Just 40 years ago, coronary bypass surgery was in its infancy. Now, barring emergencies, cardiologists and cardiovascular surgeons evaluate a patient’s age, health and heart history, and other disease conditions to decide if cardiovascular surgery, or stents are the best procedure to restore blood flow and strength to the area at risk.

Alonso Collar, M.D., Ingham Cardiothoracic and Vascular Surgeons confirms that the coronary physician initiates team dialogue, so the patient achieves the best treatment for the best clinical outcomes.

"Drug-eluting stents have decreased the incidence of recurrence, and they can be used to treat multiple vessel coronary artery disease. We balance that with research we know about what vessels should or should not be stented, and whether a patient’s age and health are amenable to stenting or surgery. An example might be a young diabetic patient whose outcome might be better with surgery.

"We know the left main coronary artery is a vessel susceptive at high risk for stenting, and therefore, might not provide the better outcome for this patient. Patients that have multi-vessel disease with branch lesions, where the artery splits into different directions generally have better outcomes with surgery.

"A patient requiring multiple stents, particularly when this is their second or third stent in the same area, often do better with surgery. A diabetic male who has single vessel disease, but a high-grade stenosis close to the origin of the artery, lends himself to off-pump bypass surgery. When an artery is inflamed, or shows unstable plaque with a clot, surgery is often inevitable. Coronary arteries with 100% blockage usually cannot be effectively opened with stents, and require coronary bypass surgery.

"We do heart valve surgery, because it preserves better heart function. This applies to heart valves with congenital disorders, leaking valves that don’t close completely, inflamed valves, and valves narrowed by clots or plaque, that prevent proper opening or closing for blood flow.

"Simultaneously with valve surgery, we can correct irregular heartbeats of the heart’s upper chambers, the atria. An electric current or radio-frequency energy destroys the extra pathways causing the atria to quiver. As the population ages, we are doing more valve repair and surgically re-establishing the heart’s natural rhythm.’

"While most people think coronary arteries when heart disease is mentioned, atherosclerosis, or hardening of the arteries, affects all arteries of the body. aortic valve can lead to stroke. Cholesterol build-up or clotting in the vascular system can mean a stroke, abdominal aneurysm, kidney disease or loss of a limb. No blood vessel is exempt from clot formation or cholesterol build-up. Larger areas are treated with an endovascular stent. Smaller arteries require stenting, atherectomy, angioplasty, laser, or re-routing of the blood supply to the legs and feet.

"We’re always learning nuances of the cardiovascular disease process and new techniques that report significant clinically-improved outcomes. But the patient need not wait until a problem arises to understand that maintaining a healthy heart and vascular system is for life. If you are a population at risk genetically, you must work harder to control known risk factors* for heart disease:

• Overall cholesterol at less than 200 mg/dl;
• HDL (good) cholesterol at 50 mg/dl or lower for women and 40 mg/dl or lower for men;
• LDL (bad) cholesterol at 100-120 mg/dl;
• Blood pressure at or less than 120/80;
• Triglycerides lower than 150 mg/dl;
• Stop smoking or don’t start;
• Maintain a body weight consistent with age and body frame. Ideally a Body Mass Index of less than 25 Kg/m²;
• Fasting glucose of less than 100 mg/dl;
• Regular aerobic exercise at least five times per week;
• Eating fruits, vegetables, whole grains and low-fat meats;
• Resist temptation to eat salty snack foods, sweets, and sugar sodas of any type;
• If your doctor puts you on medical therapy to control cholesterol, take as prescribed, and ask if an aspirin a day would be beneficial.

"Good cardiovascular health is a partnership between your primary care physician and you, the patient. They can suggest lifestyle modifications; you must make the commitment."