Many cardiovascular patients eventually are told that they require surgical intervention to help manage their disease. In some cases, the need for heart surgery is clear cut; for example, an artery that is fully or almost fully blocked requires intervention if you are having symptoms. But in other situations, decisions on whether to have heart surgery are less urgent and therefore more difficult, particularly when doctors pressure patients to have the procedure.
Here Are the Things I Recommend for the Best Heart Surgery Outcome
1. Decide About Heart Surgery Based on Your Quality of Life
My advice about whether to have heart surgery is to first consider the severity of your symptoms and whether they can be relieved through less invasive alternatives, and to base your choice primarily on your overall quality of life.
Questions to ask yourself:
- Where your blockages are located and how severe are they? (If the left main coronary artery is blocked more than 70 percent, or there is 90 to 95 percent narrowing of two or more other major coronary vessels, surgery is necessary.)
- How severe are your symptoms? Do you suffer frequent bouts of angina or shortness of breath after minimal exertion?
- Can you live your life comfortably with them?
- Can you do anything (medication or lifestyle changes) to diminish your symptoms without surgery?
- If you are a candidate for angioplasty and a stent, how many stents will be required?
I recommend surgery when blocked arteries lead to an unsatisfactory quality of life or a high risk of heart attack. “Unsatisfactory” in this case means frequent bouts of angina; shortness of breath with minimal exertion (often referred to as an anginal equivalent); or the inability to walk up a short flight of stairs, enjoy a game of golf, or play with the grandkids.
Some cardiologists may prefer angioplasty-stents over open heart surgery, but I disagree when more than one or two stents are required. Surgical patients fare better than stented patients in both the short and long term, especially those who are diabetic. Even multiple bypasses are better than multiple stents. However, I do endorse the use of a stent or two if it means you can avoid having your chest opened up.
For patients whose coronary artery disease is more stable and who are at less risk, alternative therapies are justified.
2. Before Heart Surgery: Stop Certain Supplements and Foods
Because of their blood-thinning effects and/or potential to interfere with anesthesia, stop the following nutritional supplements at least three days prior to surgery:
- Vitamin E
- Fish oil
- Ginkgo biloba
- St. John’s wort
- Ephedra (also called Ma Huang)
In my experience, you’re okay to stop five days before, and then start up again five days after. Whatever you do, though, be sure to inform your doctors.
I also tell patients who are going in for major surgery involving general anesthesia to stop drinking alcohol a month before the operation. You need your liver operating optimally and, as you no doubt know, alcohol is toxic to the liver.
I also suggest staying away from acetaminophen, which has a toxic effect on the liver. In clinical studies, this over-the-counter painkiller has been associated with unexplained liver failure. If you rely on painkillers, check with your doctor for any pre-operation advice.
3. Maximize Your Heart Surgery Recovery with Nutritional Support
Pre- and Post-Heart Surgery
- Take a high-quality multinutrient as part of your daily routine before and after surgery. Choose one that contains 25 to 50 mg of the B complex vitamins.
- Surgical trauma (particularly from cardiac surgery) causes an increase in free radicals, which disrupt and damage cellular function. For this reason alone, you should take at least 50 mg of CoQ10 as part of your daily routine before surgery, and 100–200 mg per day for at least four weeks during surgery recovery.
- Because surgery depletes your body of vitamin C, take 500–1,000 mg as part of your daily routine before surgery and 1,000 mg two times a day after surgery. Return to your usual dosage after two week. Numerous studies indicate that vitamin C helps prevent surgical shock and post-surgical bed sores, and that it significantly speeds healing time. It’s also necessary for the production of collagen—a basic structural protein used in wound repair.
- Begin taking milk thistle a month before surgery, and then continue for a month after (follow label instructions for dosage). This wonderful herb protects, rejuvenates and repairs the liver. General anesthesia and other medications used during and after surgery are exceptionally hard on the liver, so anything you can do to protect this vital organ will be a big plus for your surgery recovery.
- Increase your zinc intake to 30–50 mg for two weeks before and two weeks after surgery, using zinc picolinate. Zinc is critical to wound healing, and surgery or trauma can decrease the level of zinc in your body.
- Start taking a probiotic supplement two weeks before surgery, and continue using it for at least a month afterward—or, better yet, indefinitely. Choose a strain that contains acidophilus and bifida bacteria (follow label instructions for dosage). Surgical patients often receive oral or intravenous antibiotics in the hospital, which creates the potential for fungal disorders (including yeast infections), digestive disturbances and diarrhea. A probiotic can help counteract these problems, promoting surgery recovery.
Also After Heart Surgery
- Take 250 mg of vitamin B6 twice a day for a week, starting three days after surgery. This nutrient helps reduce post-surgical fluid retention, such as swelling of the face, hands, feet or legs. The swelling usually takes two to four weeks to go down. With B6, you can experience substantial reduction within 24 to 48 hours.
- To reduce inflammation, take 2,000–3,000 mg of omega-3 fish or calamari oil per day for two weeks after surgery. You can then go to a maintenance dosage of 500–1,000 mg per day. If fish oil is already part of your daily routine, be sure to stop taking it five days before surgery, since it can promote blood thinning and increase bleeding during surgery.
- Take bromelain on an empty stomach for two weeks after surgery (follow label instructions for dosage). This formidable pineapple enzyme supplement helps prevent blood clots, aids the liver and digestion and decreases inflammation and pain after surgery—all vital to surgery recovery. It also helps to remove protein debris that form at trauma sites.
- Another supplement to relieve pain and inflammation is the homeopathic remedy Arnica 30C. Take one pellet four or five times a day for up to two weeks after surgery.
4. Use Targeted Nutrients to Prevent Restenosis
One of the biggest problems with bypass and angioplasty (but particularly angioplasty) is restenosis, or the reclosure of the arteries. In the case of angioplasty, restenosis typically occurs within three to four months of the procedure, and it may even occur up to a year or more afterwards.
Targeted supplementation can help minimize and prevent this process. If you have a history of successful angioplasty, or a bypass, your regimen should include:
- B-vitamins (400 mcg of folic acid, 40 mg of B6, and 200 mcg of B12)
- Vitamin E (200–400 IU)
- CoQ10 (120 mg)
- L-carnitine (2 grams)
- Magnesium (400 mg)
- Fish or calamari oil (1-2 grams)
Taken together, these nutrients will help relax blood vessels, inhibit sticky blood and block excessive growth of smooth muscle cells to prevent restenosis. The B-vitamin combination of folic acid, B6, and B12 is particularly important. One study found that this vitamin combination significantly reduced the incidence of restenosis and slashed the need for a repeat angioplasty by 38 percent.
5. Remember, Your Heart Surgery Procedure Is Not a Cure
If you do undergo bypass or angioplasty, remember that neither heart surgery procedure is a cure. You still have arterial disease. What it does is “buy you time” to you help reverse your coronary artery disease and possibly even heal yourself.
Now it's your turn: Do you have any heart surgery insights to add to my list?