Comparison of coronary angioplasty with open heart surgery; Which method is better?

Table of Contents

angioplasty What are the coronary arteries of the heart? (PCI)

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بیماری عروق کرونر زمانی ایجاد می‌شود که پلاک‌های چربی داخل شریان‌های خون‌رسان به قلب تجمع پیدا می‌کنند و باعث تنگی یا انسداد جریان خون می‌شوند. این مشکل می‌تواند به درد قفسه سینه، تنگی نفس، خستگی و حتی سکته قلبی منجر شود. هدف درمان، بازگرداندن خون‌رسانی کافی به عضله قلب و پیشگیری از حوادث قلبی آینده است.

برای کنترل مؤثر این تنگی‌ها و جلوگیری از پیشرفت بیماری، معمولاً پس از انجام آنژیوگرافی قلب و بررسی دقیق وضعیت عروق، دو روش اصلی درمانی شامل آنژیوپلاستی عروق کرونری و جراحی بایپس قلب (CABG) مطرح می‌شوند. اما کدام یک بهتر است؟ In the following, this question will be answered.

Angioplasty is a minimally invasive procedure used to open blocked arteries without open surgery. In this way:

A thin catheter is inserted through an artery in the wrist or groin.
The balloon is inflated at the site of the stenosis to open the artery.
Usually a stent (metal mesh tube) is placed to prevent re-closure.
Today's stents are often drug-free and reduce the chance of restenosis.

The benefits of angioplasty are as follows:

Local anesthesia, without general anesthesia
Duration of operation is about 1-2 hours
Short hospitalization (1-2 days)
Quick recovery and quick return to activities
The gold standard method in acute myocardial infarction

But which patients benefit most from this method? Angioplasty is usually more suitable for patients with stenosis of one or two vessels.

The choice between angioplasty and bypass surgery should be made based on the anatomy of the coronary arteries, the severity of the disease and the clinical conditions of each patient; Because no method is absolutely superior for all patients.

Also, in the initial evaluations, the use of CT angiography of the coronary arteries can play an important role in diagnosing the severity and location of obstruction and cost of angiography is also one of the important factors that is checked along with the patient's condition. During the consultation sessions, Dr. Majid Faraji suggests the most appropriate treatment decision by carefully examining the heart angioplasty photo and diagnostic images.

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Open heart surgery (CABG)

Bypass surgery is an invasive procedure during which a new path is created for blood to pass around the blocked artery. Dr. Faraji recommends and implements this method in patients who have extensive or complex blockages, or in cases where angioplasty does not respond sufficiently; Usually after doing Heart scan and detailed examination of the extent of damage and blood flow to the heart muscle.

Surgery steps include:

The patient is put under general anesthesia.
The chest opens.
A healthy vein is removed from the leg, chest or arm and used as a bypass graft.
The graft is connected from the aorta to the coronary artery to restore blood supply.

Benefits of bypass surgery include:

The ideal treatment for multiple, long or complex blockages
Better long-term results, especially in diabetic patients
Suitable for left main artery occlusion
Possibility of performing several bypasses in one operation

Of course, this method also has disadvantages; Including hospitalization for 5 to 7 days, a longer recovery period of about 6 to 8 weeks, and risks such as anesthesia problems, infection, or postoperative pain.

Angiography: It is a diagnostic method. Just imaging and checking for obstruction.

Angioplasty: It is a treatment method and includes balloon and stenting.

Sometimes both are done in one session.

Coronary Angioplasty

In this section, to choose between these two methods, the structural differences and short-term and long-term results of each should be considered. The following table provides a simple and understandable comparison:

property	Angioplasty with stent (PCI)	Cardiac bypass surgery (CABG)
attack	Less invasive	Open surgery
Anesthesia	local	Public
Duration of operation	1-2 hours	3-6 hours
Admission	1-2 days	5-7 days
Recovery	Fast (1-2 weeks)	Long (6-8 weeks)
Suitable for	Simple and moderate obstructions	complex and multiple obstructions

The choice of treatment method depends entirely on the clinical conditions, the type and number of vessels involved, etc.:

1. Location and severity of obstruction

single vessel disease → angioplasty
Three-vessel disease, diabetes, left main artery occlusion → bypass surgery

2. Clinical conditions

Acute heart attack → urgent angioplasty
Stable angina → Heart team assessment

3. General health of the patient

elderly or patients with high surgical risk → angioplasty
Young patients with extensive involvement → bypass

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4. Patient preference

Some patients prefer a faster recovery, others a longer duration.

Many patients return to normal life within a few days. But we should know:

Angioplasty only removes the mechanical blockage, not the cause of the disease.
Adherence to diet, smoking cessation, exercise and antiplatelet drugs are essential.
The life expectancy of angioplasty patients largely depends on the control of risk factors such as cholesterol and diabetes.
In some people, there may be a need to retake.

After bypass surgery

After the bypass surgery, the patient enters an important stage of recovery in which it is very important to follow the care tips. These cares include:

Control Cock pain Chest
Activity limitation until bone fusion
gradual walk
Regular use of medicines
Find warning signs such as shortness of breath or swollen feet

Summary

None of these two methods are "better" in absolute terms.

Coronary angioplasty and stenting are recommended for simple blockages, but open-heart surgery is better for patients who have extensive blockages and are looking for better long-term results. To choose the best method, a detailed consultation with Dr. Majid Faraji, a cardiologist, can make the treatment path clearer and decision-making more informed.

Source:

bhf.org.uk