Surgeons at St. Michaelâs Medical Center in Newark performed a coronary bypass operation last month. http://www.nytimes.com/2007/02/25/health/25bypass.html By BARNABY J. FEDER THE NEW YORK TIMES Published: February 25, 2007 After more than a decade-long decline, is heart bypass surgery poised for a comeback? Bypass surgery is the recommended treatment for such patients, according to the guidelines of the American Heart Association and the American College of Cardiology. But some doctors say too many patients never hear about those recommendations from their cardiologists. A joint committee of the heart association and cardiology society expects to release new guidelines within the next month that could clarify the proper boundary between stenting and surgery, according to Dr. Sydney C. Smith Jr., the head of the committee. One controversial factor in such assessments is the accumulating data suggesting that surgery may help the sickest heart patients live longer. Studies tracking long-term results among patients around the nation have prompted some surgeons to argue that thousands of people with blockages in multiple arteries may be dying months or even years prematurely because they receive stents instead of surgery. Dr. Robert A. Guyton, the chief of cardiothoracic surgery at the Emory University School of Medicine in Atlanta, argues that as many as 200,000 such patients who get stents each year should be having bypass surgery instead. He bases that conclusion on studies using data from nearly 40,000 patient cases in New England and New York and at Duke University. Stenting and bypass surgery are both meant to relieve symptoms like chest pain and shortness of breath, which are caused by a buildup of arterial plaque that may eventually lead to heart attacks and gradual heart failure. Neither stents nor bypass surgery can halt the buildup of plaque. But surgery, by bypassing an entire section of diseased artery with a vessel taken from elsewhere in the body, can restore more blood flow and the benefits may last longer. And while bypass surgery still typically involves the trauma of sawing through the breastbone to open the chest, the operation is getting gentler. Blood vessels for grafting can be harvested from arms and legs through much smaller incisions than in the past, for example. And about 20 percent of the operations no longer require stopping the heart and attaching patients to an external pump, thus eliminating a step believed to increase the risk of strokes in the sickest patients. Some bypasses now can even be performed using a robotic tool through small incisions between the ribs. Most of the debate over stents versus surgery focuses on complex patients like Edgardo Hilario, 59, a Kmart shelf stocker from Spotswood, N.J. After he was hospitalized last fall with severe chest pain, his doctors found that he had four severe blockages in three arteries. Mr. Hilario was operated on last month at St. Michaelâs Medical Center, a 337-bed teaching and referral hospital in Newark. The chief of cardiac surgery there is Dr. Mark W. Connolly, a nationally known heart surgeon who was named physician of the year in 2006 by the American Heart Association. Well-regarded among stent specialists, he was invited to speak last fall at their national meeting.