I was following the dogma of the day. Before 1995, I was regularly sending patients to have coronary artery bypass surgery. This patient had blockages and by the standards of the day his bypass was appropriate. I still feel terrible about what happened to him. After the surgery, he had severe dementia and was bed bound. He had been fine prior to the surgery. He never recovered. Two women in my family lost husbands as a direct result of bypass surgery. One died on the table. One died as a result of a staph infection that began with the surgery. These are not rare problems.
Fifty-three percent of patients who have bypass surgery have significant mental impairment shortly after the operation. Six months later, one fourth of these patients still have significant impairment. For many, this improvement was temporary. Five years after the surgery, mental impairment was up to 42% again. Very often, the potential for this complication is minimized prior to the surgery. "Adjectives such as 'subtle,' 'transient,' and 'subclinical' have been used to describe the cognitive decline that occurs after CABG but such descriptions minimize the importance of these changes to clinicians, patients, and their families," the study authors write.
A 42% risk of dementia is a chance I don’t want to take if there are alternatives. These procedures are not always benign and when complications do occur they can be devastating. If patients received a truly informed consent, I am confident they would choose optimal medical therapy more often. There are no quick fixes. Optimal medical therapy (OMT) is a much better treatment for arterial disease for most patients. It is inexpensive and not much more trouble than brushing your teeth. Let’s make OMT more available to Americans across our country.
Thank you for sharing this.