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Which is better - angioplasty or an open heart surgery?

Q: My grand mother, 75-80 years old, is suffering from anginal pain for the last ten days. Angiography has revealed acute blockage in two arteries. She is very frail and weak and is eating negligibly for the last few days. One of the treating heart specialists feels that she should undergo angioplasty while another doctor (from whom we sought a second opinion) suggested that in the given situation open-heart surgery would be more effective and less risky. Please advise as to what would be the right recourse in such a situation?

A:I can well appreciate the dilemma that you must be in having had two conflicting opinions from two different doctors but unfortunately practice of medicine is still not a science and there is always scope for disagreement between doctors as long as you understand the genesis of this discord. The decision to go for angioplasty or surgery is based on multiple factors besides patient’s references. It depends on which arteries are blocked, where exactly the blockage is located, what is the qualitative nature of the block - is it present close to a major side branch, what is the socio economic status of the individual, what is the expected complication rates with the surgical procedure and so and so forth. It is for those reasons that individual’s judgement as to which form of therapy is most suited for a particular patient may vary between two doctors. I am afraid you have not provided in detail your angiography report nor do we have access to the angiography pictures and therefore it will be nigh impossible for me to comment as to which is the form of treatment which is best suited for you. I suggest, either you come and contact us with the coronary angiography film at Sir Ganga Ram Hospital, New Delhi or you contact your local cardiologist whom you have faith in and then follow his advise. Giving a definitive advise of this nature based on a clinical history submitted by patient is neither possible nor desirable.

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