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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 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.

    What Should I Do Next?

    Because stable CAD does not necessitate emergency surgery, patients followed closely by a doctor might try less invasive approaches first, if they wish.

    For some people, that might be a hard choice. Doctors and patients can feel that unless you try the most aggressive surgical approach, you’re not doing everything you can, Spertus says. “And I think that’s human nature, but it’s not really evidence-based.”

    “[Patients should] do everything they can to optimize their medical control, to minimize their smoking and other risk factors, to get more active, and see what that does to symptoms and quality of life. If it works, great, and if it doesn’t, go to bypass or angioplasty,” Spertus says.

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