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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.

Lifestyle Changes continued...

Ornish’s lifestyle plan, which includes a low-fat, whole foods, vegetarian diet; aerobic exercise; stress management; smoking cessation; and group therapy, has significantly reversed CAD in study participants, helped them avoid bypass and angioplasty, decreased heart attack rates, and improved risk factors and quality of life. Medicare recently approved Ornish’s hospital-run programs as a reimbursable treatment for CAD.

“The problem is most people are told to make moderate changes in the diet, and when it doesn’t do much, they’re told ‘We have to operate.’ But if they’re willing to make bigger changes, most people can avoid surgery and they don’t even know that’s an option,” Ornish tells WebMD.

Bypass or Angioplasty?

When you get down to considering bypass surgery vs. angioplasty, there is no one-size-fits-all solution.

“It’s not a yes or no answer. It’s rare that if a patient doesn’t have a bypass, they are facing a certain adverse outcome. There is a group of patients for whom, on average, surgery lowers risk, but the decision is always personal,” says Harlan Krumholz, MD, who is a cardiologist and professor of medicine at Yale School of Medicine.

It comes down to the details of your particular case -- what's your overall health and medical history, and how severe is your heart disease? If you've had a heart attack before, or have diabetes or severe CAD, that may make you more suitable for bypass surgery than another procedure.

If a patient has a choice between bypass surgery and a less-invasive procedure, he and his doctor must consider that patient’s individual risk for complications and likelihood of benefit. Risks of bypass surgery depend on a patient’s health before surgery and may include bleeding and arrhythmia, and less commonly heart attack, kidney failure, infection, memory loss, and stroke.

“In general, bypass surgery results in more long-term benefit in terms of symptoms, function, quality of life and even survival compared to angioplasty, but you have to take a slightly greater up-front risk of a complication and you have to recover. People recover very quickly from angioplasty,” says John Spertus, MD, who is a cardiologist and clinical director of outcomes research at Mid America Heart Institute of Saint Luke’s Hospital.

Some major studies have shown no significant difference for some patients between bypass and stents or angioplasty in terms of death and heart attack rates. The results of bypass surgery are generally longer-lasting. Patients who undergo angioplasty or have stents placed more frequently undergo additional procedures than do patients who have bypass surgery.

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