Doubts over value of bypass surgery could transform coronary care

Coronary bypass surgery - the commonest operation for heart disease - does not extend life, according to a study. Jeremy Laurance asks whether the surgical success story of the 1970s and 1980s is set to decline.

Long-term results of coronary bypass surgery are "disappointing" and the operation may have been overused, an expert in heart problems said yesterday.

Dr John Irving, consultant cardiologist at St John's Hospital in Livingston, West Lothian, said patients and relatives tended to believe that the operation would prolong life when it was unlikely to do so. Patients treated with drugs alone survived longer although severe symptoms, such as angina (chest pain), were better treated with surgery.

A study of 102 of Dr Irving's patients who were operated on in the mid- 1980s by eight different surgeons and followed for 10 years, published in the journal Heart, found a third had died, half of them aged between 40 and 59. Among those who survived, 40 per cent either had angina recur or underwent another operation.

Dr Irving said: "I do think the operation has been overused. It is also expensive at pounds 11,000 a time and patients still need drugs.

"Medical treatment may be as effective and costs only an extra pounds 500 on drugs. That is a big saving."

The operation which was pioneered in the 1970s, involves stripping out the tiny arteries that supply blood to the heart muscle when they have become clogged with fatty deposits as a result of heart disease, and replacing them with veins taken from the leg or chest wall.

It is effective at relieving symptoms of chest pain but the new veins tend to clog up and collapse like the old ones over time. Around 25,000 operations a year are carried out at a cost of pounds 275m.

The number of bypass operations has started to fall as worries about cost have grown, and there has been greater use of angioplasty, an alternative technique in which the coronary arteries are widened using a balloon attached to a catheter introduced via a vein in the groin.

The British Heart Foundation said the symptoms of heart disease could be debilitating and bypass surgery was effective at alleviating them. New drug treatments developed in the last 10 years meant doctors were now more selective about choosing patients for surgery. "Longevity may not be the only factor," the spokesman said.