Smokers, take note. If your doctor recommends that you have a coronary bypass—an operation that creates a new route for blood and oxygen to flow to your heart, bypassing blocked coronary arteries—there is a crucial step you must take to increase your chances of having the surgery be a success.
You have to quit smoking. This very bad habit is a major cause not only of the blocked arteries that necessitate the surgery, but also of the failure of that surgery.
As part of the coronary artery bypass grafting procedure, a surgeon typically removes a vein from the patient’s leg and grafts that vein into the chest. (This vein is easy for the surgeon to “harvest,” and afterward other veins in the leg take over the job of moving blood through that limb.) However, if you smoke, you face a higher risk of having this surgery fail. A recent study revealed that this is because smoking increases levels of certain enzymes that impair vein function. As a result, a smoker’s grafted vein is much more prone than a nonsmoker’s to develop postsurgical plaque buildup and/or blood clots—sometimes within as short a time as one month after surgery—which could require additional surgery or lead to a heart attack.
Good news: Quitting smoking helps optimize the results of bypass surgery by giving those vein-damaging enzymes a chance to normalize. While bypass surgery sometimes must be done on an emergency basis, most often patients know in advance that the surgery is needed.
Cardiothoracic surgeon Shahab Akhter, MD, of The University of Chicago Medicine, explained, “The more time that elapses between your last cigarette and your bypass surgery, the more time your leg vein has to recover and the less likely it is to fail in a graft.” In the new study, researchers saw noticeable improvements in enzyme levels among patients who stopped smoking at least three to six months prior to surgery. But quitting at any point before the operation is better than not quitting at all.
In addition to using the leg vein for bypass grafts, surgeons today often also use one of the two internal mammary arteries located in the chest to bypass the coronary artery blockage. Less commonly, arteries from the wrist are used.
“Both of these other grafted arteries actually have more long-term durability than leg veins in bypass operations, meaning that they hold up longer and the bypasses are less likely to fail,” Dr. Akhter said. But smoking severely damages arteries, too—in fact, Dr. Akhter said that there is much more data on the damage that smoking causes in arteries than in veins.
Incentive: There’s a chance that, by adopting a healthier lifestyle—including, of course, no smoking, plus a proper diet and regular exercise—you would be able to postpone your bypass (giving your blood vessels more time to heal) or perhaps even avoid the surgery altogether. For inspiration on how to stop smoking, read “The Five ‘Ds’ That’ll Help You Quit a Bad Habit.”
