How Should Long-Term Follow-Up and Treatment for Bypass Patients Be Managed?
One of the treatment options for coronary artery disease is bypass surgery. Every year, around 50,000 new patients in Turkey join this group.
Many of our patients believe that after bypass surgery, their blood vessels are renewed and they are cured of heart disease. However, the truth is that they will continue their lives as bypass heart patients. The main issue that led to bypass surgery is atherosclerosis, or arterial hardening, and the surgery does not stop this process.
It is essential to thoroughly investigate and address the risk factors that may lead to atherosclerotic narrowing in the heart vessels. Otherwise, new narrowing will inevitably develop over time in the bypass vessels or in the still healthy vessels.
It should be remembered that 10 years after bypass, the mammary or arm arteries used may remain open 90% of the time, while veins taken from the leg may become blocked more than 70%.
While there is no definitive practice regarding the follow-up periods for bypass patients, we believe that a cardiology examination every six months during the first 10 years will be sufficient. After the 10th year, more frequent cardiology check-ups may be necessary.
During routine checks, a full clinical and physical evaluation, EKG, and laboratory tests should be performed. If necessary, Echocardiography and exercise tests are applied.
Even in asymptomatic patients, it is appropriate to conduct a routine stress test after the 5th year. If low-risk findings are detected in stress tests, medication treatment should be adjusted, and the dose should be increased if necessary. Patients should also be reminded of lifestyle changes. In patients where high risk is detected during stress tests, coronary angiography may be recommended.
The recommended diet and lifestyle changes should be taken seriously. The goal should be for the body mass index to be below 25 kg/m2, with waist circumference under 94 cm for men and under 80 cm for women. For overweight patients, the initial goal is to lose 10% of their starting weight.
The physical activity and exercise recommendation is for at least 30 to 60 minutes of moderate-intensity aerobic activities daily. Walking is the most beneficial aerobic exercise.
It is recommended that LDL cholesterol be kept below 100 mg/dl, and below 70 mg/dl for high-risk patients. In fact, guidelines suggest high-dose statin cholesterol-lowering medications for all bypass patients, as long as there are no medical contraindications.
Since high blood pressure is one of the most important risk factors, blood pressure should be maintained at 130/80 mmHg or lower. Beta-blockers and ACE inhibitors are usually selected for this purpose.
For diabetic patients, the target HbA1c level should be below 6.5. Strict adherence to diet and medication is necessary for this goal.
Smoking cessation is absolutely crucial in the secondary prevention of bypass patients. Even passive smoking should be avoided.
While omega-3 supplements in the form of fish oil are not recommended for bypass patients, an annual flu vaccine may be considered based on the patient's age and risk factors.
In patients who have had a heart attack before bypass surgery, if there is heart muscle damage, medication treatment should be adjusted accordingly. Since heart failure may begin in the later stages, closer follow-up and treatment are necessary for these patients.
As a result, it is vital that patients make the most of the healthy life opportunity gained from bypass surgery and adhere to the requirements of secondary prevention. In bypass patients who cannot control their blood pressure and blood sugar, who stop taking cholesterol medication against doctor’s advice, and who continue to smoke, the atherosclerotic process will continue and vascular blockages are inevitable.
