Stents or Bypass Surgery, How to repair a broken heart?

*Updated 2022

Heart disease is the number one leading cause of death in the world, and almost half of all  American adults are living with some degree of it. Most forms of heart disease are usually caused by a blockage in or narrowing of the coronary arteries, making it difficult for blood to flow properly and often leading to a heart attack, chest pain or stroke.

With regard to treating heart disease, in addition to medical therapy (usually drugs), the two main courses are currently bypass surgery and heart stents. Bypass surgery involves taking a healthy blood vessel from somewhere in the body and attaching it to the blocked artery, allowing blood to flow around the blockage. Stenting – commonly known as part of a process called angioplasty – which includes inserting a small tube into the blocked passageway to keep it open, so blood can flow through it. In 2019 it surfaced that famed astronaut Neil Armstrong died due to complications from bypass surgery. As this type of treatment actually has a higher success rate than stents, Armstrong’s unexpected death renews the debate about which course of treatment is the best, safest one to combat heart disease.

Here are three reasons in favor of heart stents as the treatment of choice, and three reasons in favor of bypass surgery.

Heart Stents

 

Quick fix

Stenting is a much quicker solution than bypass surgery, which is why it’s preferable for treating time-sensitive issues. As mentioned above, most forms of heart disease are usually caused by an obstruction in the coronary arteries, resulting in all kinds of problems for the body. Unlike bypass surgery, heart stents directly address this obstruction, by opening the clogged heart artery with a balloon. The stent (a small mesh tube) is then inserted to help keep the artery open permanently and decrease the risk of the artery narrowing again. Heart stents are faster than bypass surgery in getting blood to flow through the arteries as it should.

 

Avoids surgery

Heart stents allow you a quick and relatively easy recovery, and don’t introduce new, potential risks to your health like bypass surgery does. Heart stents only require a very small incision into the skin, and the procedure calls for a local anesthetic. While heart stents run the risk of side effects, the risks are not nearly as large as those in bypass surgery, and you can usually resume daily activities within the week. In contrast, bypass surgery is very invasive, with patients rarely feeling back to normal for weeks to months afterwards. Side effects with bypass surgery can include anything from weakness and pain to risk of stroke, which occurs to 1.6-2.6% of people post-surgery.

 

Could be better for mental health?

Most people don’t think of intervening medical treatments as jeopardizing to mental health, but with heart disease treatments, that is certainly the case. Until now, there have been no studies showing that the process of angioplasty and stenting impair mental health. However, bypass surgery paints a different picture. Besides the aforementioned physical side effects, one in three patients experience depression after bypass surgery, which can greatly prolong the recovery process. Additionally, a phenomenon called “pump head” has been observed to occur in 42% of patients post-surgery, in which those patients experience cognitive impairments ranging from memory loss to poor decision-making to delirium. Worse, these impairments can persist for five years or longer.

 

Bypass Surgery

 

Reducing risk

As mentioned above, bypass surgery allows blood to flow around the blocked artery. Unlike heart stents, bypass surgery circumnavigates the problem areas of your arteries altogether. In other words, your “problem artery” is left untouched. Stenting, on the other hand, allows for many complications: Restenosis occurs in 15% of people with a stent, which is when scar tissue grows in the treated area of the artery. Additionally, 2% of people form blood clots within the stent, leading to heart attack, stroke, or other issues. Bypass surgery, well, bypasses these issues altogether, removing these risks from the equation.

 

Proof is in the pudding

Bypass surgery has a 98% success rate, which are the odds you want to see before undergoing heart disease treatment. In contrast, a study comparing heart stents with placebos found that heart stents weren’t any more effective than placebos in improving stable angina (chest pain as a symptom of heart disease). Additionally, another study showed that newer generations of heart stents still aren’t as effective as bypass surgery for people with multiple narrow arteries; people who received stents had a 47% higher risk of death, heart attack, and needing another procedure to clear out blocked arteries.

 

The simple choice for complicated problems

Bypass surgery is the safer option for people with complex medical histories overall, according to the SYNTAX study. While this may seem counterintuitive considering bypass surgery is pretty invasive, long-term studies on different populations with heart disease paint a different picture. For example, studies show that diabetic patients with severely blocked coronary arteries have a better recovery in the long run when they undergo bypass surgery as opposed to angioplasty. The Food and Drug Administration has warned against using stents for patients with Multiple Sclerosis – as they’ve had little effect and pose risks – recommending bypass surgery instead. Additionally, bypass surgery is more effective in treating people with multiple narrowed arteries than stents.

 

The Bottom Line: While heart stents are less invasive on the body and mind, bypass surgery seems to be more effective for diverse populations and has better rates of success. Which option would you recommend to a friend with heart disease?

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