Heart Bypass Surgery vs Angioplasty has always been a dilemma in the mind of patients who suffer cardiac blockages. To resolve the heart bypass surgery vs angioplasty dilemma and choose the right line of treatment, understanding the pros and cons of each are important. Most cardiologists would go the extra mile to ensure that the patient is on the same page and understands the difference appropriately. The final answer of heart bypass surgery vs angioplasty depends on the current medical situation, the number of blocked arteries, the overall health of the patient including other diseases, and of course, the patient’s preference.
Before jumping into the preferences and conclusions, let us understand the disease that causes heart bypass surgery vs angioplasty dilemma as well as the pros, cons, and risks involved in both procedures.
Table of Contents
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.
Heart Bypass Surgery vs Angioplasty
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 of 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 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 outlines narrow spots of blockages on the X-ray images.
Coronary Artery Disease Treatment
Patients suffering from coronary artery disease (heart bypass surgery) are typically put on medications to improve lipid levels, lower blood pressure and prevent blood clots; as well as advised to modify their 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 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 for the widening of a coronary artery. This procedure does not remove plaque from the coronary arteries, rather it widens the arteries to improve the 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 reported relief 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 cases, a scaffold-like mesh device called a stent is permanently placed in the artery during angioplasty. The stent helps the artery to stay widened for the long term and prevents it from collapsing again. Without the stent, the probability of narrowing the artery ranges anywhere between 30 to 40%. With a stent, this rate is reduced to 10 to 20%.
Pros and Cons of Angioplasty
Angioplasty has several advantages over bypass surgery. In addition to being a relatively simple procedure, angioplasty has a 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 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 risk of narrowed arteries in a few years and eventually need bypass surgery. Also, in a case of a 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 the 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 maintain 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 of the patient.
Heart Bypass Surgery is also called Coronary Artery Bypass Grafting (CABG).
Newer Developments for Heart 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 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.
- Diabetes –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 for angina for at least five years.
Also, read about:7 Tests for Cardiovascular Disease Diagnosis.
Heart Bypass Surgery vs Angioplasty
While it may sound straightforward, the situation of heart bypass surgery vs angioplasty is quite tricky. Typically, the surgeon uses the reports of coronary angiography to examine the degree of the arteries being blocked based on the nature of the plagues and the range of blockage of the arteries. On the basis of the reports, an experienced cardiologist weighs the heart bypass surgery vs angioplasty pros and cons. The surgeon might also actively involve the patient and their caregivers to come to a common conclusion.
Most of the decisions of heart bypass surgery vs angioplasty 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
- Patient & family preferences
Also, if you have undergone a heart bypass surgery, read about Healthy Lifestyle for a Healthy Heart
As a rule of 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, heart 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.
Common Questions Regarding Heart Bypass Surgery
Coronary Artery Bypass Grafting (CABG), commonly known as Heart Bypass Surgery, is a surgical procedure carried out in cases where the artery blockage cannot be rectified by non-surgical procedures, namely coronary angioplasty. The decision to undertake this surgery is quite critical. Therefore, doctors take into consideration many factors including a few discussed below:
1. Severe Blockage of Artery Passage
As a consequence of the deposits on the walls of the arteries, there is an acute shrinkage of the vital passage through which the blood is pumped into the heart. This prevents the smooth functioning of the heart which subsequently affects the blood supply throughout the whole body. It leads to severe pain in the chest as there is a decreased oxygen supply and this state is termed Angina.
2. Inadequate Supply of Oxygen
Due to the fat residues accumulating in the passage of coronary arteries, there is insufficient flow of blood into the heart. The blood consists of oxygen which is extremely necessary for the entire human body and therefore its limited supply hinders the smooth functioning of the body.
3. Complete Obstruction of Coronary Arteries
The situation turns grave when there is a complete blockage of the artery passage and there is a minimal flow of blood to the heart. As a result, the heart muscles began to perish which can result in myocardial infarction commonly called a heart attack.
4. Heart Bypass Surgery – Failed previous Angioplasty
In some cases, after coronary angioplasty has been performed and a stent has been placed to widen the artery, there is a recurrence of contraction, and blood flow is again hampered. In such cases, performing heart bypass surgery remains the best option for the cure.
5. Improper Functioning of Left Ventricle
The left ventricle is the foremost chamber responsible for the pumping of blood. The need for bypass surgery arises when this chamber is not performing its functions well.
