Open heart surgery or not

[Angela23]

A white 78 year old working woman goes for a regular checkup (she works at a retail store).  She is healthy with no signs of shortness of breath, weakness, chest pain, etc.  No past history of heart attacks or chest pain.  At the checkup she finds that 2 of her heart arteries are 90 percent block.  One physician tells her that she needs an open heart surgery and another physician tells her that they can open the arteries without the open heart surgery.  What is the patient to do?  Who is a good candidate for the open heart surgery and who are good for more of the non invasive procedure to fix the problem?

  

[ed34]

A tricky question with so little information. It would be valuable to know where the blockages are and in which vessels. For example, if they are in the RCA with developed collaterals, then I think I would forget any intervention. If they are in the left side of the heart, either the LAD or Circumflex, then I would certainly want them treated. The Lady in question is obviously quite fit given her age and you would want this trend to continue. There is always a risk the lesions could burst, causing devastating consequences which is why more information would be useful. Does anyone know the composition of the lesions for example. IF I had to choose between either bypass or Stenting then the obvious choice would be Stenting mainly due to age against major surgery. I know the Lady is healthy but the trauma from major surgery is bad enough for a 40 year old to deal with. I had two stents last monday morning and was walking around like nothing had happened the following morning. It took me a year to get over the bypass surgery and it had already failed three months post op. So, if I HAD to choose one or the other, I would go for angioplasty, but with more information, I might choose to have nothing done at all.

[jamesharris285]

I would truly recommend  minimally invasive cardiac surgery , patients can avoid the discomfort and fear surrounding open heart surgery and enjoy a faster recover and shorter hospital stay.
Patients with non-heart-disease-related cardiac conditions, like mitral valve defects or heart murmurs, can also benefit from top treatments – such as pacemaker insertion or  Miami Cardiology .

[kenkeith]

The American Hospital Association and the American Academy of cardiology guidelines are to not stent any coronary lesion less than 70% (no angina).  If the occlusion is greater than 70% and there is angina, treat with medication.  If medication does not relieve angina, then a stent.  If the area of the lesion can not be stented due to location, size, or there is an emergency ie heart attack, then open heart surgery.

"Healthy" and no symptoms does not warrant a cath, stent or open heart surgery.  But I am somewhat puzzled as to what is the diagnosis!  Is the medical diagnosis a condition other than coronary artery blockage?

Surgery may be indicated if there is an aorta aneurysm, valve disorder, hole in the heart, etc. Under these circumstances, there may be disagreement on treatment, and a surgeon may be the best source for an opinion as these conditions have a high likelihood of eventually requiring surgery and a surgeon would know the best time for the most favorable outcome.

[Encephalomalcia]

Stents are best at age 78.  Open heart surgery can be risking and 1 in 5 die from it according to heart surgeons I have talked with.  Most likely plavix will be needed for 6 months to a year or possibly life after coated stents placed.  The heart surgeons I spoke with said that in 12 years there will be no open heart surgery.  All heart procedures will be done through cath.  I am wondering why the doctor would even suggest open heart surgery for only two arteries unless there is something else going on.