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Duke Study: Bypass Surgery Might Be Best Option After All

Posted October 12, 2006

— A treatment option many doctors and patients with heart disease commonly try to avoid might actually be the best one, according to a recent Duke University Medical Center study.

Open-heart bypass surgery has been around for about 40 years, but since then, new medications and procedures, to open blocked arteries, such as angioplasty with stents, have become popular because they are less invasive.

But the Duke study, in which data from 18,000 Duke patients since 1986 was reviewed, found that open-heart bypass might be more effective.

About 90 percent of patients now appear to have been treated with stents, according to cardio thoracic surgeon Dr. Peter Smith, who led the study.

With angioplasty, doctors use a balloon on the end of a catheter to push away plaque in the artery and restore blood flow. A wire mesh stent is often placed in the same spot to keep open the artery.

The study showed stented vessels tend to reclot.

Smith said open-heart bypass surgery, although a major surgery with a difficult recovery period, is more durable than stenting and leads to less rehospitalization and fewer heart attacks later on.

"The success rate is about 98 to 99 percent for getting patients through the procedure," he said.

Drug-eluding stents are designed to prevent the scarring that often occurs around the device, but, Smith said, they have only been in use three to four years and were not part of his 20-year study.

More time is needed, he said, to evaluate their real benefits for heart patients with severe heart disease.

Smith stressed that treatment for heart patients differs from individual to individual and that doctors and patients need to be more aware of the options available to them and think about the long-term benefits.


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