By Tommy L. Fudge, M.D.
Medical Director,
Cardiovascular Institute of the South/Surgery

If you need treatment for serious coronary artery disease -- blockages in the arteries serving the heart muscle itself -- you will generally face one of two prospects.

Either a surgeon will graft a section of artery or vein in place to carry blood around the blockage, or an interventional cardiologist will reopen the blockage from inside the artery, usually by inflating a tiny balloon to flatten the obstructing plaque.

The central question the physician seeks to answer in deciding whether to recommend bypass surgery or angioplasty is this: What is the least invasive approach that will assure that the heart continues to receive an adequate supply of oxygen while the procedure is in progress?

In bypass surgery, the heart is stopped and chilled, so that its oxygen demands are very small. However, it is clearly the more invasive procedure.

Angioplasty, which is carried out through a tiny catheter inside the artery, is far less invasive. But it blocks the artery briefly when the balloon is inflated, which can trigger a heart attack if the blood supply to the heart muscle is already too severely restricted.

In general, bypass surgery is recommended if the blockages are severe and widespread -- if three arteries are blocked or the blockages are at critical branching points. However, angioplasty might be recommended for a patient with such blockages if age or infirmity ruled out major surgery.

New angioplasty technologies, like smaller and more flexible catheters, atherectomy tools which cut away and remove plaque, and adjunct devices like stents, which hold blood vessel open following angioplasty, continue to evolve. As they do, the gray area between what is clearly a surgical or nonsurgical patient continues to grow.

In my view, that overlap makes it all the more important that patients obtain an initial treatment recommendation or second opinion from a cardiovascular specialty group whose staff includes both cardiovascular surgeons and interventional cardiologists -- a situation which, unfortunately, remains the exception rather than the rule.

1995 Cardiocascular Institute of the South

For further information, call Jane Arnette, Cardiocascular Institute of the South/Houma, 1-800-425-2565, or Jim Keyser at 1-800-848-2715. E-mail questions or comments to: jakeyser@cardio.com.

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