6. Common symptoms acting as warning signs ofHeart Bypass Surgery
- An extreme heaviness or pain can be felt in the chest when there is a substantial blockage of the passage. This pain can be felt even while doing light physical exertion but after taking some rest this pain disappears temporarily. Other parts of the body such as the arms, jaw, throat, and the upper back area around the neck can also experience such pain or heaviness indicating warning signs.
- In certain cases, a person may only be able to sense unusual fatigue or occasional tiredness even after a minor physical activity. Such symptoms should never be taken lightly and immediate medical consultation is suggested.
An experienced cardiologist after taking into consideration all the symptoms may conduct a thorough physical examination besides recommending some blood tests. These may include some physical stress assessment tests or a CT scan. Cardiac catheterization is the most appropriate test to determine the severity of this ailment. It also reveals which arteries are damaged. It thus helps in deciding whether there is a need for coronary artery bypass surgery to be performed or not.
This article was reviewed by highly experienced and renowned doctors at Apollo Hospitals, Indore.
For more information and free personalized guidance, talk to Credihealth Medical Experts today.
Angioplasty, bypass surgery, cardiac, cardiac surgery, cardiology, Coronary Artery Disease, diabetologist, diabetology, heart, heart bypass surgery, Heart Treatment
The recovery time for angioplasty is much quicker than heart bypass, but angioplasty is not advisable for everyone with CHD. For example, people who have triple-vessel disease are recommended to have heart bypass, and if you have diabetes, heart bypass offers better survival outcomes.Which is the best between angioplasty and open heart surgery? ›
Bypass surgery is generally considered the better option in cases where the patient's arteries are blocked in multiple areas, or where their left main coronary artery is narrowed.Which surgery is best for heart blockage? ›
Coronary artery bypass surgery is done to restore blood flow around a blocked heart artery. The surgery may be done as an emergency treatment for a heart attack, if other immediate treatments aren't working.What is the life expectancy after angioplasty? ›
The mean follow-up was 31 +/- 12 months. Survival was 99.5% at 1 year and 97.4% after 5 years; "event free survival" was 84.6% at 1 year and 65.9% after 5 years; "ischemia free survival" was 84.6% at 1 year and 44.8% after 5 years.What is the 10 year survival rate after angioplasty? ›
The 10-year survival rates were 74.9% with CABG, 75.1% with PCI, and 69% with MT (P=0.089). The 10-year rates of myocardial infarction were 10.3% with CABG, 13.3% with PCI, and 20.7% with MT (P<0.010).What are the disadvantages of coronary angioplasty? ›
- Bleeding from the blood vessel where the catheter was placed.
- Damage to blood vessels from the catheter.
- An allergic reaction to the dye given during the angioplasty.
- An arrhythmia (irregular heartbeat).
The most widely used surgical alternative to a coronary angioplasty is a coronary artery bypass graft (CABG).Can angioplasty be avoided? ›
Angioplasty should not be the only choice. Less unnecessary procedures could save billions of dollars and decrease the risk of harming patients. Patients should know their options. Besides, most people prefer to avoid invasive procedures whenever possible.What is the alternative to angioplasty? ›
Carotid Endarterectomy. Endarterectomy is a surgical procedure that can be used to restore blood flow in carotid arteries – the large arteries in the neck that supply the brain with blood. In this procedure, the plaque is “peeled” away from the artery wall, so that the blood can flow normally again.What is the safest heart surgery? ›
Heart bypass surgery is a relatively safe and effective procedure that reduces the risk of heart attack and death. The procedure might also ease symptoms of coronary artery disease, such as chest pain.
One of the most common operations performed in the United States is coronary revascularization, but despite its commonality, it is extremely risky because it could have fatal consequences, according to the University of Rochester Medical Center.
Minimally invasive heart surgery involves making small incisions in the right side of the chest to reach the heart between the ribs, rather than cutting through the breastbone, as is done in open-heart surgery. Minimally invasive heart surgery can be done to treat a variety of heart conditions.Can you live a long life after angioplasty? ›
As a result, even after implanting stents in three major coronary arteries, if correctly controlled, you can live a long life.Can you live a normal life after angioplasty? ›
If you had a planned (non-emergency) coronary angioplasty, you should be able to return to work after a week. However, if you've had an emergency angioplasty following a heart attack, it may be several weeks or months before you recover fully and are able to return to work.What percentage of angioplasty is risky? ›
Applying the evidence
Within the moderate-risk group, the expected range for risk of complications is greater than 5 percent to 10 percent, with an observed rate of procedure complications of 6.2 percent, or about 1 in 16. Given these risks, the patient would likely choose to go ahead with the procedure.
