s not so scary now

Frank Vignuli couldn’t be having a heart attack, could he?

Frank Vignuli

Frank Vignuli

He wasn’t short of breath. His chest didn’t feel tight. But on the morning of Aug. 4, 2004, the 47-year-old from Wilmington, Del., didn’t feel normal. His jaw was burning, his shoulder was in pain. But he didn’t want to wake up his family. The port operations manager wasn’t in the habit of going to the doctor or asking for help about his health.

Finally, concerned about the ongoing sensation in his jaw, Vignuli woke his wife. Soon, he was in an emergency room, where a doctor told him he had just had a heart attack and needed quadruple bypass surgery immediately.

Hours later, he awoke in the cardiac intensive care unit at Christiana Hospital in Newark, Del. Since then, Vignuli has lived a successful and active life once thought impossible for people with clogged arteries, which can lead to stroke, infections and heart attacks.

He has done so thanks to a procedure once considered risky: More than 9 percent of the first 150 patients to receive the procedure at one hospital in 1966 and 1967 died before they were able to be sent home. That figure went down to 3 percent in 1999 for a large comparable group of American and Canadian patients. Today, 14 years after Vignuli’s surgery, deaths before being discharged from the hospital are between 1 and 3 percent, and surgeons have refined the procedure – and the rehab that follows – even more.

Coronary artery bypass graft surgery – or CABG, pronounced “cabbage” – is one of the best known, most studied and most effective surgeries of the modern age. “It’s a very safe operation,” says Timothy Gardner, past president of the American Heart Association. Gardner, former head of heart surgery for the University of Pennsylvania Health System, has performed thousands of CABG procedures.

People with coronary heart disease sometimes experience buildups of plaque – a combination of fat, calcium, cholesterol and other cellular junk – on the insides of their arteries. This can restrict blood flow and cause clots.

The most common symptom of a clogged artery is chest pain. Other symptoms include weakness, heart palpitations, sweating and nausea. A famous recipient of a quadruple bypass, former president Bill Clinton, experienced some of those symptoms before undergoing emergency bypass surgery 14 years ago.

During bypass surgery, doctors graft a new artery or vein onto the heart, creating a channel through which blood can flow around the blockage. To do that, surgeons remove a vein from the leg, open the chest cavity, prep the heart, stop it with the help of a heart-lung machine to keep blood circulating, sew in the graft and kick the heart into action once more. Increasingly, “off-pump” procedures allow the surgery to be performed with a beating heart instead of relying on the heart-lung machine.

Once an oxygen-rich blood flow is reestablished to the heart muscle, patients with coronary heart disease can experience less chest pain, achieve a better quality of life and reduce the risk of heart attack. In cases where three or more arteries are bypassed, patients can survive longer than if they had other therapies.

The procedure is newer than you might think. Coronary artery bypass grafts were first described in 1910 by Alexis Carrel, a French surgeon, who made an unsuccessful attempt on a dog.

It would take 50 more years for the surgery to succeed in a human.

“It has evolved and improved every decade,” Gardner says. Over the years, surgeons have continually gotten better at the complex dance of the two-to-three-hour procedure.