Surgery

Surgery

Surgery is usually recommended for patients who have:

• Unstable angina that does not respond promptly to medical treatment.
• Severe recurrent episodes of angina that last more than 20 minutes.
• Severe coronary artery disease (severe angina, multi-artery involvement, evidence of ischemia), particularly if abnormalities are evident in the left ventricle of the heart, the main pumping chamber.

Researchers have been investigating whether surgery offers any advantages if used as an early treatment for mild angina. A major analysis in 2003 reported that the use of angioplasty in patients with mild heart blockage did not reduce the risk for heart attack or death over the long term.

Choosing Either Angioplasty or Bypass

Two effective surgical procedures for heart patients are:

• Coronary artery bypass grafting (commonly called bypass or CABG).
• Percutaneous transluminal coronary angioplasty (commonly called angioplasty or PTCA), usually with coronary artery stent placement.

Click the icon to see an image about bypass grafting.

Click the icon to see an image about bypass grafting.

Each of these procedures is described below.

Studies have generally reported similar survival rates with either procedure. There are some differences, however, and decision often depends on individual conditions. Patients considering surgery should discuss all options and risks with their doctor. No surgical procedure cures coronary artery disease, and patients must continue to rigorously maintain a healthy lifestyle and any necessary medications.

Considerations for Choosing Angioplasty with Stent Placement. Angioplasty has the following advantages for most patients. It is:

• Less invasive than bypass. (Although a minimally invasive variation of bypass surgery may reduce this distinction.)
• Less expensive than bypass. (Although the postoperative need for more medications and the high risk for repeat procedures to reopen the artery may reduce the long-term difference in cost between the two procedures.)
• Life-saving emergency procedure for many patients with heart attacks. (The use of bypass after a heart attack has much higher mortality rates than when it is used electively and its use is controversial in heart attack patients.)