Dudi Amsalem, Israel’s regional cooperation minister, justice ministry minister, and liaison minister between the government and the Knesset, was reported this week to have suffered a cardiac event and undergone a successful catheterization, then been discharged home quickly. The case revived a basic question in modern cardiology, when is catheterization enough, and when is open-heart bypass surgery needed?
Dr. Asnat Raziel, a surgery specialist and head of the multidisciplinary obesity treatment center at Asya Medical, Assuta Ramat Hahayal, explains that cardiovascular disease remains the leading cause of death in the Western world. A heart attack occurs when one of the coronary arteries is suddenly blocked, usually by a ruptured atherosclerotic plaque and a blood clot, cutting oxygen supply to the heart muscle. The longer the blockage lasts, the greater the damage, which is why cardiologists say, “time is heart muscle.”
Catheterization is done by inserting a thin tube through an artery in the arm or groin and guiding it to the heart arteries. With contrast dye and X-ray imaging, doctors locate the blockage, then open it with a tiny balloon and often implant a stent to keep the vessel open. It is fast, minimally invasive, usually done under local anesthesia, and many patients go home within one or two days.
Bypass surgery is more complex. Surgeons take a blood vessel from the chest wall, leg, or arm and create a new route around the blockage, restoring blood flow even in cases of multiple or complex obstructions. It is generally preferred for a single blockage or a few blockages, but bypass may be better for widespread coronary disease, left main artery disease, or many blocked vessels.
In patients with diabetes and extensive multivessel disease, studies have shown bypass can improve survival and reduce repeat cardiac events compared with catheterization alone. The choice is not about which treatment is “better” in general, but which is right for the patient, based on artery structure, heart function, age, other illnesses, and surgical risk. Raziel said prevention remains the best treatment, through healthy weight, exercise, a Mediterranean diet, no smoking, control of blood pressure, diabetes and cholesterol, good sleep, and stress management.
