Bypass Surgery or Angioplasty has always been a question in the mind of the patients who suffer blockages? Although there can be few generalizations on which treatment option to go for, the end choice will depend on the cardiac surgeon and patient. However, the repercussions should be known and discussed well in advance, before the final choice is made.
Coronary Angioplasty: Angioplasty is a minimally invasive procedure to widening of coronary artery. The procedure, typically, involves balloon catheter to widen the blocked artery from within. Followed by placing a stent in the area that was blocked, to keep the artery open. The procedure involves use of local anesthesia and the hospitalization time of the patient is limited to 1 to 2 days, in most cases. It also has quicker recovery and rehabilitation time and involves lesser complications as a surgical procedure. Also, with recent advances in medical devices and use of drug-eluding stents, the procedure has had a very high success rate and might not need to be superseded by a bypass surgery.
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Coronary Artery Bypass Surgery (CABG): Even though the success rate of angioplasty is very high, not everyone with coronary heart disease can be recommended for angioplasty. Patients suffering from double/triple vessel disease or those who have high diabetes, would be advised to undergo CABG Surgery since it offers better survival outcomes.
Typically this surgery involves taking a section of healthy blood vessel, from the inside of the chest wall or the lower leg and attaching it above and below the blocked artery. This allows blood to bypass the blocked area and maintaining proper flow to the heart muscle. Bypass surgery is performed under general anesthesia. In hospital time, typically ranges from 5 to 10 days depending on the recovery the patient.
While it may sound straightforward, choosing between bypass surgery or angioplasty is quite tricky. Typically, the surgeon uses the reports of coronary angiography to examine the degree of the arteries being blocked and based on the nature of the plagues and range of blockage of the arteries. Basis the reports, an experienced cardiac surgeon weighs pros and cons of each surgery. The surgeon might also actively involve the patient and their caregivers to come to a common conclusion.
Most of the decisions of bypass surgery or angioplasty are based on:
- Severity and extent of spread of coronary artery disease
- Presence of chest pain and shortness of breath
- Functioning of the heart
- Other co-existing medical conditions, such as diabetes, peripheral artery disease, or prior stroke or heart attack
As a rule of the thumb, angioplasty is suited for limited blockage with no coexisting medical conditions and when the chest discomfort (angina) is due to reduced blood flow that has not responded to medication and lifestyle changes. While, bypass surgery is suggested if the arteries are narrowed or blocked in multiple areas, or the main coronary artery is narrowed and the patient has other medical conditions like diabetes.