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The Spokesman-Review Newspaper
Spokane, Washington  Est. May 19, 1883

Ask Doctor K: Two types of surgery on arteries

Anthony L. Komaroff M.D.

DEAR DOCTOR K: My friend said he had bypass surgery and angioplasty at the same time. Isn’t it usually one or the other?

DEAR READER: To answer your question, I need to explain both the traditional approach and then the new hybrid approach. The hybrid approach cannot be used in all patients. However, when it is used, the goal is to make the surgery less grueling, and the beneficial results of surgery more long-lasting.

Lifestyle changes and treatment with medicines are often all that someone with atherosclerosis of the arteries of the heart needs. But when fatty plaque narrows the arteries of the heart and threatens its blood supply, it’s crucial to restore blood flow.

One option is to open the blockages with a tiny balloon (angioplasty). This is followed by the placement of a stent – a tiny, expandable mesh tube that keeps the artery open.

Another option is to transplant blood vessels from elsewhere in your body to bypass the blockage. The blood vessels are used to route the blood past the blockage, restoring blood flow to the heart. This is known as coronary artery bypass grafting.

When it was first introduced, and as it still is often performed today, coronary artery bypass has several features:

• The surgeon saws through the breastbone to access the heart. That injures a lot of body tissue, which requires a long period of healing.

• Then the beating of the heart is stopped, and the patient is put on a heart-lung machine to pump the blood. The use of the machine sometimes can cause complications.

Over the years, surgeons have been refining various techniques for making the surgery “smaller.” These changes collectively are called “minimally invasive surgery.” In such surgery:

• Surgeons make much smaller incisions through the chest. They use tiny scopes that let them see inside the chest, and instruments that allow them to do precise surgery on a beating heart.

• Because surgeons leave the heart beating, they don’t need to use a heart-lung machine.

In my next column I’ll explain the hybrid surgery approach .