More than one way to fix the heart
Why are some people with blocked arteries asked to go for a bypass surgery while others are advised angioplasty? The decision may appear random, but there is a method to it. Sanchita Sharma reports.health and fitness Updated: Jan 24, 2009 22:32 IST
Doctors decided Prime Minister Manmohan Singh needed a bypass surgery and not an angioplasty to fix his heart. Though it often appears that the decision is based on a whim, it is not so. There are very clear guidelines laid for cardiac procedures and these should be strictly followed.
Heart disease occurs when fatty deposits (plaques) build up in the inside wall of the arteries and reduce — and at times, completely stop — the flow of blood. While non life-threatening situations should be treated using medicines, getting active and eating right, critical blockages need medical interventions in the form of surgery or angioplasty.
“Bypass surgery is the preferred option if the blockages are multiple, long or in the beginning of the artery. Surgery also works better if the patient has diabetes and small blood vessels,” says cardiac surgeon Dr Naresh Trehan, chairman, Global Health Private Ltd.
Apart from patient-specific characteristics mentioned above, cost is often one of the issues factored in while choosing the procedure. An over 99 per cent success and a cost of about Rs 2 lakh makes bypass surgery safe and affordable for most people.
The non-invasive nature of angioplasty, however, is making stents — especially drug-coated ones — extremely popular among people who can afford them and do not want to undergo the trauma of having their chest cut open.
During an angioplasty, small wire-mesh metal tube covered with a drug is used to provide scaffolding to support the damaged arterial wall. Patients need to be hospitalised for 48 hours, as opposed to a week after a bypass.
The main limitation of angioplasty is the risk of the treated artery becoming narrowed again (restenosis). Stents coated with a special medication prevent scar tissue growth in the artery where the stent is placed, significantly reducing the risk of in-stent restenosis.
“With drug-coated stents bringing down reblockages to 4-5 per cent, angioplasty can be considered even when a patient has more than one blockages, provided that the arteries are suitable for angioplasty,” says Dr Purshotam Lal, chairman, Metro Group of Hospitals. A drug-coated stents costs Rs 1 lakh each, with the procedure adding another Rs 50,000 to the cost.
Then there is rescue angioplasty, which is done within 3 hours of a heart attack, which can open the blockage while the heart attack is in progress. Primary angioplasty along with clot-busting drugs can save people undergoing a heart attack. Unlike anginal pain, the pain from a heart attack usually lasts more than 20 minutes.
Most people do not realise that bypass surgery techniques have advanced phenomenally. “The surgery is now done on a beating heart through a 6-inch incision, with the patient getting back to normal within three weeks. When a robotic bypass is done, three incisions that are barely over 1 inch long are made,” says Dr Trehan. “Because there is no risk of reblockage, bypass is a more permanent treatment for heart disease,” he adds.
In a non life-threatening situation, heart medications such as ß-blockers, nitroglycerin, and calcium channel blockers are used along with blood-thinning medications such as aspirin and cholesterol-lowering drugs. “As much as medicines, lifestyle changes are important for all those who undergo either angioplasty or bypass surgery,” says Dr Trehan.