Bypass Surgery and Angioplasty
Questions and Answers about Coronary Artery Bypass Surgery vs. Coronary Angioplasty for Heart Artery Blockage - Transcript
Specialties: Adult cardiac surgery, valvular heart disease, coronary artery disease, diseases of the thoracic aorta, minimally invasive cardiac surgery, off-pump coronary artery bypass surgery .
Hi. I’m Dr. Joseph Sabik with the Department of Thoracic and Cardiovascular Surgery .
When blood flow to the heart is restricted by a heart artery blockage, your doctor may recommend either coronary artery bypass graft surgery or percutaneous coronary angioplasty. Both are interventional procedures and they have a similar purpose – to increase blood flow to the heart.
Bypass surgery restores blood flow to the heart by using a healthy artery from the chest or arm or leg vein to bypass the clogged coronary blood vessel.
Percutaneous coronary angioplasty is a nonsurgical procedure, performed by inserting a catheter into a leg artery and advancing it into the heart arteries. At the tip of the catheter is a small balloon, which is inflated to open the artery blockage and increase blood flow to the heart. A stent, or small metal mesh tube, is usually inserted at the time of angioplasty to hold the blocked artery open.
If your heart arteries are blocked, it is important to seek the advice of both a cardiologist and heart surgeon as to which procedure is best for you.
If blood flow in one or possibly more of your heart arteries is compromised, angioplasty with stenting may be your best option. However, if you have multiple heart artery blockages, diabetes, or a weak heart muscle, coronary artery bypass graft surgery may your best treatment.
Although angioplasty may alleviate your blockages less invasively, surgery may be a better long-term solution. For some patients, coronary artery bypass surgery has been shown to help patients live longer than coronary angioplasty.
A recent study published in the New England Journal of Medicine compared the survival of 59,000 patients with coronary artery disease who were treated with either coronary artery bypass surgery or angioplasty with stenting. The study found that patients with two or more blocked coronary arteries live longer if they were treated with bypass surgery rather than angioplasty with stenting. This study underscores the importance of evaluating both options with a cardiologist and heart surgeon before moving forward with treatment.
The length of time that coronary angioplasty or bypass surgery remains effective differs, with coronary artery bypass surgery usually being effective longer than angioplasty. A recent study published in the journal Circulation from the Cleveland Clinic demonstrated that at 10 years after coronary artery bypass surgery only 12% (about 1 in 10) of patients treated with bypass surgery required a repeat bypass operation or angioplasty.
Arteries with a stent already in place from a previous angioplasty can usually be bypassed surgically at a later date if necessary.
For bypass surgery, both arteries and veins can be used as bypass grafts. The surgeon decides which grafts to use depending on which and the number of heart arteries that are blocked.
The arteries inside the chest wall, or internal mammary arteries are the most effective as bypass grafts. They have been demonstrated to stay open longer than vein grafts and when used as bypass grafts result in patients living longer and better lives free of problems related to their heart.
The radial artery is the second most common type of arterial graft. We all have two arteries in our arms, the ulnar and radial. Most people have adequate blood flow to their arm and hand from their ulnar artery, so the radial artery can be removed and used as a bypass graft.
The gastroepiploic artery and the inferior epigastric artery are also arteries that also can be used as bypass grafts. They are used less commonly.
Saphenous veins from the legs are another option. These veins usually can be removed from the leg minimally invasively.
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