Which procedure to choose? Bypass surgery or angioplasty

Bypass surgery (CABG) as the name suggests is a surgical procedure in which blood vessel(s) from the chest or leg is/are grafted to the coronary artery beyond its most diseased segments. On the other hand, coronary angioplasty (PTCA) is a non-surgical procedure designed to widen/dilate a narrowed coronary artery. Which procedure need to be opt is decided by a doctor or medical expert depending on the several factors like number of arteries showing blockages, type of blockage, number of segments blocked, diameter of vessels and functioning of heart muscle etc. One has to choose the best form of treatment out of medication, bypass or angioplasty.

One has to undergo the best procedure as per suggestions of a doctor. However, such a decision may get influenced by number of factors as was experienced by a close relative of mine. Cost is the most important factor to be considered. Cost of angioplasty is usually more if there are more number of blockages invoving number of arteries. Several hospitals prefer bypass surgery over angioplasty to record more cases of bypass surgery by the hospital. These two factors perhaps contributed substantially in influencing the decision of doctors in prescribing bypass surgery in my relative's case.

It will be intersting account of events if these are placed in chronological order and help readers to decide course of action if they are faced with similar situation. Let me name my relative as Mr 'X' now onwards.

Mr 'X' has abdominal pain in the night approx. 2 hours after dinner. It continued for 3-4 hours. Pain kept changing from upper abdomin to back side. Investigations were carried out next few days and revealed that Mr 'X' has calculus struck in the neck of Gall bladder. Mr 'X' consulted the surgeon and he recommended surgery for removal of Gall bladder. Surgeon asked Mr 'X' to get ECG and report to him. ECG report of Mr 'X' showed abnormal ECG and further consultations with Heart specialist lead further tests related to heart.

After few days, Mr 'X' consulted other heart specialist of a reputed Hospital. Mr 'X' was advised to get angiography of his heart. He agreed and angiography report showed the following facts:

Coronary Angiogrphic Profile:

Left Main: Normal

Left Ant. Desc. : Proximal 70-80 % stenosis, mid 70% calcific long segment stenosis

Diagonal -1.: Mid 70-90%  stenosis

Left Circumflex: Proximal 30-40% stenosis. Distal 99% stenosis

Obtuse Marginals-1: Proximal 50% stenosis

Obtuse Marginals-2: Proximal 99% stenosis

Right Coronary: Proximal 50-60% stenosis, Mid 80% stenosis, Distal 90% stenosis

Summary Coronaries: Coronary angiogram shows Triple Vessel Disease

Recommendations: CABG

Here it need to be mentioned that Mr 'X' were informed immediately by doctors just after the angiographic procedure  that he has several blockage and must undergo immediately the open heart surgery. He was shocked to hear all this and requested these experts if angioplasty could achieve the same results that they were trying using bypass surgery. These doctors told Mr 'X' that CABG was the only option. Mr 'X' got discharged from the hospital and got CD of angiography after 2 days. After taking the CD in his possession, he made up his mind to take second opinion of heart specialist of other leading hospital. He sought the appointment from cardiologist of other hospital and showed angiographic report and CD of the same. After examination of report and CD, doctor informed Mr 'X' that there was no need of bypass surgery and all the problems could be handled using angioplasty.

Experts reported  the history of patient as given below.

Patient is normotensive, nondiabetic, and has no family history of CAD. He is a known case of CAD, angina TVD, Gall stone for the last 2 months, post prandial epigastric discomfort (2-3 months), normal LV systolic function

Course in the hospital is shown below.

Patieint underwent coronary angioplasty/Stent (Taxus) to (D) RCA, (TAXUS x 2) to (M) RCA, Rotablation +Stent (CYPHER x 2) to LAD &  (CYPHER X 3) to D1 +inj Reporo with good end result and no residual stenosis or flap. The procedure was uncomplicated and well tolerated.

Mr 'X', thus escaped  the agony and mental trauma he had to face if underwent bypass surgery as per the recommendations of consultants of a leading hospital. Consultant of other leading hospital saved him from bypass surgery and successfully used the angioplasty procedure to achieve the same results as achieved by the bypass surgery.

I asked Mr 'X' about the pains if he had any during the procedure. He denied and told that he felt more pain during the angiography than the angioplasty and was quite satisfied with the procedure.