Bypass or angioplasty? The two major options for clearing blocked arteries leave many patients and their doctors in a dilemma: Do they want an invasive surgery that gives them the best chance for long-term recovery? Or do they want a quicker fix that might not last a year?
If you have blockages in three or more coronary arteries, your doctor is likely to recommend bypass surgery. But if you have one or two blocked arteries and neither is the vital left coronary artery, you may have a choice to make.
Consult a cardiologist first
For patients with middle-of-the-road heart disease who have time to think about treatment, heart surgeon Robert Jones, MD, of Duke University Medical Center, has some advice: Don't listen solely to people like him. And don't merely talk with an angioplasty expert either.
"Patients should talk to a well-trained cardiologist who doesn't do either type of procedure," he says. "If I'm shopping for a car, I don't get advice from a dealer."
Weighing the mortality odds
No matter which procedure they choose, nearly 99% of patients with moderate heart disease live for at least a month, 96% live at least a year, and 90% are still alive five years later, according to a 2007 report by the federal government.
Angioplasty's main selling point is that it's much less traumatic than a bypass. Surgeons don't have to cut open your chest, and you can get back to your life within a few days. But it's also less permanent. "If you want a procedure that will help you get over it and get on with your life, surgery may be the best choice," Dr. Jones says.
Bypass grafts don't last forever either, and a 40-year-old bypass patient may not relish the thought of having to go through the operation all over again. Some 40% to 50% of leg vein grafts, the most common type of bypass, become blocked within 10 years. If an artery from the chest is used, that number shrinks to about 10%.
On the other hand, a patient with severe angina may want to opt for a bypass because it offers the best chance for pain relief.
One recent review found that 89% of bypass patients were free of angina one year later, compared with 74% of patients who had an angioplasty.