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Times Of India
19 July 2012

Most Opt For Surgery As It Is The Cheaper Option In India

Shiv Sena leader Uddhav Thackeray’s heart condition has once again sparked off the angioplasty–versus–bypass surgery debate within the medical community. While cardiac surgeons insist that cutting open the chest is the best way to fix such an extensive heart disease, cardiologists insist that their minimally invasive angioplasty technique has evolved to such an extent that even the most critical patient is safe in the cath lab.

A triple–vessel disease involves multiple blockages in three arteries of the heart. "The best way or the gold standard treatment is cardiac bypass surgery," said Dr Pavan Kumar, who heads the cardiac surgery department in Nanavati Hospital at Juhu. Surgery is, after all, an older and tested procedure in comparison to angioplasty. A senior heart surgeon who didn’t want to be named pointed out that Indian arteries are among the smallest in the world. "Indian surgeons are now perhaps the best trained to carry out the most complex heart surgeries," he said.

In fact, until a few years ago, the American College of Cardiology guidelines held that the triple–vessel disease is best tackled with surgery.

But cardiologists insist that the surgery–versus–angioplasty debate for triple–vessel disease is far from settled. "Ìn an age of drug–eluting stents, the triple vessel disease, too, can be easily fixed using an angioplasty," said Dr A B Mehta, director of cardiology department in Jaslok Hospital, Pedder Road.

His confidence stems from the evidence gathered over the past fi ve years or so with SYNTAX trial, a multi–country study which compared treatment with surgery versus angioplasty for patients with complicated heart diseases such as three–vessel. Said Cardiolgost Sudhir Vaishnav from the new Hinduja Hospital in Khar, "Syntax trial assigns a score based on where the blockage is, its value, etc." If the patient scores over 33 than bypass is the option. "But for patients with lower scores, the trial found that angioplasty was good," said Dr Mehta.

Doctors said the patient’s preference plays a role too. "If a patient is young, it is best to delay surgery. The patient can fi rst utilize the angioplasty option," said Dr Vaishnav.

In India, of course, the decision between angioplasty and surgery is decided on fi nancial grounds. Drug–eluting stents are expensive. In patients with triple–vessel disease, many stents are needed to open up the arteries. "As the cost would be huge running into lakhs just for the stents, patients prefer a surgery," said a surgeon.

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