Your Heart In Their Hands: Surgeon Preferences & Survival Rates

Unless you are paying entirely out-of-pocket for a heart surgery, you will not usually get final say over which surgeon you get.

The surgeon, however, will have final say over what they actually do when they open you up.

And their preferences, it seems, can make all the difference:

MAG vs SAG

When doing coronary artery bypass grafting, (CABG), surgeons may prefer to do multi-arterial grafting (MAG) or single-arterial grafting (SAG).

Recently, there was a study analysing more than a million Americans who underwent CABG on Medicare over an 18-year period, looking at outcomes for MAG vs SAG.

The superficial news: those who received MAG had much better long-term survival chances than those who received SAG.

However: this may be less to do with the relative merits of the procedures themselves, and more to do with the preferences of the surgeon.

The “eyeball test”

If surgeons look at a patient and think they will not have many years to live after surgery, they may opt for the SAG, as the long-term benefits of the MAG will only manifest in the long-term.

This may seem a little self-defeating (indeed, maybe you won’t live to see the long-term if you don’t get the surgery type with the longer-term survival chances), there can be other factors involved, that may make surgeons more interested in your short-term survival chances.

Or you might just not have enough donor artery tissue available to pick and choose; after all, a person having a coronary artery bypass quite possibly won’t have great arteries in their arm or leg, either.

Or a person could be missing limbs (a common complication, given the comorbidities of both peripheral artery disease, and diabetes).

See also: How To Stay A Step Ahead Of Peripheral Artery Disease

Why it might be ok that things are like this

When factoring in surgeon preference for MAG or SAG as an instrumental variable, no significant difference in long-term survival was observed. This may explain inconsistencies with randomized controlled trials like the Arterial Revascularization Trial (ART), which also found no survival benefit of MAG over SAG.

Also, MAG recipients were generally younger, healthier, and from more resourceful areas, which likely had a further impact on MAG-giving decisions, and/but at the same time, may also have increased survival chances for reasons other than that they got MAG rather than SAG.

Here’s a pop-science article that goes into more detail about this:

Surgeon preferences may explain differences in CABG survival rates

How to look out for yourself, and advocate for yourself

…or your loved one, of course. Now, having a coronary artery bypass surgery of any kind is not a fun activity; it will be dangerous, it’ll be stressful before and after, and the recovery will often not be an easy time either. However, it is possible to learn more about what is going on / what will happen, ask the right questions, and get the best options for you (which may not always be the same as the best options for someone else).

We wrote about that in more detail here:

Nobody Likes Surgery, But Here’s How To Make It Much Less Bad

Take care!