The death of America’s most famous astronaut Neil Armstrong due to complications following quadruple heart bypass surgery might seem surprising, considering how routine this major operation has become.
But a top cardiologist warns that bypass operations are becoming less common, and surgeons are therefore becoming less adept at doing the surgery.
When it comes to heart surgery, practice makes perfect, and the surgeons at institutions who do the highest number of procedures have the lowest rates of death and complications, says Chauncey Crandall, M.D. Nowadays, the number of bypass surgeries is declining, so I’m concerned that not enough procedures are being done to keep doctors and hospitals in peak form.
Dr. Crandall is chief of the cardiac transplant program at the world-renowned Palm Beach Cardiovascular Clinic in Palm Beach County, Fla.
Armstrong’s death was announced by his family on Saturday. The 82-year-old underwent the four-way bypass on Aug. 9, and Armstrong’s wife, Carol, was quoted as saying he was doing great after the surgery. The former astronaut had a long history of heart disease, having suffered a mild heart attack in 1991.
In coronary artery bypass surgery, or CABG, surgeons use a blood vessel from the arm, leg, or chest to make a conduit that will bypass, or divert blood flow around the patient’s blocked coronary artery. In a quadruple bypass, four grafts are used.
Over the decades, the death rate from this procedure has declined to an average of 3.3 percent or even less. But although this type of operation is now considered routine, even in people of Armstrong’s age or older, this is serious surgery, and many complications can occur, Dr. Crandall said. This includes heart attack or stroke, chest infection, heart rhythm problems, or lung or kidney failure. Patients are also vulnerable to infection following surgery.
While it isn’t known where Armstrong had his surgery, or what complication he suffered, patients can improve their odds by choosing a hospital with a high volume of open-heart surgery.
Very experienced doctors working at hospitals that do the highest volume of cases have the lowest rates of death and complications, but this is getting harder and harder to find, Dr. Crandall said.
While 100 to 125 heart surgeries a year appear to be sufficient to keep doctors in practice, 200 such procedures are preferred, according to the American College of Surgeons. However, a study published last year in the Journal of the American Medical Association found that the volume at the nation’s hospitals is diminishing, and it is becoming more difficult for surgeons to get the volume they need to keep their skills sharp.
Between the years 2001 to 2008, researchers found that the number of bypass cases dropped by one-third, while, at the same time, the number of hospitals offering the procedure increased. As a result, while 90 percent of hospitals performed 100 bypasses or more in 2001, that number had fallen to 75 percent by 2008, a trend that concerns Dr. Crandall. Less volume in cases leads to doctors who are less experienced, and this, in turn, leads to poorer outcomes, he said.