Angioplasty vs Heart Bypass Surgery has always been a dilemma in the mind of the patients who suffer cardiac blockages. For many cardiovascular disease patients, to resolve the heart bypass surgery vs angioplasty dilemma, understanding the pros and cons is important. Most of the cardiologists would go an extra mile to make ensure that the patient is on the same page and understands the difference appropriately. The final answer depends on the current medical situation, number of blocked arteries, overall health of patient including other diseases and of course, patient’s preference.
Before jumping into the preferences and conclusions, let us understand the disease that causes angioplasty vs heart bypass surgery dilemma as well as pros, cons and risks involved in both the procedures.
What is Coronary Artery Disease?
The smooth and flexible inside walls of coronary arteries allow proper flow of blood to the heart. Coronary artery disease is caused due to the blockage of the coronary artery and this blockage occurs when the inner wall of the artery is damaged.
The inner walls of arteries get damaged due to various factors including smoking, high cholesterol, high blood pressure, sedentary / inactive lifestyle, diabetes or insulin resistance. Due to damaged arteries, cholesterol and other cellular waste products start building up at the site of an injured wall. This process is called atherosclerosis. This narrows down the path for blood flow, and reduces or sometimes completely stops blood flow to the heart. Such a medical condition is called coronary artery disease.
As these plaques of cholesterol continue to accumulate in the arteries, patients may start experiencing signs and symptoms of the disease. In some cases, symptoms of the coronary heart disease sometimes go unnoticed until the patient suffers a significant blockage or a heart attack.
Diagnosis of Coronary Artery Disease
If coronary artery disease symptoms are persistent, you must consult an experienced cardiologist. Depending on your current condition and medical history, the cardiologist will consider management by medication or recommend one of the following diagnostic tests to plan further treatment:
- Electrocardiogram: ECG is used to record electrical signals through your heart which may reveal inadequate blood flow to your heart.
- Echocardiogram: In this sound waves are used to produce images of the heart to determine the working condition of all the parts of the heart wall which contributes to the heart pumping activity.
- Cardiac catheterization: Also known as an angiogram, this test is used to determine the flow of blood through the heart. In this test, a special dye is injected into the coronary arteries through a catheter and outline narrow spots of blockages on the X-ray images.
Coronary Artery Disease Treatment
Patients suffering from coronary artery disease are typically put on medications to improve lipid levels, lower blood pressure and prevent blood clots; as well as advised to modify lifestyle to help prevent disease progression. According to cardiologists, adopting the following healthy lifestyle habits can prevent the progression of the disease and promote healthier arteries:
- Eat healthy foods
- Quit smoking
- Exercise regularly
- If obese, lose weight
- Avoid stress
- Yoga and meditation
When medical management and lifestyle changes do not control control coronary artery disease, the cardiologist may recommend a revascularization procedure – heart bypass surgery or angioplasty.
More than 250,000 angioplasty procedures are performed in India every year. Angioplasty is a minimally invasive procedure to the widening of a coronary artery. This procedure does not remove plaque from the coronary arteries, rather it widens the arteries to improve flow of blood to the heart. After angioplasty, more than 92% of patients in India have reported immediate relief from coronary artery disease symptoms. Other patients have reported relief in a few hours after the procedure. Angioplasty is also called Percutaneous Coronary Intervention (PCI).
During angioplasty, a catheter (a long, thin tube) is inserted into the narrowed part of the artery. This catheter is joined via a wire with a deflated balloon. This balloon is inflated at the narrowed part of the artery thereby expanding the artery. In almost all the cases, a scaffold-like like mesh device called a stent is permanently placed in the artery during angioplasty. The stent helps the artery to stay widened for a longer term and prevent it from collapsing again. Without the stent, the probability of narrowing the artery ranges anywhere between 30 to 40%. With stent, this rate is reduced to 10 to 20%.
