Health Matters: Stents vs. bypassDr. Wynne answers questions about heart surgery and complications during flights.
By: Dr. Joshua Wynne, Grand Forks Herald
Q. My doctor found that I have blockages in three of the arteries in my heart. She feels that further treatment is needed and has recommended bypass surgery. I would rather have multiple stents inserted and avoid surgery. What should I do?
A. Bypass surgery (called CABG for coronary artery bypass surgery and pronounced like the vegetable) has been around for about half a century, and angioplasty, with or without a stent, for somewhat less, as I discussed in a recent column(see Health Matters April 22, 2013). Both are excellent treatments for patients with multiple blockages such as you, and both generally are quite effective. As a general rule, CABG has a small survival benefit that has been demonstrated over at least a decade following surgery.
One way of looking at the difference is to compare the average survival after each procedure. A recent study found that at five years after the procedure, the typical CABG patient lived about three weeks longer than the patient undergoing angioplasty. Not a huge difference, to be sure. But sicker and higher risk patients actually did substantially better with CABG than with angioplasty. Patients with heart failure, smoking, diabetes and blockages in other than their coronary arteries did better with CABG,while patients without any of these risk factors did slightly better with angioplasty. So, the bottom line for you is that if you smoke, have diabetes, heart failure or other blockages, surgery likely would be the better option. Otherwise, angioplasty might well be the way to go for you.
Q. I am going to visit my daughter in California this summer, but I’m worried about the long airplane flight since I have some medical problems. What’s the risk of developing an in flight emergency? Should I skip the visit altogether?
A. I typically fly on a commercial airliner about a half-dozen or more times per year, and I have been a doctor for four decades. In all of those years and hundreds of flights,I have been asked to assist an on board patient in distress exactly once. So based on my experience, you have a low risk of developing a problem while on the flight. A recent study confirms my experience. The study found that an onboard medical emergency occurred once every 604 flights. Only about a quarter of the patients required subsequent transport to a hospital, and less than 1 in 10 required hospital admission. Well less than 1 in 100 experiencing an in-flight emergency subsequently died.
The most common in-flight emergencies were fainting, breathing problems, nausea or vomiting and cardiac symptoms. And in about three-quarters of the cases, there was a health care provider— usually a doctor or nurse —who was able to provide immediate on board emergency care. All U.S. airlines carry at least a basic emergency medical kit, and some carry an enhanced kit. So for the typical airline traveler, the risk of an in-flight medical emergency is small; the chance of getting immediate medical care, if needed, by a knowledgeable and trained fellow passenger is high; and a really bad outcome is decidedly unlikely. So go enjoy California!
Wynne is vice president for health affairs at UND, dean of the School of Medicine and Health Sciences, and a professor of medicine. He is a cardiologist by training.
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