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Categories > Heart Health > Heart disease: Treatment

Opening the blood gates

The heart pumps blood throughout the body, delivering oxygen to our muscles and organs. But the heart is also a muscle that needs a steady supply of oxygen-rich blood to do its job.

Over time, fat deposits can harden into plaque on the walls of coronary arteries that supply your heart with nutrients. These plaques narrow the blood vessels, and as blood flow diminishes, you may experience chest pain or angina and shortness of breath. In the worst cases, the narrowed artery closes completely, blocking blood flow and triggering a heart attack. Or the plaque may crack or break, causing platelets to clump at the area and form a clot, which blocks the artery, also triggering a heart attack.

Your doctor may recommend a procedure such as angioplasty or coronary bypass surgery to restore and improve blood flow to the heart.

Your doctor may recommend angioplasty if:

  • your blockage is small
  • your blockage can be reached easily
  • your blocked artery is not the main artery that supplies blood to the left side of the heart

Your doctor may recommend bypass surgery if:

  • your blood vessels are small
  • you have very severe chest pain
  • you have multiple blocked sites
  • your blockage involves the left coronary artery (the main artery)
  • angioplasty hasn’t been effective or deemed not to be your best option

Read on to learn about the differences between the two procedures. Only your doctor can tell you which option may be best for you.

In the last 20 years, angioplasty has become a common way to open clogged arteries and restore blood flow. During angioplasty, a cardiologist inserts a thin wire with a tiny balloon on the end through a blood vessel in your arm or groin and threads it through your blood vessels up to the blockage or narrowed coronary artery. The balloon is then inflated, compressing the plaque against the artery wall and restoring good blood flow. Often, a small springlike mesh tube, called a stent is placed in the artery to prevent it from clogging again. Stents are sometimes coated with medication that’s slowly released to prevent re-clogging.

Angioplasty usually takes one to two hours under local anesthesia and mild sedation. You’ll need several hours to recuperate and likely remain in the hospital for a day or two.

Angioplasty may not offer a permanent solution. Up to 40 percent of patients experience further blockages within six months of the procedure. However, only 10 percent of people who also receive stents have this problem. It remains unclear, however, whether angioplasty actually prolongs life or prevents heart attacks, and some experts believe that lifestyle changes are more effective.

In coronary bypass, cardiac surgeons remove a healthy blood vessel from elsewhere in your body (such as your leg) and attach it to your heart to replace—and bypass—the blocked artery. The surgeon makes an incision in your chest, and blood flow is diverted through a heart-lung machine. Surgery typically takes three to six hours under general anesthesia. Afterwards, you’ll spend one or two days in intensive care. Most patients are discharged from the hospital within a week, but full recovery takes six to 12 weeks. Newer procedures, including “off-pump” and minimally invasive techniques, may eliminate the need for a heart-lung machine and reduce the incision’s size.

Bypass surgery may not be the best option if your doctor believes it won’t prolong your life. Risks include memory loss and other cognitive effects, stroke and a mortality rate of 3 percent to 5 percent, especially if you have other serious medical conditions such as emphysema, kidney disease or diabetes.