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Although the complexities of coronary bypass surgery are beyond the scope of this book, a few comments are in order. Briefly stated, this recent surgical advance is a procedure involving the removal of one or both of the major veins (saphenous vein) in the leg and its careful transplantation in the chest. After appropriate cardiac catheterization to determine the adequacy of the coronary circulation, the vein is placed between a hole made in the aorta as it leaves the heart and the more distant part of the coronary artery. With its 5-10% risk to life, the exorbitant cost ($30-50 thousand), and the lack of long-term statistics as to its effectiveness (at best 2 years), this operation should be regarded as a last resort.

Reconditioning programs are springing up around the country and offering a superior alternative to many bypass candidates. The combination of a low fat diet free of cholesterol and progressive exercise in a center with preventive capabilities will often minimize the necessity for cardiac drugs, while relieving chest pain and similar cardiac symptoms. Nevertheless, a few individuals with disease of all three coronary vessels or underlying impairment of the heart valves may need and profit from this operation. In such cases, it is my recommendation that a medical center experienced in heart surgery be selected with much prayer and care.

Following the bypass operation, cardiac rehabilitation should begin in a lifestyle conditioning center where both diet and lectures are calculated to prevent recurrence. As rapidly as possible this will recondition the patient for a return to normal living. Otherwise, the temporary relief obtained by a revascularization procedure may be short-lived as the new vessels plug themselves with cholesterol once again. One can easily see how every aspect of coronary heart disease from the cradle to the rocking chair will benefit from preventive measures.

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