Open heart surgery, which many patients and doctors have avoided in the last decade in favor of less-invasive heart stents, is making a comeback.
Recent studies suggest that bypass surgery could extend many patients' lives longer than stents, the tiny devices designed to reinforce damaged arteries.
The newest generation of stents, which are coated with drugs meant to inhibit blood clots, might actually increase the risk of clots compared with older, bare-metal versions, other studies suggest.
Last month, a study found that for patients with clogged arteries who have not had heart attacks, the widely used surgical treatment of balloon angioplasty with the insertion of a stent was no better than conventional drug treatment.
"The basic concern is that stents may not be the best medical intervention for a significant number of patients getting them today," said Dr. Peter K. Smith, chief of cardiothoracic surgery at Duke University Medical Center in North Carolina. Smith reports that he has been performing more bypass surgeries in recent months.
Although no official statistics are available to document a rebound, doctors at several medical centers, including Cedars-Sinai in Los Angeles and Emory University in Atlanta, report bumps in heart surgeries.
For surgeons, that increase is helping them get their mojo back. Once the undisputed kings of the medical field -- to many, they were the profession's version of quarterbacks, receiving heaps of cash and glory -- heart surgeons' fortunes have fallen of late.
By some estimates, their average annual salary has dropped from nearly $1 million a decade ago, in today's dollars, to half that now. According to an article in the Annals of Thoracic Surgery last year, 12% of the cardiothoracic residents surveyed received no job offer in 2004.
"The rules of the game changed dramatically a few years ago," said Dr. Richard Shemin, the newly installed chief of cardiothoracic surgery at UCLA Medical Center, pointing out that cardiologists have been performing more heart procedures, and surgeons fewer. "Things may be changing again."
On the advice of her doctor, Gail Miller, a 60-year-old art instructor in Sacramento who had been diagnosed with advanced heart disease, chose to have bypass surgery two days after Christmas last year.
"At first, I was terrified, and my family was even more scared," said Miller, who was close to full recuperation. "But after I read about all the issues with stents lately, I am kind of happy I got a bypass."
