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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.

Coronary Artery Disease

Coronary artery disease (CAD) happens when plaque builds up in the coronary arteries, hampering blood flow to the heart muscle. The most common symptom is chest pain (angina), which can be severe, although some people are more bothered by breathlessness or even unusual fatigue.

Coronary artery disease predisposes people to develop a heart attack and is also the most common cause of heart failure, in which the heart has trouble pumping enough blood to the body.

CAD can block one or more coronary arteries. The plaque may be limited to a small segment of the artery or may be more widespread.

There are several effective treatments for CAD, which can reduce chest pain, make a heart attack less likely, and may prolong life. Generally, the most severe cases warrant the most aggressive treatment, which can also carry the highest risks.

Whether one of these treatments is better than another has long been debated by experts. Here is what each option involves.

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.

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