Bypass § Mitral Regurgitation

[Konopka1955]

Hi,  How are you? Good I hope. I had a cath done last week before my surgery for MR and my RAC showed 30% stenosis - but the left cath could not adequately see my right side.  The doctor shot alot of dye in over to the right but it wasn't a 'great' picture.So its inconclusive.Surgeon thinks its greater than 30% - previous caths have indicated my RAC to be 60% but he thought if its 50% blockage it should be bypassed at the time of my valve surgery.I've had this 60% RAC blockage for 10 years and it hasn't deteriorated my QOL in any way.I understand the arteries you are born with are the best arteries, replace it with a sapheneous vein would not be as good as what I have even if it is 60% blocked. (In my opinion)  Aren't caths eyeballed anyways so 60% could actually be a 40% clog.Isn't it a minimim of 70% clog before bypass. Is there a more 'defined' test for detecting blockage? He wants to go over the pictures again with his colleagues and see me in his office later. I asked to 'see' these pictures myself so that I might feel more comfortable that bypass is necessary. Why not take the mammary artery instead of the sapheneous vein?  Wouldn't that be a better replacement. Doesn't a saphenous vein last approximately 10 years? My mechanical valve will last about 20 -30 so I asked why bother to do a mechanical valve when the vein won't last that long?What will we do after the 10 years are up on my vein? The surgeon is one of the 'best' in the Northeast but I'm wondering if 'just' by going "in" he's doing to much? My RAC was never mentioned for bypass or stent previously.

Thank

[CCF-M.D.-RCJ]

Konopka1955,

Thanks for the post.

Q:"Aren't caths eyeballed anyways so 60% could actually be a 40% clog."

Yes, although you are seeing the cardiologist primarily for his opinion, so you might as well use it.  Otherwise, you are discounting some of his opinions, but no others.  How do you know which ones are right?

Q:"Isn't it a minimim of 70% clog before bypass."

No.  It's a judgement call.

Q:"Is there a more 'defined' test for detecting blockage?"

IVUS is promoted by some as detecting plaque, but is not yet established for deciding which arteries to bypass.

Q:"not take the mammary artery instead of the sapheneous vein?"

Because we generally reserve the IMA for truly critical lesions or critical vessels.  So if there is some question about how critical something is, we don't use it.

Q:"Doesn't a saphenous vein last approximately 10 years?"

The patency rate for SVGs is on the order of 50% at 5 years, based on old data.

Q:"so I asked why bother to do a mechanical valve when the vein won't last that long?What will we do after the 10 years are up on my vein?"

Because the SVG may not lose at 10 years, and if it does, a percutaneous approach might be effective to open it, if indeed it needs to be opened.

Best of luck.