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"When is surgery necessary after a heart attack?"

ZocdocAnswersWhen is surgery necessary after a heart attack?


My dad had a heart attack and although he?s okay, I fear that he may need surgery.


Heart attacks are a serious medical problem, but surgical intervention for coronary artery disease (the cause of heart attacks) is not without its own set of risks. That is why this question must be discussed with your father's cardiologist. The short answer to your question is that surgery is indicated after a heart attack when the risk of future heart disease is high enough that the benefits of the surgery outweigh the risks. If you want to get into greater depth than that, things get quite a bit more complicated. The most common type of heart surgery performed after a heart attack is the coronary artery bypass graft, known to most people simply as a "bypass". This surgery uses a conduit (usually an artery or vein harvested from elsewhere in the body) to bring blood to coronary arteries that have a narrowing or blockage upstream, thus "bypassing" the blockage. This can be done for one, but usually two or more coronary arteries, giving rise to the terms double, triple, and quadruple bypass. The American College of Cardiology and the American Heart Association have published some guidelines that recommend bypass surgery in certain situations. I will try to give you basic information about them, but they are very complex. Bypass surgery is recommended for people with a significant narrowing in the left main coronary artery, as well as those who have severe narrowing in both the left anterior descending coronary artery and circumflex coronary artery. People with 3 or more diseased coronary arteries are likely to benefit from bypass surgery in many situations. In certain situations, patients with narrowings in any one or two of the coronary arteries may benefit from bypass surgery as well. Finally, people with severe narrowing in the left anterior descending coronary artery alone are recommended to undergo bypass surgery if their heart function is poor or in certain other situations. There are other situations in which bypass surgery may be recommended, but they are more complicated, patient specific, and sometimes based on weaker clinical evidence. This information probably does not bring you any closer to knowing whether your father needs bypass surgery. That is because the decision about who needs heart surgery is enormously complex, relies on very specific details about the condition and anatomy of your father's heart, and it requires years of specialized training to interpret and apply the guidelines for surgery to each individual patient. If you are concerned your father may need heart surgery, you need to visit a cardiologist and, if needed, a heart surgeon in person, who can evaluate your father fully and make recommendations based on his specific situation.

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