Cardiovascular Services

Coronary Bypass Surgery Choosing the right surgeon and team matters

East Jefferson General Hospital’s outcomes have earned five-star and “Best in Region” honors from HealthGrades in the areas of Cardiac Surgery and Coronary Bypass. Additionally, EJGH ranks in the nation’s top 10% for patient safety in cardiac care, as determined by CareChex.

More than 30 years ago, a new surgery was developed that could bring relief to many who suffered with severe coronary artery disease. That new procedure, commonly known as coronary bypass, has proved to be a reliable, repeatable and effective tool for physicians hoping to prolong the duration and quality of life of their patients.

Coronary bypass is a procedure that allows a surgeon to “bypass” diseased portions of one’s artery, giving a new pathway through which blood can flow more freely. A healthy artery or vein is taken, usually from the patient’s leg, and is grafted into position, creating a bypass around the diseased or blocked portion of the artery. As this procedure continues to evolve, there are now several surgical techniques that all fall under the umbrella phrase of bypass. Many of these newer techniques are less invasive. The type of bypass chosen for you depends upon both your clinical condition and the preference of your surgeon.

In these less invasive procedures, smaller incisions are used, reducing blood loss and recovery times. In these cases, the heart is slowed with medication throughout the surgery and a heart/lung bypass machine is not needed. For a more traditional, open-chest, bypass procedure, a heart/lung bypass machine is needed to pump blood and oxygen throughout the body during surgery.

East Jefferson General Hospital has been successfully performing various types of the bypass procedure for more than a quarter of a century. In that time, the surgeons, nurses and processes at EJGH have evolved to the point that East Jefferson General Hospital’s outcomes have earned five-star and “Best in Region” honors from HealthGrades® in the areas of Cardiac Surgery and Coronary Bypass. As an independent reviewer of hospitals, HealthGrades compared EJGH surgical outcomes against those not only of other hospitals in our region, but throughout the nation.

Ann Stadjuhar of HealthGrades knows how difficult it is for a hospital to earn a five-stars. She says, “As an independent healthcare rating entity, HealthGrades can stand outside politics, commentary or reputation. We simply look at outcomes. You can’t argue with success and a five-star rating. ‘Best in Region’ means your hospital has achieved the highest level of success possible within our rating system.” Of the hundreds of hospitals rated by HealthGrades, less than five percent earn a five-star rating. And, obviously, only one can achieve “Best in Region.” That places EJGH in rare company.

Dominick Bonura had been under the care of EJGH Cardiologist Stanley Bleich, M.D. for more than eight years. Over that time, Dr. Bleich had monitored Mr. Bonura’s condition with regularly scheduled appointments. It was during one of these routine visits in early March of 2009, that a stress test indicated a progression of Mr. Bonura’s condition. A visit to East Jefferson’s Cath Lab confirmed that Mr. Bonura had a blockage that required bypass surgery. Mr. Bonura sums up the events that followed, “In less than a week I had my surgery and the next day was up and walking. It was all a blessing.” Now, less than a month after his procedure, Dominick is walking and doing small projects around his home and “thrilled” to have Doctors Bleich and Tubb on his side. Dr. Stanley Bleich believes Mr. Bonura’s experience is a perfect illustration of East Jefferson General Hospital’s excellence in cardiac care, “One of the hallmarks of our cardiac care is the excellent teamwork that exists between our cardiologists and surgeons. That teamwork also extends to the nursing and surgical teams, along with the various departments such as ICU, CCU, Cardiac Rehab, Cath Lab and more. Within this case you have all these various elements working perfectly with the patient to produce an excellent outcome.”

Here’s why Choosing the right surgeon and team matter.

