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Jun 07, 2018

Advances in an Alternative Procedure to Open Heart Surgery

Recent medical statement highlights the evolution of percutaneous coronary intervention and for which heart patients it is most appropriate.

Advances in technology and research have greatly improved the use of percutaneous coronary intervention, a minimally-invasive procedure used to treat heart disease, based on a clinical update recently published in the Journal of the American Medical Association.

This update, written by Deepak Bhatt, MD, MPH, Executive Director of Interventional Cardiovascular Programs at Brigham and Women’s Hospital Heart and Vascular Center and Professor at Harvard Medical School, looked at how far we’ve come with minimally-invasive heart procedures in the past few decades.

Specifically, the update focused on percutaneous coronary intervention—a nonsurgical procedure that improves blood flow to the heart. It is used to treat patients with heart disease, which is the leading killer of men and women in the United States. The take-home message, according to Bhatt, is that this common procedure has improved in leaps and bounds since it was first introduced in the late 1970s.

Percutaneous coronary intervention, often referred to as PCI or coronary angioplasty, involves the use a small catheter tube, usually inserted through the wrist or groin, and injection of a dye to identify any arteries that are narrowed or significantly blocked by plaque. It then uses small balloons to widen any trouble spots and may use a small mesh tube called a stent to provide added support and help keep the arteries open.

PCI was first introduced in 1977 as an alternative to open heart surgery, but carried high risk of complications and didn’t always work.

However, Bhatt explains that we’ve come a long way since that initial procedure decades ago.

For starters, the procedure itself has improved over the years, making PCI more safe and effective. Stent technology has advanced, which has helped reduce risk of complications and has reduced the need for repeat procedures.

PCI has also become more safe, thanks to a better understanding of which patients are most appropriate for the procedure. For patients with blocked arteries who are not experiencing heart attack, PCI is recommended mainly in patients with symptoms like chest pain and shortness of breath. PCI is not typically recommended in patients who have no symptoms, since the risks may not outweigh the benefits. PCI is also only recommended after medication has failed to improve blood flow and relieve symptoms.

These guidelines are based on a number of studies conducted in the past few decades, which have helped identify which patients stand to benefit most from PCI.

In patients who are experiencing heart attack, however, guidelines are much different. It’s estimated that about 60% of patients having a heart attack will receive PCI, with the remainder undergoing open heart surgery or receiving medication alone. PCI is much less invasive and often less risky than a full-blown surgery, making it the ideal treatment for many heart attack patients.

However, the decision between PCI and open heart surgery in heart attack patients is not always clear, according to Bhatt. Open heart surgery may be more effective in patients with more severe blockages and can be safer in patients with pre-existing conditions like diabetes. Thus, these more complex treatment decisions should be made with a heart care team that includes both interventional cardiologists and cardiac surgeons.

With additional research, experts hope to continue to improve PCI and the treatment of heart disease.

Questions for You to Consider

  • What is percutaneous coronary intervention (PCI)?

  • Percutaneous coronary intervention (often referred to as balloon angioplasty or simply angioplasty) is often recommended for patients diagnosed with diseased arteries of the heart (coronary arteries) or for patients suffering a heart attack. Percutaneous coronary intervention includes a variety of procedures developed to compress fat and cholesterol build-up in the arteries, known as plaque deposits, to help increase the size of narrowed or blocked arteries and improve blood and oxygen flow to the heart.
  • What are the most common complications of PCI?
  • The most common complication from PCI is blood clotting, despite efforts to reduce this risk through the use of blood-thinning medications. Risk of heart attack is about 1–2% in patients undergoing PCI. Although most PCI procedures are successful, about 1–2% of procedures may fail and require emergency coronary artery bypass graft surgery.

Infographic: Coronary Artery Disease (CAD)


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