Heart Surgery

Three hospitals in Los Angeles County -- County-USC Medical Center, Citrus Valley Medical Center/Inter-Community Campus in Covina and Torrance Memorial Medical Center -- had the highest mortality rates in California for coronary bypass surgery in 2005, according to a statewide analysis scheduled to be released today.

The last time Antisha Anderson was in this third-floor operating room at Long Beach Memorial Medical Center, she was groggy from anesthesia and puzzled by the big, round lights shining down on her. "They looked like alien eyes," she said, laughing. Anderson, a four-time national youth heptathlon champion and aspiring Olympian, was in that surgical suite Nov. 28 to undergo a rare heart procedure. Returning recently for a visit she was greeted like a friend, not merely a statistical success.

Cynthia Burstein Waldman of Los Angeles got tired of feeling she knew more than her doctors did about her hereditary heart condition, hypertrophic cardiomyopathy; tired of worrying that a provider might accidentally give her a contraindicated drug, like nitroglycerin, in an emergency; tired of hearing conflicting information from doctors who rarely saw a woman her age with the condition. "It's not a disease most people, even cardiologists, see in their practice," she says.

As an American tourist visiting Hanoi in 1997, Marichia Simcik Arese extended a simple goodwill gesture to a group of struggling teenage students in Vietnam. The youths were working at a restaurant and using their down-time to fashion picture frames from empty aluminum cans. "They would sell the frames to pay for their education," she recalled. "I told them if they would make 50 and send them to me, I would try to sell them in the U.S. and send the money back to them."

THERE are times, despite dangerous international conditions, when one is more concerned with self than with the world. We turn inward when illness threatens our lives, oblivious to the larger tragedies besetting the globe, because in pain, we become the larger tragedy. I say this in reference to my recent removal from the scene due to heart surgery. Because survival is a major instinct of the human condition, it was my primary concern during recuperation. But things have changed.

Open heart surgery, which many patients and doctors have avoided in the last decade in favor of less-invasive heart stents, is making a comeback. Recent studies suggest that bypass surgery could extend many patients' lives longer than stents, the tiny devices designed to reinforce damaged arteries. The newest generation of stents, which are coated with drugs meant to inhibit blood clots, might actually increase the risk of clots compared with older, bare-metal versions, other studies suggest.

Californians needing a coronary bypass can now, for the first time, look up which surgeons in the state have the best -- and worst -- mortality rates for that operation. A report released Thursday names and rates 302 surgeons who performed heart bypass operations at 121 California hospitals during 2003 and 2004. Prepared by the Office of Statewide Health Planning and Development, the 143-page study is posted on the office's website, www.oshpd.ca.gov.

Vice President Dick Cheney, who has a history of heart problems, had surgery to replace an implanted device that monitors his heartbeat. Doctors at George Washington University Hospital replaced his battery-powered defibrillator. If the device were to sense an abnormal rhythm, it would deliver an electronic shock to reset Cheney's heart to a normal beat. "The device was successfully replaced without complication," said Megan McGinn, Cheney's deputy press secretary.

A drug widely used during heart surgery to control bleeding doubles the risk of kidney damage, forcing an estimated 10,000 patients onto dialysis each year, according to a study from a group calling for surgeons to abandon its use. Known as aprotinin, the drug also increases the risk of heart attack by 48%, heart failure by 109% and stroke by 181%, the study of about 4,400 patients reports today in the New England Journal of Medicine.

One of medicine's greatest triumphs is hitting a snag: Up to 1 million people born with once-lethal heart defects now have grown up, a pioneering generation largely unaware that heart repairs can wear out as middle age approaches. Few even get cardiac checkups, apparently believing they were cured as children. Worse, few cardiologists outside of children's hospitals know how to care for these special hearts.