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When Bypass Beats Angioplasty

For Complex Heart Disease, Surgery Often Best Treatment Choice

Angioplasty/Stents Still a Good Option continued...

Even so, Carrozza says the new results "are a sobering reality check for those who hoped the benefits of drug elution would level the playing field between [bypass surgery] and stents for patients with multivessel disease."

Does this mean all patients with multiple blocked arteries should have bypass surgery? No, Hannan says.

"When we talk about two procedures like angioplasty and bypass surgery, there is a big difference," Hannan tells WebMD. "In bypass surgery your chest is sawed open. You spend time in the hospital, and you don't feel well for a long time. After angioplasty, you go back to work the next day and feel fine."

There are medical reasons, such as dementia, that rule out bypass surgery for some heart patients. And Hannan notes that while bypass surgery has better long-term results for many patients, the short-term results are worse than for angioplasty.

"One reason to choose angioplasty and stenting is if patients just prefer not to get very aggressive surgery that will discommode them for many months," he says. "And the short-term adverse-outcome rate for bypass -- including the in-hospital mortality rate -- that is higher than for angioplasty. So if you have a strong need to survive for a short period of time, like a big event you want to be around for, that contraindicates bypass surgery."

Hannan says the next step for researchers is to find out whether patients with particular conditions do better with bypass surgery or with angioplasty.

What Heart Patients Need to Know

Because researchers and doctors continue to improve both bypass surgery and angioplasty, Hannan says there will never be a one-size-fits-all answer to which technique is best. For this reason, he strongly suggests that patients discuss all of their options with both an interventional cardiologist and a surgeon.

Before either bypass surgery or angioplasty, cardiologists use a heart catheter to look at the conditions of a patient's arteries. Since the catheter already is in place, some cardiologists may choose to perform an angioplasty at that time.

"I would say you need to consult with a multidisciplinary team, including a cardiologist and a surgeon, starting with the cardiologist," Hannan advises. "When you engage in dialogue with this doctor, be sure that person is aware of the most recent studies, and that these studies are part of the decision-making process. But you need to take into account what is the typical nature of the recovery period, what procedures will be done and when, and what are the contraindications of each procedure."

O'Neill says that if patients are offered the option of either bypass surgery or angioplasty, it means that they have an excellent chance of long-term survival with either procedure.

"Bypass provides more effective long-term relief in multivessel cases," O'Neill says. "In the Hannan study, 5% of patients who underwent bypass needed a [a second procedure] compared to 30% of the angioplasty patients. So if patients don't want to come back, they need a bypass. If inconvenience, invasive surgery, and length of recuperation come into play, then patients may prefer angioplasty."

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