Bypass vs. Medication Alone
Medication alone is most often used to treat low-risk patients who have heart disease that is unlikely to cause serious damage. In addition to recommending lifestyle modification to lower your heart disease risk, your doctor will give you medications to slow the progression of coronary artery disease and relieve symptoms like chest pain and shortness of breath.
Compared with taking medication alone, bypass surgery improves long-term outcomes in high-risk patients, especially patients with multivessel disease. If only one vessel is narrowed or blocked, medical treatment and bypass surgery produce similar results.18 In the case of low-risk patients, bypass surgery doesn't save more lives than medical therapy. Therefore, the procedure is aimed at improving physical function and providing symptom relief.
In some cases it may be too risky for you to undergo bypass surgery or angioplasty. For example if you have a severe medical conditions such as chronic obstructive pulmonary disease or heart failure, or if your heart disease is too diffuse and extensive. In these patients, medical therapy may be the only treatment option.
Bypass vs. Angioplasty and Stenting
Angioplasty with or without stent placement is a procedure in which a catheter is fed through an artery in the groin to the heart, and a balloon is used to clear the blocked arteries. A stent (a tiny wire mesh tube) may be left in place to prop open the artery. These treatments have the advantage of being less invasive than surgery: your chest cavity is not cut open, the heart beats normally during the procedure, and there is only mild anesthesia. The procedure usually takes less than 2 hours, and patients are discharged from the hospital in 1 to 2 days, compared with 7 to 10 days for bypass surgery. Typically this approach is used in patients with a single blocked artery, although recently the procedure's use has been expanded to some patients who have blockages in more than one coronary artery.
The decision to undergo bypass or angioplasty is based on both the physician's evaluation of your disease and your personal preference. When an artery is totally blocked (known as a total occlusion), bypass may be your only option. Bypass surgery is generally preferred if you have blockages in 2 or more arteries, blockage in the left main coronary artery, or if angioplasty has failed to provide adequate relief from symptoms. People with diabetes fare better with bypass surgery than angioplasty.19 When considering which option is best, the advantages and disadvantages of each procedure must be taken into account. Angioplasty is much less invasive and you can leave the hospital the following day. However, the artery is more likely to become blocked again after angioplasty than after bypass, which means you may need another angioplasty in the near future. Bypass grafts generally last 10 to 15 years and provide better relief from angina, but these benefits must be weighed against the fact that it's a more serious operation with a long recovery period.
