Know your options: procedures to treat coronary heart disease

While it’s true that more Canadians die of coronary heart disease (CHD) than any other illness, things are changing. You're now far less likely to succumb to a fatal CHD-related heart attack, thanks to better medicines and real surgical innovations.

For severe cases, surgery can be a lifesaving option. Unfortunately, nothing will cure you of CHD. But the right procedure, an angioplasty or a bypass, can give you enormous relief from pain and discomfort — and significantly prolong your life.

• If your CHD becomes severe or your angina hard to control (it comes and goes or lasts for more than 20 minutes), your cardiologist may recommend surgery.
• The two standard procedures are bypass surgery and angioplasty. There are pros and cons to each and it may not be an easy choice.

For a coronary bypass, formally known as a coronary artery bypass graft (CABG), the surgeon opens your chest wall to expose your beating heart. After connecting you to an external pump that acts like a heart, the team actually stops your heart temporarily. The surgeon stitches a healthy, plaque-free section of vessel (from your leg or chest) beside the problem artery, creating a new route for blood to flow freely. If more than one artery is congested, the surgeon may place several grafts. About 16,000 bypasses are done in Canada every year.

• Pros: It maintains blood flow in the affected artery for a longer time than can be expected with angioplasty. A repeat procedure is not usually necessary (at least not for many years).
• Cons: It’s major open heart surgery, requiring general anesthesia and several days in the hospital, followed by weeks of home recuperation. Complications can include heart attack, infection, postoperative confusion and thinking problemsm or even a stroke from the tiny clumps of plaque that can be stirred up by the procedure and caught in a narrowed brain artery.

With an angioplasty, your cardiologist restores blood flow to the heart by inflating a balloon inside the artery to compress the plaque against the vessel walls. This revolutionary technique began two decades ago and, with 18,000 angioplasties done annually in Canada, is now more popular than a bypass.

• Pros: It takes about one hour, requires only local anesthesia and one hospital night, and recovery is relatively quick.
• Cons: There’s a 20 percent to 30 percent chance the artery will block up again (restenosis), necessitating a second procedure. Other potential risks: blood clots, artery spasms or a heart attack due to coronary artery injury. The concern about restenosis is now significantly less with the use of stents.

About 85 percent of angioplasty patients get stents, which reduce the need for follow-up procedures by about 33 percent. But complications such as blood clots and vessel scarring persist.

• Scientists are hoping to bypass these problems by coating the stents themselves with medications that combat tissue growth and clots.

For extreme cases of CHD, surgery may be your only option. Keep this guide in mind and contact your doctor for more information.