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Bypass surgery better for complex patients

Surgery is better for patients with significant coronary artery disease than angioplasty. The death rate after open-heart surgery (bypass surgery) is 20% lower than after angioplasty.

Hart bloedsomloop tekeningThis has been shown by research carried out by Erasmus MC and others, and has been published online in the leading scientific journal The Lancet. The international study was led by Stuart Head, thoracic surgeon at Erasmus MC and trainee specialist.

More than 38,000 people in the Netherlands undergo angioplasty every year. It is a procedure used to widen blocked or narrowed coronary arteries by inflating a balloon in the arteries and using a stent to scaffold the arteries. A catheter with a small balloon at the end is inserted through an artery, usually in the groin or wrist, which means that only a skin puncture is needed.

New route
A bypass operation, a procedure where the chest is fully opened up to perform the operation, is much more invasive than angioplasty and therefore performed less often (4,500 times per year). During a bypass operation, the surgeon grafts an artery from the chest and a piece of vein (from the leg) to bypass one or more narrowed coronary arteries. The blood will then flow through the new route.

The treatment given to a patient will depend on how acute the condition is and the severity of the blockage. But if unsure, a physician will often go for angioplasty. However, open-heart surgery appears to be the best option for patients who do not require urgent treatment but do have severe blockages or multi-vessel disease, particularly if they also have diabetes.

The researchers studied the cases of 11,518 patients who had undergone a bypass operation or angioplasty in various randomized trials in recent years. Patients who underwent surgery were 20% less likely to die than patients who underwent angioplasty. A total of 9.2% of the patients who underwent surgery died within five years. This was 11.2 per cent for the patients who underwent angioplasty.

Easily accessible
If the blockages or narrowing are less severe or complex, and are relatively easily accessible, angioplasty can still be a good option. Head emphasizes that angioplasty with stents that emit medication to prevent vessel re-closure, continues to be a good treatment option for patients who do not have extensive or complex blockages, or other diseases such as diabetes. 

See the press release.

Date published: 27 February 2018.

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