I was practicing in Connecti-
cut in the late 1960s and felt
secure in referring patients for
this type of surgery to my col-
leagues at the Cleveland Clinic.
However, my Connecticut col-
leagues did not share my en-
thusiasm for the coronary
bypass surgery.
I was not a surgeon, merely a
consulting cardiologist. I con-
tacted other cardiologists, near
and far, for their opinions. The
results were quite revealing,
though not unexpected. Cardi-
ologists associated with those in-
stitutions reporting the best
results were most enthusiastic,
while those working where the
surgical results were poor were
understandably negative.
Since then, many excellent
coronary bypass surgeons have
been trained. In the United
States today most coronary by-
pass surgeons are truly expert
and able to report excellent ben-
efit for their patients. However,
it is still appropriate for the pa-
tient to query his doctor's expe-
rience and results before
agreeing to have coronary by-
pass surgery.
In the late 1970s in Switzer-
land, a new coronary interven-
tion was devised: coronary
angioplasty. This procedure uses
devices on the end of catheters
to open coronary artery nar-
rowings and blockages from in-
side the artery without opening
the chest. As had coronary by-
pass surgery 10 years before,
coronary angioplasty received
mixed reviews.
Early on in this country, a
group of cardiologists in Kansas
City, Mo., and another group in
San Francisco had the best re-
sults. Most others did not do as
well.
Coronary bypass surgery has
not changed much in the near-
ly 30 years since it was intro-
duced. There are only a limited
number of ways to suture blood
vessels and a limited number of
available veins and arteries to
bypass blocked coronary arter-
ies.
Recently this surgery has
been accomplished through
much smaller incisions in the
chest, and lasers have been used

to create new blood carrying
channels in the heart muscle it-
self. At present, these new in-
novations are appropriate for a
small minority of patients who
need coronary bypass surgery,
and only a few surgeons have
the expertise to do them.
Coronary angioplasty, on the
other hand, has changed great-
ly in the 15 years or so since its
inception. Initially, the only de-
vice used was an inflatable bal-
loon at the end of the catheter.
The deflated balloon would be
positioned in the blocked portion
of the artery and then inflated,
crushing and compressing the
material causing the blockage,
thereby decreasing the severity
of the blockage. The balloon then
was deflated and removed, leav-
ing a larger channel through
which the blood could flow.
Later, drills and cutting de-
vices were developed. These
actually removed the blockages
to improve blood flow. Research
using lasers to open blocked
arteries is under way. Cylindri-
cal struts, called "stents," deliv-
ered on the end of catheters and
left inside the artery to keep it
open, represent one of the more
recent innovations. Each of
these new devices carries dif-
ferent indications for use and de-
mands new skills for the
operator to learn.
As this is written, even more
devices and procedures are be-
ing developed. Some of the
equipment companies manu-
facturing these devices are re-
quiring the physicians who plan
to use them to take courses of in-
struction on proper use and ap-
plication of the equipment. In
doing so, they hope to avoid
those problems incurred in the
early days of coronary bypass
surgery and coronary angio-
plasty.
As a patient, it is your right
and responsibility to ask about
a doctor's experience as well as
complication and success rates
before agreeing to any proce-
dure, and it is your doctor's re-
sponsibility to tell you. El

I

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46,„.

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Orchard
Medical
Center

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13 Mile Road

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e Doctor Ordered!

COME AND VISIT OUR
EW SHOWROOM!

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Dr. Marshall Franklin is a San
Dr.
Diego-based cardiologist who
writes for Copley News Service.

173=I
if-

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