Should You Have Coronary Bypass Surgery?

Dr. Sinatra: Another question from a newsletter subscriber who is really confused. She's read differing opinions that you should never have a bypass. She's asking, "What's your opinion and how do you make a decision?"

Look, folks, I get this question all the time. First of all, bypass surgery is about increasing blood flow. Let me tell you what I mean. If you are symptomatic with angina, if you can't walk across the room, if you are short of breath, if you are sweating at night in the middle of the night and you're clutching your chest with chest pain, if you are symptomatic and you've tried medical therapy, you've tried targeted nutritional supplements, you've tried mind/body medicine, it's time to call a surgeon. You've got to take a knife and open up that blood vessel and improve blood flow. So, if you go to five different doctors, you may get five different opinions, but having a bypass is all about quality of life.

If your quality of life is unacceptable and if you can't live with your symptoms, then have a bypass and enjoy your life, because I can tell you this from loads of experience with bypass candidates is that when these people do have bypass, their quality of life soars. Now, if you do choose to have a bypass because of unsatisfactory quality of living, talk to your doctor about beating heart bypass. A beating heart bypass is one where the doctor, the surgeon, doesn't put you on a heart/lung bypass, but actually does the surgery on a beating heart. I like this a lot better because one of the complications of open heart with heart/lung bypass is that a lot of these patients can develop confusion and depression, even six months later or a year later following bypass. So, I do like to have the heart operated on while it's beating so you don't go on heart/lung bypass.

Now, what about stents? I have a lot of patients ask me about stents. Well, first of all, if you have a severely blocked artery and you're getting a lot of angina and quality of life issues, again, you've got to have a stent, if it's one vessel. But I don't like multiple stents, I don't like three, four, five stents in vessels, particularly if you're diabetic. The data shows that multiple stents in the diabetic is not as good as revascularization with bypass surgery.

So, when it comes to bypass, it's all about symptoms. It's about your quality of living. This is where I'm an integrative doctor.