dr pankaj goel: Heart Attack- Stent or Bypass Surgery- Which is better?

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Dr Pankaj Goel, is currently working as a Director and Head of the Cardio-thoracic and Vascular (Heart, Lung and Vascular Surgery) unit at the Ivy Hospital, Amritsar.

After completing his MCh in cardio-thoracic and vascular surgery from GB Pant Hospital, Delhi University in 1998, Dr Goel worked at Madras Medical Mission, Chennai for three years. Here he obtained training in complex paediatric cases. Thereafter he went to Australia (Royal Perth Hospital) for further training and experience.

Dr Goel joined the Fortis Escorts Hospital, Amritsar in 2003. Since 2008 , in his capacity as HOD at the same hospital he has done pioneering work and established cardio-thoracic and vascular surgery in the city.

The Goel's unit now routinely performs all types of cardiac, thoracic and vascular surgeries with results comparable to the best centres in the world. Dr Goel is responsible for many firsts in the region.

Dr Goel has several research papers published in indexed journals. He has authored a book on cardiac surgery. He has an original technique for harvesting saphenous vein to his credit.

In 2009, Dr Goel was elected member of the prestigious Society of Thoracic Surgeons , USA. He is also a member of the Indian Association of Cardio-thoracic surgery and CTS Net.

At Ivy Hospital, Dr Goel routinely performs all types of Cardiac, thoracic (including thoracoscopic) and vascular procedures.

Tuesday, 29 September 2020

Heart Attack- Stent or Bypass Surgery- Which is better?

Heart attack is caused by blockages in the arteries supplying blood to the heart muscle (Coronary Artery Disease). Severity of the disease is commonly graded according to the number of heart arteries diseased. The aim of any treatment of this disease is to restore blood supply and prevent further damage to heart muscle. It may be achieved by opening up the blockages -stenting or providing an alternate source of blood supply beyond the block- Bypass surgery. Medicines too can increase the blood flow but to a limited extent.

Each treatment has its advantages, disadvantages and limitations. No one treatment is suited for all. Therefore, matching the right treatment with the right patient is essential for a good long term result. In practice, any of the the 3 modalities may be used concurrently or serially to provide relief over several decades.

Matching the right treatment to the patient is based on guidelines established by experts after analysing thousands of patients and outcomes. The decision is based on presentation, complexity of disease and general condition of patient. Unfortunately many patients fall in the grey zone creating confusion in the minds of patients. Some general rules are:

Not all patients with coronary artery disease require stent or surgery. Stable patients with no life threatening blocks and normal heart function can be managed on medicines for several years.
The severity of disease is established by coronary angiography. In most stable cases, putting in a stent in the same sitting is convenient though not compulsory. For patients with ongoing heart attack immediate stenting is advisable.
In most cases the aim is to provide complete revascularization i.e. restore blood flow in all the blocked arteries.
Patients with single or double vessel disease are generally managed with stents. Where stenting is technically not possible or failed -bypass surgery is advised.
The first line of therapy for triple vessel disease is bypass surgery. Where general condition of the patient prohibits surgery, stenting is advised.
In ongoing heart attack emergency stenting to open up the “culprit” artery is advised.
In difficult cases, a combination of stent and bypass surgery may be required.

In properly selected cases, the procedural risk is the same for stenting or surgery i.e. about 1%. Surgery is more invasive and requires a weeks stay while after stenting patient is discharged in 2-3 days. The main advantage of surgery lies in the use of left internal mammary artery to graft the largest artery of the heart- the left anterior descending (LAD). This graft has 95% success rate even at 20 yrs and secures life of the patient.

Coronary artery disease is a progressive disease. With advancing age, stents and grafts can get blocked or new disease can appear. Most cases can be managed on medicines.Re interventions i.e. repeat stenting or bypass may be required in a few.

Thus, all three modalities are complementary to each other and are used serially to provide several decades of symptom free life.

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