"If put you put a stent in the LAD, you are only protecting that area of blockage, and the rest of that artery is still vulnerable," Cutlip says, "whereas a bypass will protect the downstream portion of that vessel probably forever."
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.
Why it's done. 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.
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).
CABG has a longer recovery time than coronary angioplasty and a higher risk of complications. But, some evidence suggests that CABG is usually a more effective treatment option for people with diabetes.
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.
While stents offer a minimally invasive way to reopen a blocked artery, bypass surgery also remains a leading treatment for people with complex coronary artery disease (CAD).
The cumulative survival rates at 10, 20, 30 and 40 years were 77%, 39%, 14% and 4% after CABG, respectively, and at 10, 20, 30 and 35 years after PCI were 78%, 47%, 21% and 12%, respectively. The estimated life expectancy after CABG was 18 and 17 years after the PCI procedures.
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.
Heart bypass surgeries are a serious procedure but relatively safe. Outcomes of heart bypass surgery are typically positive. The procedure can reduce symptoms of arterial blockages and improve quality of life.
CABG effectively improves blood flow to the heart, but the rigors, risks and long recovery time of open-heart surgery mean it's not an option for the many heart disease patients who are elderly, frail or have additional health problems.
If your arteries are narrowed or blocked in several areas, or if you have a blockage in one of the larger main arteries, coronary bypass surgery may be necessary.
While the answer to this question will be different for every person, there is good news in general: Patients undergoing CABG can and often do live long, healthy lives afterward.
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%.
By clinical guidelines, an artery should be clogged at least 70 percent before a stent should be placed, Resar said. "A 50 percent blockage doesn't need to be stented," he said.
Coronary arteries with severe blockages, up to 99%, can often be treated with traditional stenting procedure. Once an artery becomes 100% blocked, it is considered a coronary chronic total occlusion, or CTO. Specialized equipment, techniques and physician training are required to open the artery with a stent.
The study shows that ten-year-survivors have an increased mortality of between 60 and 80 per cent when compared with the general population. This may be due to the fact that the disease is progressive and that the atherosclerosis or hardening of the arteries increases, or that the implanted material begins to fail.
In general, you can resume your normal activities within one to two weeks after a minimally invasive heart procedure. For open-heart surgery, you can return to many activities within a month after surgery. Allow up to three months for proper recovery and healing.
By restoring blood flow to the heart, CABG can relieve symptoms and potentially prevent a heart attack. Coronary bypass operations are performed half a million times a year with an overall success rate of almost 98 percent.
Risks of surgery
As with all types of surgery, a coronary artery bypass graft carries a risk of complications. These are usually relatively minor and treatable, such as an irregular heartbeat or a wound infection, but there's also a risk of serious complications such as a stroke or heart attack.
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.
Heart bypass
This is a major heart operation which is used routinely for the treatment of patients with coronary artery disease and angina. A blood vessel will be taken from another part of your body and attached to the coronary artery above and below the narrowed area or blockage. This is known as a graft.