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Do You Really Need Bypass Surgery?

What to consider if it's not an emergency and your coronary artery disease is stable.

Bypass Surgery

In bypass surgery, surgeons take a blood vessel from your leg, arm, or chest and create an alternate route around the blockage or blockages. This is similar to creating a traffic detour around a bad stretch of road.

“If you do bypass surgery, you’re redirecting the blood vessel [flow] around the blockage,” says cardiologist Jonathan Murrow, MD, and assistant professor at Medical College of Georgia-University of Georgia Medical Partnership.

Bypass surgery is most often recommended for patients with blockages in multiple blood vessels or for patients with a blockage in their heart's left main coronary artery, which supplies most of the blood flow to the heart's lower left chamber, the left ventricle.

Angioplasty and Stents

In this procedure, doctors guide a tube through an artery in your arm or groin to reach your blocked coronary artery. When the tube, which is very long but only slightly wider than a pencil lead, reaches the artery, a tiny balloon at the end is inflated to reopen the blood vessel. This is similar to fixing the worst part of a deteriorated road to help alleviate traffic jams.

“For people with single-vessel disease [CAD in only one coronary artery], many times the preferred treatment is angioplasty,” Murrow says.

During angioplasty, doctors may also insert stents -- mesh tubes that hold the arteries open. Some stents, called drug-eluting stents, slowly release medications that help to prevent the artery from narrowing again.

With angioplasty, you're not getting your chest cracked open for heart surgery. That means a shorter recovery time.

But “when you put a stent in an artery, you’re only treating that 1-2 centimeter segment. The rest could be developing plaque,” Murrow tells WebMD.

Medical Therapy

If you don’t have very severe CAD, treating it with medicines alone may be an option. These drugs may include aspirin to prevent blood clots; beta blockers to reduce the workload on the heart; ranolazine and nitroglyerine for chest pain; ACE inhibitors for heart failure; and statins for cholesterol.

A 2007 study of 2,287 patients, known as the COURAGE trial, showed no difference in death or heart attack rates among stable CAD patients treated with medicine alone vs. those treated with angioplasty. Angioplasty, however, was shown to be a more effective treatment of chest pain.

Lifestyle Changes

A tobacco-free lifestyle that includes exercise, a diet low in saturated fat and salt, and limited alcohol has long been encouraged to prevent heart disease. However, some studies show that comprehensive lifestyle modifications can not only prevent the disease but also treat it.

Studies led by Dean Ornish, MD, who is the founder of the nonprofit Preventive Medicine Research Institute and professor of medicine at the University of California, San Francisco, have continually shown the impact of major lifestyle changes on CAD.

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