What is Bypass Surgery? What Are Its Types?

Open Bypass Surgery is a type of surgery performed to restore blood flow to a blocked or partially blocked artery in the heart. A long incision is made in the middle of the chest, and the chest cavity is opened. After the chest is opened, the heart is temporarily stopped, and the surgery is performed. Open-heart surgery usually lasts about 3 to 6 hours, depending on the number of blocked arteries. Since open bypass surgery involves a large incision, the risk of complications is higher compared to closed bypass surgery. The risk of infection is also increased, especially in diabetic patients. Due to issues with bone healing and a higher risk of infection in diabetic patients, closed bypass surgery is often considered superior to open bypass surgery.

Closed Bypass Surgery is performed with smaller incisions and does not involve cutting the breastbone. It is done through incisions under or beside the breast. After closed bypass surgery, patients are discharged from the hospital more quickly, allowing for a faster return to social life.

What is a Stent? Why Is It Used?

A stent is a small tube used to keep arteries open and ensure uninterrupted blood flow. Stents are commonly used to treat conditions that arise from blocked or damaged blood vessels. These metal tubes, placed inside the arteries with the help of a balloon, can remain permanently in the body. The procedure is typically performed by accessing the artery from the groin or wrist. Recovery time varies depending on the location of the stent. If placed through the wrist, the patient can get up almost immediately; if through the groin, the patient needs some time to rest.

The stenting procedure is not completely risk-free. In some cases, complications may arise, requiring emergency surgery. Complications may include bleeding, bruising, acute stent blockage, artery tears, dislocation of the stent, heart attacks during the procedure, or even death.

Does Multiple Stent Placement Eliminate the Need for Bypass Surgery?

When arteries supplying the heart become blocked or narrowed, two methods can be used to restore blood flow:

  1. Bypass Surgery
  2. Stent Placement

Stent placement is a simpler procedure compared to bypass surgery. For patients with multiple blocked arteries, bypass surgery may be more suitable. If diagnosed early, some patients can avoid bypass surgery with the placement of stents, achieving similar outcomes.

The patient’s medical condition, past surgeries, age, chronic illnesses, genetic factors, weight, and diet all play a critical role in determining whether the patient is suitable for bypass surgery or stent placement.

In most cases, stent placement does not prevent future bypass surgery. However, stents are permanent metal pieces that can increase the likelihood of clotting as the number of stents increases. In certain cases, too many stents can block areas needed for bypass surgery, limiting the patient’s chances of undergoing the procedure. Since stents are not removed during surgery, their placement in critical areas could eliminate the option for bypass surgery.

For diabetic patients, stent placement poses additional challenges due to thinner blood vessels. Thin stents may lead to earlier blockages, and repeated angiography procedures—necessary for stent monitoring—can harm the kidneys, especially in diabetic patients prone to kidney issues.

In conclusion, placing too many stents can sometimes eliminate the chance of bypass surgery, and diabetic patients are at a higher risk of acute or chronic kidney failure due to repeated angiography procedures. Therefore, patients considering multiple stents should seek a second opinion from a cardiovascular surgeon to preserve future surgical options.