Ashish Pershad, MD, is an interventional cardiologist at Banner – University Medical Center Phoenix. For more information, talk with your doctor or call (602) 230-2273 (CARE).
Question: I'm a heart patient with several clogged arteries and my doctor is recommending treatment as quickly as possible. But I am not sure which way to go. Is it better to undergo bypass surgery or are stents better for treatment of heart blockages?
Answer: This is a very common question I get as a cardiologist and with so much information available online these days, it can often confuse the issue. The fact is, traditionally, every physician has had his or her own way of doing things and deciding on the line of treatment, and it's not been standardized.
The main message for the patient is to be an informed patient in the decision of treating heart disease because there is too much variability in care. Definitely ask questions before getting a bypass because once you make the step it's a committed step and it's a long-term price you may pay.
The current standard of care which patients should also make sure is happening in their case is that the decision is not made in a silo anymore. A heart surgeon and a cardiologist should ideally come up with a treatment plan after looking at an angiogram and then a combined decision should be made, with both experts putting their stamp of approval.
At centers of excellence, decisions are made in collaboration, so as a patient, you must ask:
- Is there a heart team to make a combined decision?
- What are the outcomes at your institute with bypass, angioplasty and stenting?
- Has the decision for my treatment been discussed with any other specialist?
Also, patients must know the basics about their heart disease including how many blockages they have, location of blockages, whether they have any 100 percent blockages that are not bypassable, whether they have a weakness in heart muscle function or valve problems along with blockages.
Everyone wants the least invasive option but sometimes that may not be the best option you have. Sometimes a combined or hybrid procedure works best, so you may have a heart surgeon and a cardiologist working on to do a bypass from one vessel and stents from another.
Collaboration by a heart team and a multidisciplinary approach is very important so that the right treatment decision is made the first time, and you don't end up with multiple procedures and a poor outcome.