Government of India has regulated the prices of stent. To know more about types of stent and stent pricing, read
Pros and Cons of Angioplasty
Angioplasty has several advantages over bypass surgery. In addition to being a relatively simple procedure, angioplasty has faster recovery rate, fewer complications and lower costs. Also, after a stay of 1 to 2 days in the hospital, the patient can resume normal activities. For uncomplicated cases, angioplasty is now becoming the first choice for most of patients and cardiologists.
But the convenience that comes with the angioplasty often comes with a price. It is estimated that 15 to 20% of patients who have undergone angioplasty might be at the risk of narrowed arteries in a few years and eventually need bypass surgery. Also, in a case of the drug-eluting stent, the patient must take medication for a year to prevent the deadly clots to be formed around the stent.
Heart Bypass Surgery
In India, as per estimates, each year more than 120,000 patients undergo heart bypass surgery to improve blood flow to the heart. Typically heart bypass surgery involves taking a section of healthy blood vessel, from the inside of the chest wall or the lower leg and attaching it above and below the blocked artery. This allows blood to bypass the blocked area and maintaining proper flow to the heart muscle. Heart Bypass surgery is performed under general anesthesia. In hospital time, typically ranges from 4 to 7 days depending on the recovery the patient.
Heart Bypass Surgery is also called Coronary Artery Bypass Grafting (CABG).
Newer Developments for Bypass Surgery
The minimally invasive direct coronary artery bypass (MIDCAB) technique is newly introduced and is proven to be a less invasive version of the traditional CABG. In this new procedure, the use of a heart-lung machine and the cut through the breastbone is not required. Instead, a nick of incision between the ribs is made to operate on the blocked artery. Unlike the conventional bypass surgery, the MIDCAB procedure is performed on the beating heart with the use of a stabilizing device. Despite its convenience, this technique cannot be used when there are multiple cases of blocked arteries.
Pros and Cons of Heart Bypass Surgery
Even though the success rate of angioplasty is very high, not everyone with coronary heart disease can be recommended for angioplasty. Heart bypass surgery is usually chosen over angioplasty for patients with one or more of the following conditions:
- Narrowing of the left main coronary artery – Left main coronary artery is the main artery supplying blood to the heart. Even a small blockage or brief period of stoppage of blood flow through this artery could be fatal or severely damage the heart.
- Narrowing of three or more arteries:
For patients suffering from triple or quadruple or more vessel disease, heart bypass surgery is a better option than angioplasty.
Patients who have high diabetes would be advised to undergo CABG surgery since it offers better survival outcomes.
In comparison with angioplasty, bypass surgery is more complicated as it requires opening the chest, general anesthesia, a several-day hospital stay, and weeks of sometimes painful recovery. But in Bypass, very few patients need a repeat procedure than angioplasty as it keeps the arteries wide open longer and may have better blood flow to the heart muscle. Bypass surgery generally provides good relief of angina for at least five years.
Angioplasty vs Heart Bypass Surgery
While it may sound straightforward, dilemma angioplasty vs heart bypass surgery is quite tricky. Typically, the surgeon uses the reports of coronary angiography to examine the degree of the arteries being blocked and based on the nature of the plagues and range of blockage of the arteries. On the basis of the reports, an experienced cardiologist weighs pros and cons of angioplasty vs heart bypass surgery. The surgeon might also actively involve the patient and their caregivers to come to a common conclusion.
Most of the decisions of angioplasty vs heart bypass surgery are based on:
- Severity and extent of spread of coronary artery disease
- Presence of chest pain and shortness of breath
- Functioning of the heart
- Other co-existing medical conditions, such as diabetes, peripheral artery disease, or prior stroke or heart attack
As a rule of the thumb, angioplasty is suited for limited blockage with no coexisting medical conditions and when the chest discomfort (angina) is due to reduced blood flow that has not responded to medication and lifestyle changes. While, bypass surgery is suggested if the arteries are narrowed or blocked in multiple areas, or the main coronary artery is narrowed and the patient has other medical conditions like diabetes.