Any amount of blockage in the LMCA, such as from plaque buildup or a clot, is referred to as “LMCA disease.” However, treatment is only needed when there is a blockage of 50% or more. At that level, there is an increased risk of death, a major heart attack, or a life-threatening arrhythmia (irregular heartbeat).Can 100% artery blockage do angioplasty? ›
“A 100% blocked artery does not mean a patient has to undergo a bypass surgery. Most of these blocks can be safely removed by performing an Angioplasty and the long term results are as good or are better than surgery.Do angioplasty and stents last for the rest of your life? ›
A coronary stent is made up of a biocompatible medical-grade metal. The stent helps reduce recurrent blockages or re-narrowing of arteries after one undergoes an angioplasty. Once a metallic stent is implanted, it remains in the patient's artery permanently.Who is not a candidate for angioplasty? ›
If you have an existing health condition like diabetes, a weak heart muscle, or severe artery blockages, you might not be a candidate for angioplasty.Will angioplasty prevent future heart attacks? ›
If you've had a heart attack, an angioplasty can increase your chances of surviving more than clot-busting medication (thrombolysis). The procedure can also reduce your chances of having another heart attack in the future.
The complication rate or mortality due to angioplasty in the young is 0.4% and 0.8% in patients above 80 years old.Can heart blockage cure without angioplasty? ›
When Patient says No to Angioplasty And Bypass Then. ESMR Treatment is the best option that time So Remove Heart Blockage Without Surgery. ESMR Treatment forms new natural blood vessels which improve the oxygenated blood supply to the affected portion of the heart non-surgically or non-pharmaceutically.How do you clear blocked arteries without angioplasty? ›
You may be able to help reverse clogged arteries through diet, exercise, and stress management. Making lifestyle changes and taking medications as prescribed could also reduce plaque buildup.What is the alternative to bypass surgery? ›
It may be possible to have a procedure called a coronary angioplasty instead of a coronary artery bypass graft (CABG). This may be done if the arteries around your heart are severely narrowed.How long does it take for artery to heal after angioplasty? ›
Faster recovery with minimally invasive angioplasty
The average recovery period for individuals undergoing a minimally invasive procedure is two weeks. It can take anywhere from six to eight weeks to recover if you have an open angioplasty.
Angioplasty may be a treatment option for you if: You have tried medications or lifestyle changes but these have not improved your heart health. You have chest pain (angina) that is worsening. You have a heart attack.How can I avoid heart bypass surgery? ›
The most important is that the need for bypass surgery arises as the result of a preventable condition, namely, coronary artery disease. If you take care of yourself, eat well, exercise, and take heart-healthy supplements, the chances are good that you may be able to avoid a bypass.Can an artery be unblocked without a stent? ›
A landmark study has finally gotten to the heart of an age-old debate in the cardiology community: for patients with stable coronary artery disease, medication is just as effective as bypass or stenting to reduce heart attack, stroke and death risk.What is the #1 cardiac hospital in the US? ›
California has seven of the world's top 100 hospitals for cardiology, ranked by Newsweek in its World's Best Specialized Hospitals 2022 list.
The Johns Hopkins Heart and Vascular Institute's team of board certified vascular surgeons are world-renowned leaders in vascular surgery and minimally invasive endovascular therapy.Which is worse bypass or stent? ›
And this question has an answer—bypass surgery—as long as the individual's surgery risk isn't too high. "For three-vessel coronary disease, bypass now has been shown to be superior to stenting, with the possible exception of some cases in which the narrowing in the artery is very short," Cutlip says.What surgery has the worst survival rate? ›
The operations with the highest mortality in the 1.5 months after surgery were femur fracture reduction, hip arthroplasty (other, i.e., not total replacement), and coronary artery bypass.What is the easiest heart surgery? ›
The aortic valve is one of the heart's 4 valves. The valves help blood flow through the heart's 4 chambers and out to your body normally. The surgery is called “minimally invasive” because it uses a smaller incision than a traditional open repair. This may lead to easier and faster recovery from surgery.At what age is open-heart surgery not recommended? ›
While some surgeons weigh age more than others, conventional wisdom has been that patients over 80 don't fare as well as younger candidates when undergoing cardiac bypass surgery.At what age do they stop doing heart surgery? ›
Conclusions: Cardiac surgery can be performed in patients 85 years and older with good results. There is an associated prolonged hospital stay for elderly patients. Consistent successful outcomes can be expected in this patient population with selective criteria identifying risk factors.What is the new technology for heart surgery? ›
What is robotic cardiothoracic surgery? Robotic cardiac surgery is heart surgery done through very small cuts in the chest. With the use of tiny instruments and robot-controlled tools, surgeons can operate in a way that is much less invasive than conventional open-heart surgery.How long is bed rest after angioplasty? ›
Bedrest may vary from two to six hours depending on your specific condition. If your physician placed a closure device, your bedrest may be of shorter duration. In some cases, the sheath or introducer may be left in the insertion site.What are the chances of stroke during angioplasty? ›
Rates of serious complications, including stroke, myocardial infarction, and death, are less than 1% for most catheterization procedures.What is high risk angioplasty? ›
High risk percutaneous transluminal coronary angioplasty was defined as: salvage cases (3 patients) where the patients presented in cardiogenic shock or the vessels were not bypassable; multivessel coronary artery disease (22 patients) where a large area of jeopardized myocardium was dependent on the angioplasty vessel ...
