Bypass surgery best for heart disease
Bypass surgery is still the best choice when the main coronary artery or several arteries are affected.
Although
angioplasty is increasingly being used to treat severe
heart disease, recent research suggests that
bypass surgery is still the best choice when the main coronary artery or several arteries are affected.
Coronary bypass surgery is heart surgery in which the rib cage is spread open and a section of a healthy blood vessel is grafted to bypass the blocked section of the coronary artery and improve the blood supply to the heart.
Angioplasty is a less invasive procedure used to widen narrowed or blocked arteries. A thin tube, or catheter, is threaded through a blood vessel to the affected area and a small balloon is inflated to open the blockage, followed by stenting, to keep the blocked artery patent.
Researchers from America did a study wherein 1,800 patients with severe heart disease underwent bypass surgery or angioplasty. In all cases, heart surgeons and cardiologists conferred beforehand and agreed that both procedures would be comparable in their ability to repair the blocked coronary arteries. The researchers' main focus was on the percentage of patients who experienced one or more of the following after 1 year: a
heart attack,
stroke, death or need for another treatment. Overall, 12 percent of the surgery patients experienced one of these events compared with 18 percent of angioplasty patients.
Patients who underwent coronary bypass surgery were less likely to require repeat treatment at 1 year than those who underwent angioplasty. No difference in deaths or heart attacks was seen between the groups, but the surgery patients were more likely than the angioplasty patients to experience a stroke, although the risk was small.
Patients with severe coronary disease should be encouraged to undergo bypass surgery. Physicians recommend that patients with less severe disease should be informed of the pros and cons of angioplasty and surgery, and be allowed to make an informed choice.
The New England Journal of Medicine
February 2009
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