What is by-pass surgery?
Coronary Artery By-pass Graft surgery is commonly shortened to CABG and pronounced as ‘Cabbage’ for short. It is also known as ‘by-pass’ or ‘by-pass surgery’ or ‘bypass operation’.
This is a big operation where patients need to be fully anaesthetized (‘fully asleep’). The chest bone (breast bone) is then split with a saw and the heart exposed. A long vein from the leg is carefully removed. Sometimes an artery from the forearm may also be removed. One end of this ‘harvested’ vessel is then joined to the narrowed heart artery at a point beyond the narrowing. The other end is joined to the large artery leaving the heart called ‘aorta’. In this way, blood rich in oxygen leaving the heart can travel down this newly implanted vessel and be diverted to the heart. Therefore, the narrowed diseased portion of the artery is ‘by-passed’. The breastbone is then sewn up with wires and skin closed. Patients usually need to stay in Intensive Care Unit for about 2-3 days and then another 4-5 days on the ward before discharged.
What is angioplasty?
Angioplasty is also known as ‘ballooning’, ‘stenting’, ‘spring’ or ‘ring’ colloquially. It is also known as Percutaneous Coronary Intervention or PCI for short in the medical circle.
"Angio" means blood vessel and "Plasty" means to make something big. Therefore "angioplasty" means to make a blocked vessel bigger. Another words, to unblock the artery. This is now done with catheter (tube), which is inserted into the artery (see section on angiogram). Once the catheter is in place, a wire the width of a human hair is slowly maneuvered across the blockage (plaque). Once it is through, a balloon is placed over the wire and pushed into the blockage. The balloon is then inflated. This pushes the plaque aside and the artery is made bigger. To prevent the recoil of the muscular artery, a stent (metal tube or dissolvable tube) is placed in the area of the plaque to hold the arterial wall in place. After this, the balloon, wire and catheter are all removed. The stent will remain in your artery and becomes part of you. The dissolvable stent will completely dissolve in 1-4 years’ time leaving nothing behind.
Angioplasty is now becoming treatment of choice when it comes to narrowed coronary artery. It is minimally invasive. Patients can usually be discharged the next day. There is minimal pain at the site where the tube is inserted. Some patients may even return to sedentary work as early as 3rd day after the procedure. There are no big scars anywhere. The risk of stroke is lower than by-pass operation although the chances for repeat stenting may be higher. Nowadays, ever very complicated narrowings such as Chronic Total Occlusion (CTO) or Left Main disease may be treated with stenting.
What is the difference between ‘By-pass’ and ‘Stenting’/’Ballooning’/’Spring’
Under the respective description of What is angioplasty and What is by-pass surgery we describe each of the processes. The main differences between these 2 procedures are;
- 1) By-pass is a major operation with big scar on the front of the chest. Angioplasty is done with 2-3mm tubes inserted from the wrist or groin. It is minimally invasive.
- 2) By-pass requires 3-4 hours to perform. Angioplasty is completely typically in 1 hour.
However, there are some very complex blockages that may also take a few hours.
- 1) By-pass operation is known to have higher stroke risk compared to angioplasty.
- 2) Angioplasty may have higher chance of repeat procedure a few years later.
- 3) By-pass requires patient to stay in hospital for about 5-7 days. Angioplasty patients typically go home the next day with minimal discomfort.
- 4) By-pass is typically more expensive than angioplasty. Although the very complicated angioplasty may come close to the cost of by-pass operation.