Risky business, this
8:24 As the surgical resident prepares a pneumatic bone-saw, looking for all the world like a miniature, stainless steel saber saw, he commands "lungs down," and the anesthesiologist deflates the lungs to keep them away from the saw. This is neither the first nor the last time the team must manipulate air or blood pressure during the operation. The mind jumps briefly to a group of overpaid plumbers, then realize that a man's life is on the line. Men, incidentally, receive 73 percent of bypasses, and they tend to survive them better. Two possible reasons for this are that women have much smaller blood vessels, and because men get heart disease when they're younger, meaning they tend to be in better condition for surgery.
8:25 Enter Robert Love, assistant professor of thoracic (defined) surgery at UW-Madison Medical School, and head of this team. Love specializes in the rare lung transplant operation, but kept his hands busy last year performing 150 heart bypass operations.
Love assesses the progress. Smith had kidney surgery years ago and is on medications that decrease his resistance to infection. From years of partial kidney function he has become uremic (defined), and his platelets, cells in the blood that are essential for clotting, are damaged. He has high blood pressure, and his arteries are calcified, making them harder to sew, Love explains, and easier to tear.
In total, Smith "has about eight risk factors" (defined), Love says, and has a 10 to 15 percent chance of dying in surgery. Still, Smith chose those odds over living with the angina (defined), shortness of breath and fatigue that have plagued him for years.
Love explains that Smith would be a high risk for most hospitals, but UW is a teaching hospital, and it gets cases nobody else wants to touch. For a teaching hospital, he's an average risk.
Waiting for a heart attack is not necessarily a good idea. Within six years after a heart attack, 23 percent of men and 34 percent of women will have another attack, and 20 percent of people will have a disabling heart failure (defined).
Nevertheless, Smith can't expect his condition to actually improve, Love explains: "The reason to do this is to preserve the heart function he has -- it won't make his heart muscle stronger." Heart muscle does not tolerate shortages of oxygen, which is exactly what happens when blood flow slows or stops. Clogged arteries, of course, are the problem in atherosclerosis -- the buildup of fat deposits and plaque in the arteries that reduces blood supply and leads to pain and fatigue and can be treated with bypass or angioplasty (defined) operations.
Statistics courtesy of the American Heart Association, 1992.
Here's a normal artery, seen in cross-section. And here's one with a lot of plaque buildup. We found a good, high-magnification picture of an atheroma (defined).
And even if the operation won't actually improve the heart, Love says, "it will greatly reduce the risk of another heart attack, and improve the quality of life." In other words, once the supply of blood is restored to the heart, the big pump's muscles will stop dying. Although the incidence of heart disease has fallen in recent years, about 1.5 million Americans will have a heart attack this year, and about one-third will die. Heart attacks remain the largest single killer in the United States, and cardiovascular disease killed 954,000 people in 1993.
Or you can read about some touchy preparations.
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