A heart bypass operation is used to treat blocked coronary arteries, which give rise to angina and heart attacks. The procedure is actually called a Coronary Artery Bypass Graft (CABG) and it involves open heart surgery.
The heart is stopped and the patient is placed on a bypass machine for the duration of the operation. The blocked arteries are removed and replaced with vessels taken from the patient's calf.
Most bypass surgery involves the three main coronary arteries - hence the term triple bypass. The exact number of bypasses which have to be carried out is determined by a test called an angiogram. Dye is injected via an artery in the groin into the coronary vessels and the exact site of the blockages determined.
CABG is a major surgical procedure requiring a post-operative stay in intensive care. Most patients are fit for discharge 10 to 12 days after the procedure.
The Republic
Jimmy is a 65-year-old postman who was sent to the casualty department of a Dublin hospital with severe chest pain in September 1999. He was admitted under the consultant "on take" (not a cardiologist) and discharged some days later on medication for angina. He was referred for a stress ECG; a cardiograph (indicating how effective his heart is working) carried out while exercising as an outpatient to confirm the diagnosis.
This was performed on October 12th. The test was positive and Jimmy's chest pains were actually getting worse. He was now unable to work. Because of the junior doctors' strike his outpatient review with the original specialist was deferred until December 1999.
He was then referred to a cardiac specialist "to be seen as soon as possible". He attended for the appointment in late January 2000. The cardiologist felt he had moderately severe angina and that he required an angiogram in the near future.
It took eight months for this to be carried out under the public system. The angiogram in August 2000 showed triple vessel disease and Jimmy was referred for cardiac surgery in the Mater Hospital.
A triple bypass CABG was carried out in late November 2000, which went well. Jimmy is now symptom-free but has retired from his job.
The entire process, from first chest pain to surgery, took almost 15 months in the public hospital system. Jimmy was unable to work and because of the continuing severity of his symptoms, he was always at risk of a heart attack throughout the 15month wait. The cost of a CABG in a public hospital is £6,800 (Department of Health figure).
Northern Ireland
Raymond is a 70-year-old pensioner from west Belfast who went to his GP with a two-week history of chest pain. The pain came on with exercise and was relieved by rest.
He was sent to a dedicated chest pain clinic on June 16th, 2000. An exercise stress ECG carried out on June 23rd was positive. A cardiologist in outpatients who saw Raymond on July 25th, ordered an angiogram.
This took place on August 23rd and, as expected, it showed three blockages in his coronary arteries. He was lined up for cardiac surgery which took place on November 2nd, but not before he had to be readmitted to hospital with worsening angina in mid-September.
Raymond is now well after successful surgery. It took just under five months from referral to surgery for the NHS to treat him. The cost of Raymond's CABG was £8,000 sterling (provided under National Health Service Fundholding system).
If Jimmy's case history is typical, then the North of Ireland is a safer place to have serious heart disease. Fifteen months is too long to wait for a bypass when you have severe angina. Apart from the risk of sudden death or a serious heart attack which could have rendered him inoperable, it is possible that Jimmy would not have given up work if he had been treated more promptly.
Although Raymond had a shorter wait of only five months for his surgery, it would be more acceptable if all patients with operable heart disease received treatment within three months. He did, however, benefit from being seen in a dedicated chest pain clinic.
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