There is one main reason why surgical revascularization is no longer a first-line therapy in the setting of an ST-segment myocardial infarction, and it comes down to the time it takes to restore flow to the occluded vessel. Even in the best case scenario, where the surgeon and operative team are in the hospital, and an operating room is readily available, it will likely take an hour or longer to interrupt the ischemia with a surgical procedure, and even longer to restore normal flow to the heart. Bypass surgery requires the induction of anesthesia, placement of monitoring lines, and patient positioning and prepping, in addition to the harvesting of conduits before the actual operation begins. All during this time, muscle is being lost. In addition, emergency cardiac surgery has a much higher risk of morbidity and mortality compared to non-urgent cardiac surgery, not only due to the critical nature of the patient, but due to the rapidity with which revascularization needs to occur and the lack of time to provide optimal patient preparation and perform the best operation possible. Unlike an emergency surgical procedure, percutaneous intervention can be readily performed as the patient is already in the appropriate location with the proper operator and care team. While it may sometimes be technically challenging, the delays inherent in a surgical approach are not present. Only if percutaneous interventions are impossible, or have failed, is emergency cardiac surgery necessary and the elevated risks justified.
Cardiac stenting versus bypass medical expert witness specialties include interventional cardiology and cardiovascular surgery.