Angioplasty Versus Bypass Surgery – Which is Best Suited?

Angioplasty and bypass surgery are two prominent procedures to treat narrowing or blockages in the coronary arteries. Coronary arteries are the prominent blood vessels that supply blood to the heart. Coronary artery disease specialists may recommend a bypass or angioplasty following a heart attack or as a preventive measure. Continue reading to understand when to choose bypass or angioplasty in the heart.

Purpose

Both bypass and angioplasty in the heart help boost blood flow during a narrowed or blocked coronary artery. These arteries supply blood to the heart and narrow from plaque build-up or atherosclerosis. When plaque build-up is left untreated, it may trigger a heart attack.
Studies show coronary heart disease is the number one cause of death globally.

Risks

Both these procedures come with their risks. There’s a definite risk of death from both, depending on the heart disease’s severity and other associated factors.

Angioplasty experts in India point out the following risks:

• Stroke
• Artery damage
• Heart attack
• Bleeding, demanding a transfusion
• Allergic reaction to contrast dye

Coronary artery disease specialists point out the following risks associated with bypass:

• Reduced kidney function
• Atrial fibrillation
• Stroke
• Heart attack (highest in the 30 days from the surgery)
• Infections

Effectiveness

Angioplasty

Angioplasty experts in India state that angioplasty stenting is the preferred treatment choice for:

• Heart attack
• Unstable angina
• Spontaneous coronary artery dissection

Typically, angioplasty proves lifesaving during a heart attack.

Note: Whether angioplasty improves the outlook for people with CAD is controversial, as much evidence suggests against it.

Bypass Surgery

As opposed to medication alone, bypass can lower the death rates by up to 10 years in people with

• low left ventricular function
• insufficient blood supply to the heart

When people with CAD receive a bypass, they have the following

• Better life quality
• Less angina
• Higher survival rates

Procedure

Angioplasty

Time: 30 minutes to 2 hours

Steps

1. You sit on an X-ray table.
2. The attending doctor gives an IV line and a local anaesthetic, delivering

• Contrast dye
• Sedatives
• Pain relievers

3. The cardiologist makes an incision to access the artery.
4. The incision may be either in the:

• Wrist
• Groin
• Arm

5. A sheath is inserted to keep the artery open.
6. A catheter is implanted in this sheath.
7. A thin wire passes via the catheter.
8. A thin balloon goes in with it.
9. The wire has to reach the coronary artery.
10.The balloon is inflated for about 30 seconds.
11. The coronary artery opens.
12.The balloon will put the stent in place.

Bypass Surgery

Time: 3- 6 hours

Steps

1. You receive general anaesthesia via an IV.
2. The anaesthesia puts you to sleep.
3. The surgeon will form an incision along the sternum.
4. It spreads open the ribcage.
5. You are connected to the machine that handles your lung and heart functions.
6. Medication is used to stop the heart.
7. The surgeon takes a blood vessel from:

• Arm
• Chest
• Leg

8. You may require multiple grafts for this.
9. This blood vessel can help create a bypass around the blockage.

Note: The bypass may be done without ceasing heart function.

Preparation

Angioplasty

Doctors may advise taking blood thinners in advance during a non-emergency surgery.

Bypass

Bypass recovery period is extended.

To prepare

1. Arrange a drive home from the hospital.
2. Stock up on some easy-to-prepare food.
3. Have help handy for at least two weeks.
4. Prep your home to support comfort and mobility.

Recovery

Angioplasty

• You may have to stay in the hospital overnight.
• In minor surgeries, you can return home the same day.
• Most people receiving a non-emergency surgery can resume work within a week.

Bypass

• You must stay in the hospital for a week after the procedure.
• Complete recovery may take 12 weeks.

Costs

Most insurances cover bypass and angioplasty surgery.

The cost depends on your region.

• Bypass: Between Rs 95,000 and Rs 4,50,000
• Angioplasty: Between 1.2 lakh and 1.6 lakh.

Source Link : Hopkinsmedicine.org