President George W. Bush's successful heart surgery, which involved placement of a stent in a coronary artery, is performed roughly a million times a year nationwide, sometimes without even a night in the hospital, according to cardiologists.
“The technology of stenting has really evolved over the last 10 to 15 years to the point that it is a fairly routine procedure," said Dr. Raj Makkar, director of the Interventional Cardiology and Cardiac Catheterization Laboratory at Cedars-Sinai Medical Center. "They did almost a million stents last year in the U.S. and another million outside of the U.S."
Makkar had been at work since 5 a.m. Tuesday, performing nearly identical procedures to the one done on the 43rd president that morning at the Texas Health Presbyterian Hospital in Dallas. Makkar's team places about 1,500 stents in patients each year.
Bush, 67, was reported to be in good spirits, according to a written statement.
His case was in many ways typical - a minor blockage was discovered after a routine physical examination of an otherwise healthy male in his sixties.
The American College of Cardiology capitalized on the publicity generated by the procedure to remind people to refresh their knowledge of the signs of heart trouble.
“Every person should know their own situation and know that there are things you can do to reduce your risk of heart disease,” said John Harold, president of the college. “The earlier you begin, the more likely it is to make a difference.”
Doctors said that except perhaps for a fondness of Texas cuisine, Bush did not exhibit any high-risk factors for coronary disease, which include diabetes, poorly controlled blood pressure, smoking, a high-cholesterol diet and a genetic history of cardiovascular troubles. While in the White House from 2001 to 2009, and since, Bush rode a mountain bike, jogged and labored on his Texas ranch. His annual medical reports indicated a minimal to low risk for coronary artery disease.
President Clinton, often lampooned for his admitted love of fast food, was not so fortunate. He underwent major heart surgery in 2004 and had a stent placed in a coronary artery in 2010.
Details of the Bush procedure were not available. Generally, placing a stent can take as little as an hour and involve only a minor puncture in the groin area, although increasingly the entry point is the wrist. About 70% of the stents placed in coronary arteries these days are medicated - the mesh tubes deliver drugs that help deplete plaque and prevent re-narrowing of the passage.
In Europe and India, bio-absorptive stents that disappear after a few years already are in use, though they remain in the study phase here.
“You put in the stent and in a couple of years the stent will actually completely disappear after it has done its job,” Makkar said. "The degradation of the stent occurs very slowly while the plaque is being pushed out. And the healed tissue keeps the plaque out.
Patients such as Bush, who do not exhibit classic signs of coronary distress (such as shortness of breath and pains in the chest and arms), usually will undergo a non-intrusive CT scan before an angiogram is considered. In addition, hospitals are increasingly using catheters designed to measure fractional flow reserve, a pressure differential between an area before and after the stenosis (narrowing).
Heart disease remains the leading cause of death in the U.S., with 600,000 deaths attributed to that cause annually, according to the Centers for Disease Control and Prevention. Healthcare costs associated with coronary heart disease have topped $100 billion a year, the agency reported.
Although death rates due to coronary disease are higher in the South, the Texas county where Bush's ranch is located has a middling rate - about 431-473 per 100,000 residents over age 35, according to the CDC. Those ranges reach a high of 523-747 per 100,000 - the range for a broad swath of the lower Mississippi River region.
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