Why did my doctor recommend bypass surgery for me, but my uncle, neighbor, or spouse underwent coronary stenting? The answer to this question is unique for every patient, and your doctor considered many factors before making the recommendation. It is impossible for a website to answer which treatment is right for you. However, SecondsCount can provide general, up-to-date information, and suggest questions to ask your doctor to understand why a procedure is right for you.
Interventional cardiologists and cardiac surgeons are doctors who have been trained to perform procedures to treat cardiovascular disease. Interventional cardiologists specialize in angioplasty and stenting to treat cardiovascular disease. By using catheters, interventional cardiologists are able to treat many conditions without open surgery. Cardiac surgeons specialize in performing bypass surgery and other open-chest operations to treat disorders of the heart. Both catheter-based procedures and bypass surgery are effective options for treating heart disease. The question you may be facing is, which option is right for you, a loved one, or a friend who has a cardiac condition.
As you and your care team consider your treatment options, you will probably feel more comfortable evaluating your treatment options if you are familiar with how interventional cardiologists and cardiac surgeons decide to recommend angioplasty and stenting or bypass surgery.
Much of the information about cardiovascular treatments -- on the news and even what you might hear from friends and family -- may be outdated, incorrect, and even dangerous. Understanding your options and understanding the alternatives for your specific case can happen only with the physician who knows your situation.
If you have been diagnosed with heart disease, you will have many questions.
Here are some questions to get you started and some background information to help as you talk with your doctor.
Question 1: What are my options for treating my heart disease?
When you learn you have heart disease, this is a very important question. To be an informed patient, you’ll want all of the information you can get about your options going forward. Heart disease is a chronic, progressive disease, which means you and your doctor won’t be curing it so much as managing it and working together to control the symptoms so you can live the life you choose. When you and your doctor discuss this question, consider all of the options for your specific situation.
Question 2: Why are you recommending angioplasty or surgery for me?
In some cases, your heart disease will rule out angioplasty and stenting as a treatment option for you. In some cases where bypass surgery is recommended, angioplasty and stenting may be an option. Be sure to ask your doctor to explain why he or she believes one treatment or the other is best for YOU. It is likely your doctor will talk about the severity of your disease, your overall health status, how any other conditions you may have impact the recommendation, and the benefits and risks that apply to you specifically.
- Heart disease severity: This refers to how many of your heart arteries have blockages and how blocked those arteries are. Your doctor may tell you how blocked the artery is using a percentage, such as, "This artery is 80 percent blocked.” Or your doctor may describe your condition in terms of how much of your heart muscle is supplied by the blocked artery, whether the branches of the artery are involved in the blockage, and whether the blockages are long or short. All of this information is unique to your situation, which is why your doctor is the best person to recommend a treatment option for you. Together, you can decide which treatment option to pursue.
- Other medical conditions: Some studies have suggested that surgery may be a better treatment for people with diabetes. If you have lung disease, surgery may not be the right choice for you. Be sure your doctor is aware of your full medical history. The information available to help doctors evaluate how other medical conditions affect treatment of heart disease is constantly evolving. And each new study is evaluated in the context of all the research done before. It is rare for a single research study to drastically alter the practice of medicine by itself.
- Overall health: Your doctor will consider your overall health when recommending a procedure to treat blockages of the heart. For some patients, especially if they are older or weakened by another condition (such as heart valve problems), the risks of open-heart surgery outweigh the benefits of the procedure. Ask your doctor to explain the benefits and risks - for you, specifically - with each of your options.
Doctors make recommendations about treatment based on scientific evidence compiled over decades of research and medical judgment acquired by treating many patients, each with a somewhat unique situation. Talk with your doctor about what’s right for you. If you don’t feel comfortable, seek a second opinion.
Question 3: How many angioplasties or surgeries have you performed, and are you Board certified?
Your doctor’s experience matters because greater experience tends to result in better results. Don’t hesitate to ask your interventional cardiologist how many procedures he or she performs each year and how many of them are on patients like you. Professional medical societies that recommend standards for care have advised that most doctors performing angioplasty and stenting procedures perform at least 75 procedures per year although there are some exceptions for those practicing at busy hospitals and for doctors who have been on leave for reasons such as pregnancy. Likewise, if you are considering bypass surgery, ask your cardiac surgeon how many surgeries he or she performs each year.
You may also want to ask if your interventional cardiologist or cardiac surgeon has been certified in his or her specialty. Doctors are granted certification by taking regular exams and completing other requirements to demonstrate they have the knowledge, skills, and attitudes essential for excellent patient care.
Question 4: What results has your hospital had with patients like me?
No matter how skilled your doctor is, he or she does not work alone. In other words, your results will be affected not just by your doctor, but by the whole healthcare team. So ask about the hospital’s outcomes with patients like you who undergo the treatments you are considering.
Question 5: What is the recovery like for angioplasty and stenting and for bypass surgery?
Recovery from bypass surgery is more difficult than for angioplasty procedures. Your cardiologist and surgeon will consider your ability to recover and complete cardiac rehab when making their recommendation.
Question 6: What should I do if I have more questions?
Ask them. Any time you have a healthcare decision to make, the conversations you have with your doctor are the key to successful results. Be sure your doctor is aware of all of your symptoms as well as all of the medications, vitamins, and supplements you may be taking. And ask every question you have.
We hope you will also use this website to learn more about your cardiovascular health and treatment options. SecondsCount.org was developed by the Society for Cardiovascular Angiography and Interventions (SCAI), the medical society for interventional cardiologists. Learn more here about interventional cardiologists.