Coronary atherosclerotic heart disease is a heart disease caused by atherosclerotic lesions in the coronary arteries, resulting in narrowing or blockage of the lumen, causing ischemia, hypoxia or necrosis of the myocardium, often referred to as “coronary heart disease”. There are three main ways to treat coronary heart disease: medication, surgery and stent intervention, each with its own strengths and weaknesses. Medication does not change the condition of the narrowed blood vessels, but it is still the basis of coronary heart disease treatment and an important tool. In the past, heart bypass surgery was considered when a narrowing of the heart vessel occurred. And with the development of medical technology, stent intervention can be considered when there is stenosis (70% or more) or occlusion in the coronary vessels. However, when coronary lesions reach a certain severity, coronary artery bypass grafting becomes the only treatment. Stenting Cardiac stenting is a new technique that has been developed in the last 20 years to improve the blockage of heart arteries due to insufficient blood supply to the heart muscle caused by coronary heart disease. Simply put, the procedure of cardiac stent surgery treatment involves puncturing a blood vessel, allowing the catheter to travel forward in the vessel, reaching the opening of the coronary artery, delivering the stent to the site where it needs to be placed using a special delivery system, placing and withdrawing the catheter, and ending the procedure. The patient undergoes the procedure under local anesthesia and is usually out of bed 24 hours after the puncture, and the procedure is not complicated. The patient is usually discharged from the hospital three days after the procedure. Most patients with asymptomatic myocardial ischemia or mild angina, patients at high risk of significant ischemia as confirmed by platelet exercise testing or 24-hour ambulatory electrocardiography (Holter) monitoring, may be considered for coronary stenting in order to maintain their physical activity and participation in physical exercise, to improve their quality of work and life, and to reduce the risk of serious or fatal cardiac events if they have severe lesions on coronary angiography. This group of patients has a high success rate and a low rate of disability or death. Many patients with moderate to severe stable angina or unstable angina who do not respond to medications are usually candidates for coronary stenting. Most patients in this group have single or multiple coronary lesions, and coronary stenting has a high success rate, low risk, and significant postoperative angina relief. Acute myocardial infarction is caused by a severe reduction and sudden cessation of myocardial blood flow, most commonly due to atherosclerosis – thrombotic occlusion – of the major coronary arteries. Stenting is a very effective means of reestablishing coronary perfusion and is appropriate in more than 90% of patients with acute myocardial infarction. Intracoronary stenting can further extend the results of coronary interventions. This approach yields immediate results in acute myocardial infarction treatment, allowing more myocardial protection, less time for myocardial ischemia, and more benefit to the patient. Patients with respiratory disease may be at risk for general anesthesia and are not candidates for conventional extracorporeal bypass in favor of stenting. Stenting procedure Cardiac stenosis site and X-ray image Balloon access to the stenosis site and balloon dilation Stent access and release process Contrast imaging to confirm the effect of coronary treatment Bypass surgery As the name suggests, bypass surgery is performed by taking the patient’s own blood vessels (e.g., internal thoracic artery, saphenous vein in the lower extremities, etc.) or vascular substitutes to connect the distal end of the stenotic coronary artery to the aorta, allowing blood to spare the stenotic part and reach the ischemic area, improving the blood flow. The purpose of this procedure is to improve the blood supply to the myocardium, thereby relieving angina symptoms, improving heart function, improving the quality of life and prolonging the patient’s life. This procedure, called coronary artery bypass grafting, creates an open pathway between the aortic root, which is filled with arterial blood, and the ischemic heart muscle. According to national and international guidelines, surgery is the first choice for left main stem lesions. This is because a blockage or restenosis of the left main can be fatal if it occurs. To minimize the risk, bypass is the best option. If the lesion is more vascular, the interventional option would require the placement of many stents, which would increase the chances of restenosis and thrombosis significantly. Moreover, the financial burden on the patient is higher. Complications after myocardial infarction in coronary artery disease, such as ventricular rupture, septal perforation, and mitral valve insufficiency, must be treated with surgical bypass surgery. Patients with diabetes mellitus have a higher rate of restenosis if they undergo normal stenting, while drug stents have been available for a short time, and there is no clear evidence that interventional therapy has better efficacy than bypass. The procedure of stenting is done by general anesthesia, sawing through the sternum, extracting part of the internal mammary artery, or taking the saphenous vein as a bridging vessel. 