Pitfalls Of Heart Surgery

It is understandable that heart disease is terrifying for patients. Especially when they are told they risk a heart attack or death. The truth is that if a patient of heart disease is stable, he / she has alternatives to going under the knife in a hurry.

There are a lot of studies to prove the strong impact of the “placebo effect” for many things, including for heart procedures. So, in effect, a lot of the initial relief the patient feels comes from the mind. They feel – “I have taken care of the problem”. In fact this is followed with a laxity in doing what is needed to prevent the issue from returning. After all, a stent is not a magic device, nor is bypassing coronary arteries. They might take care of the imminent issue, but not the root cause. So, whatever is causing the problem creates the problem all over again.

Another thing is that many surgeons do their surgery, medicate, and then don’t emphasise the lifestyle part enough to patients. Patients need proper guidance for exercise, diet and stress-management recommendations, whether intervention is planned or not.

Let’s consider the findings of some clinical trials.

The recent ISCHEMIA (International Study of Comparative Health Effectiveness With Medical and Invasive Approaches) trial (published on March 30, 2020, and we quote, “failed to show that routine invasive therapy was associated with a reduction in major adverse ischemic events compared with optimal medical therapy among stable patients with moderate ischemia.”

The 2003 RITA-2 trial looked at the 7-year outcome in coronary angioplasty versus medical therapy. According to the trial, an initial strategy of PTCA (percutaneous transluminal coronary angioplasty) did not influence the risk of death or MI (myocardial infarction), but it improved angina and exercise tolerance. Patients considered suitable for PTCA or medical therapy can be safely managed with continued medical therapy, but percutaneous intervention is appropriate if symptoms are not controlled.

Then, in 2017, The Lancet published the ORBITA trial findings. The trial found, “In patients with medically treated angina and severe coronary stenosis, PCI did not increase exercise time by more than the effect of a placebo procedure. The efficacy of invasive procedures can be assessed with a placebo control, as is standard for pharmacotherapy.”

There are numerous similar trials. There is ample evidence to show that surgical intervention should not be done as a preventive measure. It in fact puts stable heart patients at risk of complications related to the procedures. If there are additional health conditions, it tends to complicate things further. Surgery should only be used in emergency situations.

Patients are not generally educated about all this by doctors. It’s really important to go to a doctor one trusts completely, and always ask about ALL your options. In fact, a second opinion is absolutely a must before going under the knife for anything, and certainly so for the heart. Some doctors tend to be “interventionists” – they either believe in surgical intervention, or they do it because it’s what they do! Take another opinion—even if it’s a third opinion—from a Preventive Cardiologist. Again, go to a reputed one who has experience and is result oriented.

Most cardiologists don’t even mention alternative therapies like EECP (Enhanced External Counter Pulsation) to their patients. This is despite all the positive evidence out there. However EECP may not be beneficial for everyone. Right patient selection is critical for patient success. Unfortunately many overzealous eecp centres have cropped recently who tend to give eecp to anyone who visits them to avoid bypass or angioplasty which gives bad name to the eecp therapy amongst the cardiologists. Hence when patients visits for second opinion should be careful about selecting the right preventive cardiologist after doing thorough research of the professional training and compentency along with testimonials.

Dr Pratiksha Gandhi MD,world renowned preventive cardiologist and founder of Institute of Preventive Cardiology (IPC) Heart Centre, has treated more than a 100,000 cases in and around Mumbai, with conservative non-surgical therapies, with over 95% success rate.

Reach out to IPC to book an appointment on www.ipcheartcentre.com to get honest medical opinion if you are advised angiography,angioplasty or bypass surgery or for more information call or whats app +91-9930099975

Sources:

https://www.acc.org/latest-in-cardiology/clinical-trials/2019/11/15/17/27/ischemia

https://pubmed.ncbi.nlm.nih.gov/14522473/

https://www.thelancet.com/journals/lancet/article/PIIS0140-6736(17)32714-9/fulltext