Bypass Surgery (CABG) in India: When to Get a Second Opinion

Bypass or Not — A Decision Worth a Second Look

Over 1 lakh CABG surgeries are performed in India every year. The decision between CABG, angioplasty with stenting (PCI), and optimal medical therapy (OMT) depends on the number of vessels blocked, ejection fraction, age, diabetes, and co-morbidities.

International guidelines (ACC/AHA, ESC) require a "Heart Team" approach for borderline cases. A second opinion provides exactly that team-based reassurance.

When CABG Is Clearly Indicated

• Left main coronary disease (>50% blockage)
• Three-vessel disease with reduced LV function
• Diabetes + multi-vessel disease
• Failed previous PCI / multiple complex lesions

When CABG May Be Avoided

• Single-vessel disease — PCI with drug-eluting stent is usually preferred
• Stable angina with normal LV function — Medical therapy + lifestyle changes may suffice
• Mild-moderate symptoms — Stress testing first, not straight to bypass

Reports to Bring

1. Coronary angiogram CD-ROM with images

2. Echocardiogram with ejection fraction

3. ECG, Stress test / TMT if done

4. Blood reports — lipid profile, HbA1c, kidney function

5. List of current medications

Questions to Ask

• "How many vessels are actually blocked, and how severely?"
• "Is this Left Main disease?"
• "Can angioplasty (PCI) achieve the same outcome?"
• "What is your mortality rate for CABG in patients like me?"

Bypass surgery is sometimes truly life-saving. But it is irreversible. A second opinion in 48 hours gives you confidence in the right path.