Open heart surgery or not

[Angela23]

A white 78 year old working woman goes for a regular checkup (she works at a retail store).  She is healthy with no signs of shortness of breath, weakness, chest pain, etc.  No past history of heart attacks or chest pain.  At the checkup she finds that 2 of her heart arteries are 90 percent block.  One physician tells her that she needs an open heart surgery and another physician tells her that they can open the arteries without the open heart surgery.  What is the patient to do?  Who is a good candidate for the open heart surgery and who are good for more of the non invasive procedure to fix the problem?

  

[Encephalomalcia]

Stents are best at age 78.  Open heart surgery can be risking and 1 in 5 die from it according to heart surgeons I have talked with.  Most likely plavix will be needed for 6 months to a year or possibly life after coated stents placed.  The heart surgeons I spoke with said that in 12 years there will be no open heart surgery.  All heart procedures will be done through cath.  I am wondering why the doctor would even suggest open heart surgery for only two arteries unless there is something else going on.  

[kenkeith]

The American Hospital Association and the American Academy of cardiology guidelines are to not stent any coronary lesion less than 70% (no angina).  If the occlusion is greater than 70% and there is angina, treat with medication.  If medication does not relieve angina, then a stent.  If the area of the lesion can not be stented due to location, size, or there is an emergency ie heart attack, then open heart surgery.

"Healthy" and no symptoms does not warrant a cath, stent or open heart surgery.  But I am somewhat puzzled as to what is the diagnosis!  Is the medical diagnosis a condition other than coronary artery blockage?

Surgery may be indicated if there is an aorta aneurysm, valve disorder, hole in the heart, etc. Under these circumstances, there may be disagreement on treatment, and a surgeon may be the best source for an opinion as these conditions have a high likelihood of eventually requiring surgery and a surgeon would know the best time for the most favorable outcome.