Bypass Surgery: Antiphysiological, Degenerative and Repetitive Procedure

 Quintiliano H. de Mesquita, M.D.

The saphenous vein graft segment, an inadequate material used as bypass, suffers the effect of maximum arterial pressure during the ventricular ejection, leading commonly to its complete obstruction, sometimes in a very short space of time (less than 2 weeks ). This early occurrence of obstruction in the bypass clearly shows the tendency to the progressive stenosis effect, being responsible for the 'demand' of frequent re-operations what jeopardizes the general surgery concept as extreme and radical method of cure.

Moreover, the bypass surgery provoke changes in the coronary circulatory pressure, acting as an anti-physiological method because the blood flow determined by it represents as a lash in the pre-diastolic phase through the impelling force of residual systolic pressure far above the diastolic pressure. Such alterations in the coronary circulatory level from a gentle and natural diastolic state to an artificial and aggressive state is interpreted by us as cause for the acceleration of the atherosclerotic process, being noted in necropsies (Roberts, W. C. and Buya L. M., 1972).

These alterations in the coronary circulatory level seems to be related with the results of a study realized during 15 years by A. A. Voors and cols. ( European Heart Journal, October 1997: vol. 18; number 10, p. 1670-1677) in a series of 446 consecutive coronary bypass surgery patients. This study revealed that pre-operative systolic blood pressure was not associated with cardiac mortality while higher systolic blood pressure 1 year after surgery showed a trend towards increased cardiac mortality. The systolic blood pressure 5 years after surgery appeared to be a strong independent predictor of cardiac mortality during the subsequent follow-up period in this study.

 In our clinic we have had the chance to attend many new patients who underwent to bypass surgery looking for a medical option to treat their persistent angina according our concepts (by cardiotonic drugs + coronary dilators) what revealed to be successful in all cases. From these patients, we observed that in 3 among 5 of them, who have brought ventriculograms for our analysis, presented ventricular degeneration with the ventriculographic pictures showing, in a period from 1-3 years after the surgery, large systolic and diastolic volumes, almost equivalent. The bypass surgery resulted in a permanent state of ventricular hypocontractility in the forementioned patients.

So, I am really curious to know statistics about this question, which was firstly identified by Soloff L. A., in 1972. If you have any information about this, please tell us! 

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