What if I’m not a candidate for heart bypass surgery? 

Published: Tuesday, February 20, 2024
Cardiology, Interventional Cardiology

Coronary artery bypass surgery, also called heart bypass or CABG, is a common way of treating severe blockages in the arteries that deliver blood to the heart. What are your options, though, when you aren’t eligible for a heart bypass? 

More than 18 million Americans have coronary artery disease, making it the most common type of heart disease. Coronary artery disease, or CAD, occurs when plaque builds up in the coronary arteries, which deliver blood to the heart. 

CAD is diagnosed and sometimes treated during what is known as cardiac catheterization. During this procedure, a thin tube called a catheter is inserted into a blood vessel in the wrist or groin and directed through the blood vessels to the heart where an angiogram is performed to assess flow. 

If a severe blockage is detected, it may be treated using percutaneous coronary intervention (PCI), which is also called angioplasty or stenting. During PCI, a very fine wire is placed across the blockage, and an uninflated balloon is tracked over the wire to where the coronary artery is blocked. The balloon is then inflated, which dilates the narrowed area of narrowing. Usually, a second balloon covered with a stent is then placed across the area of blockage and inflated, pressing the stent into the blood vessel wall. This stretches the blood vessel open. The balloon and wire are removed, leaving behind the stent. The stent scaffolds the blood vessel open to improve blood flow.  

When cardiac catheterization reveals multiple critical blockages, or if the pumping function of the heart is reduced, coronary artery bypass may be recommended. That procedure, however, isn’t most appropriate for every patient. 

Who might not be a candidate for a heart bypass?

While the CABG procedure is commonly used to treat blockages in the coronary arteries, it is not the best option for some people: 

  • Those who have significant disease in other body systems such as bad lung disease, liver disease, kidney disease or prior stroke(s). 
  • Those with poor surgical targets for bypass grafts or repeat operations. 
  • Older patients who may have an expected lifespan less than 10 years. 
  • Those with a severe physical disability. 
  • Those who have a terminal illness. 

Sometimes, bypass or stenting could be considered equal options to treat the patient. A discussion with the patient regarding the pros and cons of each procedure can guide a family-centered decision regarding the next step. Sometimes, the next step may be a trial of medication. 

How are blockages treated without a heart bypass?

If you are not considered a good candidate for heart bypass, there is another option for restoring blood flow in the coronary arteries—a procedure known as complex (or advanced) PCI. Like the PCI mentioned above, a complex PCI is a catheter-based procedure used to eliminate blockages in the coronary arteries and restore normal blood flow. 

Patients with the most severe blockages can get the advanced care they need through Georgia Heart Institute. Our team of interventional cardiology experts offers complex PCI for patients at high risk of surgical complications to improve quality of life.  Advanced techniques are used to lessen the overall risk of the procedure and improve outcomes. Intracoronary imaging is essential, and ventricular pump support devices such as Impella or balloon pump (IABP) may be used.   

A highly specialized technique of PCI to open completely occluded (blocked) vessels, known as CTO PCI, may also be used. When occlusions occur in the coronary arteries, smaller blood vessels called collateral blood vessels form alternative pathways from one main blood vessel back to the occluded artery to help with blood flow. During CTO PCI, guide wires can be moved from these collateral vessels backward to the occluded vessel as well as forward to the occlusion, essentially attacking the blocked artery from both directions. Once the wires are placed across the occlusion, a balloon is inflated to create an opening that restores blood flow. 

Next steps

Georgia Heart Institute offers innovative and advanced treatment options for high-risk patients through the Center for Complex Coronary Disease. Call 770-219-4044 or click here to learn more. 

Glen Henry, MD, an interventional cardiologist, is the Medical Director of Interventional Cardiology and the Cardiac Catheterization Labs at Georgia Heart Institute. Before relocating to Gainesville, Dr. Henry practiced at Yale Medicine for nearly 30 years.