Is the era of heart surgery over?

Dr.. Osama Abu Lord

Is the era of heart surgery over?

This question arises these days, after a US study found that many heart patients - who suffer from severe but stable conditions and are subject to frequent medical intervention to open the blocked and narrow arteries - will reach the same result by taking drugs and changing their lifestyle.

In fact, this question has always been on the table, and although there are those who ask it purely from a scientific point of view, there are others who ask it to question the heart surgeries. According to them, cardiologists undergo unnecessary surgeries for their patients, in order to increase their profits, in an alleged conspiracy theory.

Also, there are many who warn people of heart surgery, and say that it is harmful, and that the patient should not undergo a heart operation, and that medicines are sufficient to treat it.

There is no doubt that this offering may be accepted by many, as undergoing any surgery, however simple it carries risks and raises the concerns of patients, how if the operation in the heart!

To answer, "Is the age of heart surgery over?" Let us first identify the most prominent types of heart surgery, and then discuss the data of the recent study.

Commenting on the results of the study said. Abdul Rahman Orabi, head of the cardiac catheterization department and vice president of cardiology at the Heart Hospital Hamad Medical Corporation in Qatar, said that coronary arterial disease (sometimes called coronary artery disease) is a different set of diseases caused by the presence of stenosis in one or more heart arteries.

And explain d. Orabi, in special statements to Al Jazeera Net - that coronary arterial disease can appear in one of two main forms:

- The first is called acute coronary syndrome or the so-called "heart attack / heart attack" and is usually caused by the formation of thrombus within the coronary arteries leading to obstruction or narrowing in one of the arteries of the heart. This form can manifest with chest pain of varying intensity, but is usually severe and sometimes associated with nausea and sweating. It can also demonstrate sudden cardiac arrest, an emergency condition that requires urgent intervention to reopen the artery, as many previous studies have shown.

Second , chronic and stable ischemic ischemia, which, as the name implies, is a chronic disease caused by the slow accumulation of cholesterol over many years in the lining of the arteries, which, when the stenosis reaches a certain degree, lead to chest pain when exerting effort, and the pain usually goes away At rest, the pain usually does not occur during sleep or during rest, and rarely leads to sudden death. This is the type of study.

Dr. The study is undoubtedly qualitative and important, and is a confirmation of another large study published more than ten years ago. Both studies have shown that in patients with chronic and stable coronary ischemia, the introduction of drug therapy as a primary treatment line is a safe option, and that catheter dilatation or surgery may be retained for cases that do not respond adequately to drug therapy alone.

The head of the cardiac catheterization department added that it should be emphasized here that this study does not deal with patients with acute coronary syndrome (heart attack), which collects recommendations on the need for cardiac catheterization and enlargement when necessary, otherwise resulting in damage to the heart muscle later lead to insufficiency Heart muscle.

Heart operations
It is a medical procedure to help control symptoms or reduce the chance of a sudden heart disease in the future, and aims to improve the quality of life and even save it in some cases, by:

• Restore blood flow to the heart by opening or replacing clogged coronary arteries.
• Repair or replace a damaged heart valve.
• Correct or regulate abnormal heart rhythm.

The heart operation may be performed in a pre-planned, or emergency manner.

Cardiac surgery includes many surgeries, including:

Open heart surgery
Surgery in which the chest is opened and surgery is performed on the heart. The term "open" refers to the chest, not the heart itself, as the heart may or may not open, depending on the type of surgery selected.

Coronary angioplasty and stenting
This procedure is used to open narrow or clogged arteries that feed the heart muscle, and also to remove the symptoms of angina.

The narrowed artery is opened using an angioplasty balloon, and a metal stent is implanted with the coronary artery, keeping it open and allowing blood to flow freely.

3 - Heart bypass
Also known as coronary artery bypass grafting (CABG), it is used to treat narrowed or blocked arteries that supply the heart muscle. It is done to treat patients with coronary artery and angina.

A blood vessel is taken from another part of the person's body, and it connects to the coronary artery above and below the area where it is narrowed or blocked.

Valve surgery
It is surgery to treat a damaged heart valve, and is done via stretching, repair or replacement of the valve.

TAVI (Transcatheter Aortic Valve Implantation)
For some valves repair or replacement options may not be suitable, so a catheter is implanted, by inserting a catheter (a hollow tube) with a balloon at the tip of an artery in the thigh, for example, then inserting the catheter into the heart inside the aortic valve opening, and the balloon is gently inflated to make room for the new tissue valve Which has been put into place, so that the new valve becomes inside the damaged valve.

Interventions for the treatment of arrhythmias, an abnormal heart rhythm. Of these surgery interventions, implantation of pacemakers .

7- Heart transplantation
The patient's heart is replaced by a correct one, a treatment usually reserved for people who have tried drugs or other surgeries but whose condition has not improved sufficiently.

Heart transplantation is not suitable for everyone and carries risks during the pre- and post-operative stages as well as during healing.

Back to study
The new American study found that stents are no better than drugs for many heart patients, and the researchers said that many of them who suffer from severe but stable conditions and frequently undergo medical intervention to open the blocked and narrow arteries will reach the same result by taking drugs and changing their lifestyle.

Their proposals, if adopted in medical practice, could save hundreds of millions of dollars a year on health care for heart patients, the researchers said.

The government-sponsored study, costing about $ 100 million, was presented at a meeting of the American Heart Association in Philadelphia in the largest study of its kind to examine whether there is an added benefit of measures to restore normal blood flow in stable heart patients for more conservative treatment such as taking aspirin and prescription drugs. Reduces blood cholesterol and other procedures.

At least two previous studies have concluded that arterial dilatation, stenting, opening of an alternative bloodstream and medical treatment do not significantly reduce the risk of heart attack or death compared to treatment that does not involve surgical intervention.

It says dr. Judith Hutchman, a cardiologist at the Langon Center at New York University, who led the study, said that about 500,000 people are diagnosed each year with a stable condition of coronary artery disease, which causes narrow artery pain in the chest, especially after exercise or emotional stress.

"There is always a fear that if you don't do something quickly they will get a heart attack and die." But the seven-year study, involving 5,179 patients, did not show much benefit for rapid surgical interventions. But interventional therapies have already led to an improvement in symptoms and the quality of daily life for those with recurrent chest pain.

During the study, everyone received lifestyle medications and counseling, and about half of the participants added intervention. At the beginning of the study period, the group receiving interventionist treatment had more heart problems than medications alone, but that changed in the fourth year. In the end, there were no significant differences between the two groups.

But it is too early to say goodbye to surgery
In fact, the study does not mean that surgery is no longer necessary. There are cases where resorting to surgery is inevitable and life-saving. But the study suggests that there are some cases that may not require surgery, namely people with stable condition of coronary artery disease.

The other thing is that failure to perform surgery if necessary may lead to severe complications up to death, the drug is not enough treatment in many cases, and also change the lifestyle, because damage to the heart has already occurred.

Even the head of the study says the findings do not apply to all heart patients. "If someone has a heart attack, the stents are life-saving," she said.

Add to that the advantages of surgery - according to many cardiovascular doctors - that patients who get stent arteries feel immediate improvement.

On the other hand, the study - the largest of its kind - may be the beginning of a review of the recommendations of cardiac surgery, which certainly requires other studies, because the medical recommendations are not based on a single study, but need a lot of data to support the amendment of surgical recommendations.

The last recommendation for patients need to follow up with the doctor, discuss any queries with him, and also can get more of a medical opinion from more than one specialist. In the end, the patient has the right to understand the treatment options available to him and the pros and cons before making a decision.