The first time coronary arteries become blocked beyond repair, doctors can replace them, and the heart is good as new.
The second time around, the medical approach is a little less scientific: Cross your fingers and pray.
About a half-million times each year, doctors across the United States replace blocked coronary arteries with veins taken from the legs. The procedure is called coronary bypass surgery.
Grafted veins can be lifesavers. But after about 10 years, they can clog with a chalky, cheesy, gunky material different from the fat that blocked the arteries in the first place.
Until now, patients with blockages in grafted vessels had few options. Repeat bypass surgery and balloon clean-outs, known as angioplasty, both carry great risk.
But a new device, approved by the U.S. Food and Drug Administration this summer, offers heart patients another chance.
The danger in reopening blocked bypass vessels is that the gunk can break loose and travel to the heart, causing a huge and sudden heart attack while the clean-out is still in progress.
The new distal protection device, manufactured by Medtronic, uses a balloon to barricade the blocked vessel, keeping gunk away from the heart during clean-out.
"This allows us to treat patients that could not be safely treated in the past," says Dr. Daniel Diver, chief of cardiology at St. Francis Hospital and Medical Center in Hartford.
Diver started using the device as soon as it was approved and already has done almost a dozen clean-outs with it.
Alphonse D'Amato, whose famous name continues to get attention, although he is not related to the former U.S. senator from New York, says he is glad his latest heart blockage happened last month, after the new treatment became available.
A year ago, D'Amato, 58, of Bristol, had a heart attack while doctors tried to open a blockage in one of his bypass grafts. Only a pump installed in his aorta kept him alive until his heart recovered.
Although D'Amato's heart suffered permanent damage in that incident, he survived. Diver has seen patients die from heart attacks during procedures to open blocked bypass grafts.
"You just crossed your fingers," Diver says of opening clogged bypass grafts without the distal protection device.
On Aug. 28, D'Amato had his blocked vessel opened with the protection device in place. Diver threaded a wire fitted with a deflated balloon into the clogged vessel. Diver says that while the idea is simple, it took a technological breakthrough to develop a wire thin enough to fit into a heart vessel but capable of carrying fluid to inflate and then deflate a balloon.
Diver inflated the balloon downstream from D'Amato's clog, so gunk scraped from the vessel could not travel to the heart. After using balloon angioplasty and a stent to clear the vessel, Diver vacuumed out the gunk before deflating the barricade balloon and reopening the vessel to blood flow. This time, D'Amato had no complications.
Diver says that in the future, all artery-cleaning procedures may be done with a protection device. Doctors are already testing a similar device to prevent stroke when clearing clogged carotid arteries.
Meanwhile, Diver estimates that millions of people could someday benefit from using the barricade to clean out clogged bypass grafts.
"Several hundred thousand people have bypasses every year," Diver says. "Many vein grafts have significant problems within 10 years. You're talking about millions of people walking around with vein bypass grafts that are degenerating."
A version of this story first ran on Sept. 25.Copyright © 2014, Los Angeles Times