2. Establishing extracorporeal circulation and infusing myocardial protective fluid. At the same time, the incidence of in-stent restenosis, which is a concern, has been significantly reduced by the use of drug stents, from 17%-30% for bare metal stents to less than 10% for drug stents. The outstanding advantage of surgical bypass surgery is that it can completely treat 100% of occluded coronary lesions, requiring less revascularization. However, coronary artery bypass surgery involves opening the chest under general anesthesia and extracorporeal circulation, exposing the heart and aorta, resulting in greater surgical trauma, longer hospital stays, and slower return to normal activities. Thirty percent of patients who undergo stenting require reoperation within 18 months, while only 5 percent of patients who undergo bypass surgery require reoperation. The long-term survival rate for stenting was 98.2% compared to 98.9% for bypass surgery Patients with three arterial obstructions treated with stenting had 1. 56 times more deaths within three years than those treated with bypass surgery. The number of deaths for two obstructions was 1.33 times higher than for those treated with bypass surgery. Therefore, the patient can only be treated in the most favorable way if the correct surgical procedure is chosen according to the patient’s specific situation. The correct surgical approach is determined by the physician based on a comprehensive assessment of the patient’s coronary lesions, medical history, physical signs, and functional status of the organs. The characteristics of the coronary lesion are a prerequisite for bypass or stenting, while the functional status of the patient’s organs (liver and kidney function, respiratory function, cardiac function, etc.) is also necessary for the choice of surgery. Of course not all people with congenital heart disease need surgical treatment. The incidence of congenital heart disease is high, but there is a wide variation in severity. The most severe congenital heart disease, which cannot establish good blood circulation because of its poor development and the structure of the heart is not suitable for survival in a normal environment, so it dies soon after birth and should be operated on immediately with the possibility of being saved, which is not possible in our current situation in the vast rural areas. There are also children who have congenital heart disease but are very mild, have little effect on the circulation, or just have harmless murmurs, and generally do not need surgical treatment. It would thus appear that congenital heart disease is only those in the middle of the spectrum who have a better chance of getting surgery to save their lives and benefit from it a little more. Determining the timing of surgery for congenital heart disease should be a comprehensive consideration Regarding the best time for surgery, different patients with the same disease, the same disease in different generations, the same patient at different times, the same patient at the same time in different hospitals will have different answers. Therefore, the decision must be made in the context of the specific disease, the patient’s specific situation, the hospital’s equipment and technical strength. But there are two main cases: Early surgery: Generally speaking, surgery can be performed within 0.5-1 years of age, or just after birth. But after all, there are many complications and even life-threatening, and the younger the age, the greater the risk. However, some congenital heart diseases must be operated early, otherwise good surgical opportunities are lost, such as transposition of the great arteries, main pulmonary window, severe pulmonary valve stenosis, etc. Due to the difficulty of maintaining blood circulation or a large number of left-to-right shunts, repeated pulmonary infections in infancy with heart failure is not easily controlled, and resistance pulmonary hypertension is prone to occur, so the surgery should be completed early, or palliative surgery should be done first, and then after a period of time Radical surgery. Surgery at the age of 2-6 years: It is suitable for congenital heart diseases that have less impact on the growth and development of the body and heart, such as atrial septal defect, small ventricular septal defect and patent ductus arteriosus. Considering that some ventricular septal defects can close naturally with age, there is a tendency to operate earlier with the development of technology. For patients with preexisting heart disease, the current success rate of surgery is over 95%, and if the child is in good condition and the hospital and operator are experienced, the operative mortality rate has been close to zero. Other complex malformations, such as endocardial cushion defect, pulmonary vein malformation drainage, right ventricular double outlet, single ventricle, etc., can also be operated on with relatively good results. Don’t get a cold before congenital heart disease surgery for children who have been diagnosed with congenital heart disease and need to wait for surgery due to age or other factors, the following aspects should be noted during the waiting period for surgery: Try to keep the child quiet and not too much activity to reduce the burden on the heart. Meals should be reasonably arranged. The child should eat less and more meals, food should be diversified and easy to digest, sufficient protein and vitamin intake needs to be ensured, and bowel movements should be kept smooth. Pay attention to the cleanliness of the surrounding environment, keep indoor air circulation, and avoid staying in crowded public places as much as possible to reduce the chances of catching a cold or respiratory tract infection. Use antibiotics if you have an infection or have minor surgery or tooth extraction. In any case, if you have a fever that does not go away for several days, you should consult a physician early to prevent complications such as endocarditis. Follow up regularly at a hospital cardiology clinic to adjust the recuperation treatment plan according to different stages and choose the right time for surgery.