Can you have a bypass surgery and angioplasty at the same time?

DEAR DOCTOR K:

My friend said he had bypass surgery and angioplasty at the same time. Isn’t it usually one or the other?

DEAR READER:

It is usually one or the other, but your friend may have been treated at one of a few select medical centers in the United States currently offering a new hybrid approach. If so, he may have had both bypass surgery and angioplasty during the same surgery.

To answer your question, I need to explain both the traditional approach and then the new hybrid approach. The hybrid approach cannot be used in all patients. However, when it is used, the goal is to make the surgery less grueling, and the beneficial results of surgery more long-lasting.

Lifestyle changes and treatment with medicines are often all that someone with atherosclerosis of the arteries of the heart needs. But when fatty plaque narrows the arteries of the heart and threatens its blood supply, it’s crucial to restore blood flow.

One option is to open the blockages with a tiny balloon (angioplasty). This is followed by the placement of a stent — a tiny, expandable mesh tube that keeps the artery open.

Another option is to transplant blood vessels from elsewhere in your body to bypass the blockage. The blood vessels are used to route the blood past the blockage, restoring blood flow to the heart. This is known as coronary artery bypass grafting (CABG).

When it was first introduced, and as it still is often performed today, CABG has several features:

  • The surgeon saws through the breastbone to access the heart. That’s pretty grueling, and it injures a lot of body tissue, which requires a long period of healing.
  • Then the beating of the heart is stopped, so that it is not moving when the surgeon does the delicate operation. But if it’s not beating, the heart can’t do its job of pumping blood throughout the body. Instead, the patient is put on a heart-lung machine to pump the blood while the heart is stopped. The use of the machine sometimes can cause complications.
  • The traditional CABG technique also uses veins from the legs to route blood past the blockage.

Over the years, surgeons have been refining various techniques for making the surgery “smaller.” These changes collectively are called “minimally invasive surgery.” In such surgery:

  • Surgeons do not cut through the breastbone. Instead, they make much smaller incisions through the chest. They use tiny scopes that let them see inside the chest, and instruments (including robots) that allow them to do precise surgery on the blood vessels of a beating heart.
  • Because surgeons leave the heart beating, they don’t need to use a heart-lung machine.
  • Another change in CABG over the years has been that surgeons use arteries from other parts of the body — arteries the body can “spare” — because they last longer than veins.

With this background on angioplasty and the traditional approach to CABG, in tomorrow’s column I’ll explain the newer approach of hybrid surgery that you asked about.