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Bypass Surgery is Better Than Either Angioplasty or Heart Medications

Coronary artery bypass surgery is a treatment option for ischemic heart disease (too little blood reaching the heart muscle). Coronary surgery is recommended when there is disease of the left main coronary artery, disease of three or more vessels (triple vessel disease), or nonsurgical management hasn't worked. Coronary arteries are the small blood vessels that supply the heart muscle with oxygen and nutrients. Fats and cholesterol can accumulate inside these small arteries, and the arteries can gradually become clogged.This buildup of fat and cholesterol plaque is called atherosclerosis.

When one or more of the coronary arteries becomes partially or totally blocked, the heart does not get an adequate blood supply. This is called ischemic heart disease or coronary artery disease (CAD). It can cause chest pain ( angina ).

Sometimes CAD does not cause pain until the blood supply to the heart becomes critically low, and the muscle begins to die. The first symptom of CAD in this case may be a potentially deadly heart attack .

Heart bypass surgery creates a detour or "bypass" around the blocked part of a coronary artery to restore the blood supply to the heart muscle. The surgery is commonly called Coronary Artery Bypass Graft, or CABG (pronounced "cabbage").After the patient is anesthetized and completely free from pain, the heart surgeon makes an incision in the
middle of the chest and separates the breastbone.

On the pther hand,Angioplasty is a medical procedure in which a balloon is used to open narrowed or blocked blood vessels of the heart (coronary arteries). It is not considered to be a type of surgery.

A balloon catheter may be used to open the heart artery as an alternative to open heart surgery. The catheter is a small, hollow, flexible tube that has a balloon near the end of it.

The procedure starts with the patient lying on a padded table. Local pain medicine is given, and the catheters are then inserted in an artery (usually near the groin). The patient is awake for the procedure, but pain medicine can be given as needed.

A recent study shown that coronary artery bypass surgery is more effective at extending the lives of patients with severe coronary artery disease than either angioplasty or heart medications, Duke University researchers report.

They analyzed the records of more than 18,000 patients who had at least one coronary artery that was more than 75 percent blocked (severe coronary artery disease) and who received bypass surgery, angioplasty or heart medications at Duke between 1986 and 2000.

The patients were divided into three groups, based on when they were treated: 1986-1990; 1991-1995; and 1996-2000. The final period is the most important, because that's when doctors first started inserting stents during angioplasty procedures, the study authors said. Stents are tiny wire-mesh tubes used to keep arteries open after blockages have been cleared.

Among patients treated between 1996 to 2000, those who received bypass surgery lived an average of 5.3 months longer than those treated by angioplasty, the study said.

The researchers also found that both bypass surgery and angioplasty were better than medicines alone at extending patients' lives.

The study was published in the October issue of the Annals of Thoracic Surgery.

The Duke team noted that up to 40 percent of patients with severe coronary artery disease are first treated with angioplasty or medications and not given the opportunity to receive bypass surgery, which is more expensive and more invasive.

"It may sound very appealing to patients with severe coronary artery disease to get a treatment that is less expensive and less invasive, but they many not be getting the same survival benefit as those patients receiving bypass surgery," lead investigator Dr. Peter Smith, chief of cardiothoracic surgery, said in a prepared statement.