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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.

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.

7 Questions to Ask

Here are some questions you may want to ask before deciding on a procedure:

  1. “Am I already on the best medication possible?” says Eric Velasquez, MD, whose recent study in the New England Journal of Medicine compared the benefits of bypass plus optimum medications to medications alone.
  2. “What are my personal chances of being better off in the long run? How am I likely to be doing a year from now in terms of survival and quality of life?” Spertus says.
  3. “What are my personal chances of short- and long-term complications with this procedure?” Murrow says.
  4. “How many of these procedures have you done?” Krumholz says. He stresses the importance of patients knowing their doctors’ and hospitals’ success rates.
  5. “What will my recovery time be in the hospital and after?” Murrow asks.
  6. “Are there great-enough lifestyle changes to obviate the need for treatment at all?” Spertus says.
  7. “Will there be long-term limitations on what I can do?” Murrow says.

“For patients with CAD,” Morris tells WebMD, “it is a team approach with you and your doctors.” Being knowledgeable about your heart disease and informed about treatment choices will only make you a better member of the team.

Reviewed on June 20, 2011

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