During angioplasty, blood clots that may form can break loose and travel to your brain. You'll receive blood thinners during the procedure to reduce this risk. A stroke can also occur if plaque in your artery is dislodged when the catheters are being threaded through the blood vessels.What is the new technique to remove heart blockage? ›
Angioplasty and stenting are minimally invasive procedures used to remove heart blockages. During an angioplasty, a thin, flexible tube called a catheter is inserted into a blood vessel in the groin or arm and guided to the blocked artery in the heart.What percentage of blockage requires a bypass? ›
Any amount of blockage in the LMCA, such as from plaque buildup or a clot, is referred to as “LMCA disease.” However, treatment is only needed when there is a blockage of 50% or more. At that level, there is an increased risk of death, a major heart attack, or a life-threatening arrhythmia (irregular heartbeat).Can angioplasty be done for 100 blockage? ›
“A 100% blocked artery does not mean a patient has to undergo a bypass surgery. Most of these blocks can be safely removed by performing an Angioplasty and the long term results are as good or are better than surgery.What are the disadvantages of bypass surgery? ›
The wounds in your chest and arm or leg (depending on where the grafted blood vessels were removed) can become infected after a coronary artery bypass graft. Infection can also affect your lungs or the inside of the chest after having a coronary artery bypass graft.What dissolves plaque in arteries? ›
Cyclodextrin Dissolves Cholesterol Crystals So They Can Be Excreted by Body; Reduces Arterial Wall Inflammation.How can I unblock my arteries without surgery? ›
You can “unclog” your arteries with natural methods, including diet, exercise, and stress management. Quitting smoking, if you smoke, can also help reverse plaque.What vitamin removes plaque from arteries? ›
Optimal Vitamin K2 intake is crucial to avoid the calcium plaque buildup of atherosclerosis, thus keeping the risk and rate of calcification as low as possible.Which artery is the most common to have blockage? ›
Although blockages can occur in other arteries leading to the heart, the LAD artery is where most blockages occur. The extent of the blockage can vary widely from 1% to 100%.What is the most serious coronary artery to have a blockage in? ›
A heart attack is particularly dangerous when it's caused by blockage in the left anterior descending artery, which supplies blood to the larger, front part of the heart, earning it this scary-sounding nickname.
A narrowing or blockage in the LAD is more serious than narrowing or blockage in the other arteries. Bypass surgery usually is the best choice for a blocked LAD. If the LAD is not blocked, and there are no other complicating factors, stents are more likely to be used, even if both of the other arteries are blocked.Is it possible to remove heart blockage without angioplasty? ›
When Patient says No to Angioplasty And Bypass Then. ESMR Treatment is the best option that time So Remove Heart Blockage Without Surgery. ESMR Treatment forms new natural blood vessels which improve the oxygenated blood supply to the affected portion of the heart non-surgically or non-pharmaceutically.Can angioplasty go wrong? ›
Complications can occur during or after an angioplasty. It's common to have bleeding or bruising under the skin where the catheter was inserted. More serious complications are less common but can include: damage to the artery where the sheath was inserted.What is high risk in bypass surgery? ›
What are the risks of bypass surgery? The chances of having a serious problem with bypass surgery increase with age. Your risk is also higher if you have other problems such as diabetes, kidney disease, lung disease, or peripheral arterial disease. Your doctor can help you understand what your risk for problems is.What is the average life of bypass surgery? ›
After a heart bypass, most people perform quite well and live for at least 15 years before needing another surgery, which is usually a stent insertion. If stenting isn't an option, a second heart bypass could also be performed.Can you avoid heart bypass surgery? ›
The most important is that the need for bypass surgery arises as the result of a preventable condition, namely, coronary artery disease. If you take care of yourself, eat well, exercise, and take heart-healthy supplements, the chances are good that you may be able to avoid a bypass.