According to the findings of three different studies conducted by British scientists, the result of minimally invasive heart bypass surgery is longer and better quality of life than the use of artery-opening stents for people having a single blocked coronary artery.
Two of these studies discovered that the minimally invasive bypass surgery was more lucrative than stenting. The third analysis discovered that minimally invasive heart bypass procedure led to fewer complications than stenting.
"In this day and age, a lot of patients, when visiting their cardiologist, are informed, or a least it is suggested, that the same effect as during surgery may be attained through a stent, and that’s not the case," explained Dr David Taggart, a professor of cardiovascular surgery at the University of Oxford and author of an accompanying editorial in the March 24 issue of the British Medical Journal.
Risks not understood
What are stents? These are minuscule mesh tubes inserted into arteries in order to increase blood flow. However, according to Taggart, a lot of patients do not understand that within several years after stenting, they have a seven times greater risk of requiring new treatment in comparison to patients who had a bypass. "What’s even more significant, they experience greater likelihood of dying than if they had a bypass surgery," he exlpained.
In two of these examinations, a group of scientists led by Dr Thanos Athanasiou from the department of biosurgery and surgical technology, Imperial College London and St. Mary’s Hospital, London, analyzed published findings that compared minimally invasive bypass surgery with stenting.
In one of the reports, the scientists discovered that a procedure known as "minimally invasive left internal thoracic artery bypass" study can be a more lucrative medium- and long-term alternative to coronary artery stenting. In the examination, the investigators came to conclusion that this surgery "brought about fewer complications in the mid-term" in comparison to stenting.
In the third investigation, Dr Harry Hemingway, a professor of clinical epidemiology in the department of epidemiology and public health at University College London Medical School, and his team analyzes randomly chosen patients who underwent either cardiac procedure.
Stenting not lucrative
The group led by Hemingway discovered that coronary bypass procedure was cost-effective, and stenting wasn’t. Actually, they came to conclusion that, "cost-effectiveness analysis based on observational data indicates that the clinical benefit of percutaneous coronary intervention [angioplasty plus stenting] may appear not to be enough to justify its cost."
Taggart observed that regardless of these reports, selecting which procedure is the best has to be determined on a patient-by-patient basis.
"Patients experiencing this kind of complex disease ought to be treated by means of a multidisciplinary group of healthcare professionals, including a cardiac surgeon, rather than just a cardiologist," Taggart explained. "If you are not treated by a team, you will not always be given the proper information to determine which therapy is ideal for you," he added.
Taggart is convinced that patients frequently choose stents, due to the fact that they are afraid of the bypass operation. "If someone told you, ‘You can either have your chest cracked open or I can fix you with a couple of little stents,’ the substantial majority of patients would answer, ‘Of course, I don’t want my chest cracked open.’ "
Risks either way
According to one of the specialists, there are risks and drawbacks concerning each procedure.
"It’s not surprising at all," claims Dr William Maisel, a cardiologist at Beth Israel Deaconess Medical Centre, Boston. "It has been known for a long time that bypass surgery, for patients with considerable coronary blockage, is more probable to provide long-term relief of symptoms, due to the likelihood that you will not require further treatment for many years, it is more lucrative in the long run."
However, risks connected with the operating table are still higher with bypass, he emphasized. "What these reports gloss over is that your likelihood of dying [in the course of surgery] is doubled with bypass surgery than it is with stenting," Maisel added.
But in reality, both bypass and stenting are practical methods of treatment for patients, Maisel explained. "If you survive your surgery, you are almost certainly better off with a bypass," he added. "Nevertheless, a lot of the patients are afraid of the up-front mortality. however, both procedures remain sensible," he said.