While surgeons get the bulk of the credit for a successful procedure, they are usually quick to point out that they are dependent upon an entire team of professionals who all have a hand in creating successful outcomes. One such surgeon is Dr. James Tubb, a cardiovascular-thoracic surgeon practicing at East Jefferson General Hospital. During a career that began more than 30 years ago, Dr. Tubb has performed thousands of bypass procedures. He has watched it grow from a seldom used "open heart surgery" to something that has become a primary weapon in our fight against heart disease. He has been a key figure in the hospital's growing reputation in this area. Dr. Tubb on EJGH surgical excellence, "Surgery is never something to be taken lightly. We work hard to find non-surgical means of treating our patients, but I am proud of the quality, and consistency, of care we provide our bypass patients." Dr. Tubb believes experience plays a key role in EJGH's surgical success, "As a hospital, we average one bypass every other day and perform other cardiac procedures on a daily basis. That experience is important in keeping surgeons and the entire surgical team at their best."

Bypass surgery can’t cure coronary artery disease. Patients will still need to make changes in the ways they eat and exercise in order to see the full benefit of the procedure. While each case is unique, most physicians agree that any of the following might make you a candidate for the surgery:

  • Your left main heart artery is very narrow.
  • All three arteries of the heart are blocked, or blood flow through them is very small.
  • You also need surgery to repair or replace a heart valve damaged by heart valve disease.
  • You have diabetes and two or more arteries are blocked.
  • Your heart is having trouble beating (decreased ejection fraction).

Perhaps the most difficult time to determine if someone is or is not a candidate are those cases when two arteries are blocked, but neither is the left main artery. In those cases, other factors such as age, your current state of health and the severity of your ongoing chest pain are all factors your physician will consider.

Coronary procedures deserve a great deal of the credit in creating significant changes in how a patient’s surgical recovery is handled. Several years ago, it would have been unthinkable to have a surgical patient up and walking the day of, or day after, heart surgery. Today, in part thanks to innovative work with cardiac surgery patients, we know a patient’s recovery is significantly improved when they are mobilized shortly after surgery.

Kay Pastor, RN, oversees Care Management at East Jefferson General Hospital. She sees firsthand what a difference mobility makes in a recovering patient. “If you think of how stiff and achy you feel when you lay in bed too long, imagine that after suffering the trauma of surgery. There are now numerous studies that show patients enjoy shorter hospital stays, faster recovery, fewer complications and better outcomes if they are up and walking within a day of their procedure, or as soon as it is clinically appropriate. While cardiac patients were some of the first to enjoy these benefits, this practice has been almost universally adopted at our hospital.”

When polled, bypass patients tend to give very high satisfaction scores. This, in part, is almost certainly due to the life-changing, and saving, nature of the procedure. Some credit must also be given to the fact that many fill out these questionnaires after they have already joined East Jefferson’s Cardiac Rehabilitation Program.

Now a quarter of a century old, this is our region’s oldest, most established program of its kind. It methodically takes bypass patients through their physical and emotional recovery processes and often is utilized by patients the rest of their lives. The program provides clinically proven fitness programs designed specifically for this population with a built-in buddy program that gives post-surgical patients the kinds of support they need as they make the lifestyle changes needed to ensure they never undergo a second bypass.

Bypass is called for when your heart disease has progressed to the point that adequate blood flow is no longer occurring. Heart disease is the result of your own diet and lifestyle as well as heredity. In fact, more and more data gives the bulk of the blame to heredity.

If your immediate family—a parent, sibling or grandparent—have heart disease or have suffered a heart attack or stroke, you are deemed to be at higher risk for a similar event. Like most other prevention programs, it starts with a diet built around fruits, vegetables and fish, while reducing red and processed meats. A recent study showed men eating too much red meat or processed meats increased their risk of heart attack and stroke by as much as 25 percent, and for women, it was more than 20 percent. You should maintain a daily exercise program and you, particularly after the age of forty, should undergo annual physical exams and screenings.

Most importantly, don’t ignore your body and the warning signs it offers. If something isn’t feeling the way it always has, pay attention and consult a physician. Hopefully, your preventive program will be effective and you will never need surgery, but if you do, it is nice to know a hospital right here in your region ranks among the top five percent in the nation.