Heart By Pass surgery, what can I expect now?

[Opa John]

I have had three MI's, some heart muscle loss, and quadruple bypass in 1992. Feb-Mar 2004 went thru ECCP. Exercise regularly and maintain low fat diet. Meds are Lipitor 80mg, Toprol 25mg, Prilosec 40mg, niacin 1000mg, aspirin low dose, and vitimans. My most recent Echo Cardiogram revealed 45-50% ejection fraction after 10 minutes on treadmill, which confirmed last years Angiogram that 3 of the four grafts have failed. One remaining is the artery that was repositioned from chest wall. Three veins grafts taken from leg have not held up as well. I am 71 years old, have been told that surgery is no longer an option, keep exercising and watch my diet. I have had numerous episodes of moderate angina which I medicate with nitro patch. My heart is strong. I lost my dad to coronary thrombosis (age 35) and brother died instantly of same (age 56). My sister and three nieces all have elevated cholesterol. In 1990 my Cholesterol was 310 with HDL reading of only 7. Today it is 178, HDL 47, LDL 104. Is my anticipation now that medication is the only option left? Is there a medication to increase blood flow in the corollary artery system? I realize that I have already exceded the average life of by pass survival.

[Cleveland Clinic]

Opa,

Thanks for the post.

Is my anticipation now that medication is the only option left?

People have more then one bypass.  When you are looking at having a second or third procedure it should be done at a higher volume center.  Also, sometimes if you are having persistant symptoms there are some percutaneous options to restore blood flow to the heart. A lot depends on anatomy of your arteries so you should seek opinion with a higher volume center.

Is there a medication to increase blood flow in the corollary artery system?

Optimizing your blood pressure and cholesterol as well as your antiplatlet regimen with aspirin and perhaps plavix will all optimize the function of the heart. Other antianginal medications such as nitrates, beta blockers and calcium channel blockers can also hellp with continuing anginal symptoms.

[bunos]

Realize that you are receiving excellent medical advise and care to 'maximize' your lipid profile. I too have a lower than normal HDL level and it's been pretty resistant to the usual therapies.Possibe level of 'improvement' in risk factors... have you tried adding Zetia to lower your LDL to the target numbers for our higher risk group,i.e. LDL of 70 or less?
I had an awful reaction to a higher doseage of Lipitor a few years ago(but much less than the level you are taking),a lot of muscle pain as well, and had to pursue other alternatives. I now take 10mg Lipitor and 10mg Zetia and get the desired result that I would with 80mg Lipitor,i.e level of 65 or so on LDL. The side effect profile is absolutely mimimal..especially compared with the alternative of such a high doseage of Lipitor. It's a big quality of life issue for me and, I suspect, many others as well. (I am aware that there is some minor improvement for some on improving HDL levels but you are probably getting that from the niacin--but I'm a layman,not a DR.). Anyway,good luck with whatever you decide to do based on the options presented.

[Healthyself2]

It sounds like you are doing well and have arrested your disease.  The combo of Lipitor, Niaspan, and exercise is the key.  If they had been available in 1990, you could have avoided bypass surgery.

I'm pretty much in the same boat.  Had a heart attack 6 years ago (they say not my first) followed by 2 unsuccessful attempts at angioplasty.  Also have family history.  Refused successive sales pitches for CABG surgery, even though I was told that I probably would be dead by now.  Have a totally occluded RCA, 70-90% ostial occlusion of the circumflex, and ruptured plaque in my left main.  Fortunately they left no steel in me and I didn't think bypass surgery was a good idea.  

Took me a while to get on the right drugs, but I am now a believer that the disease can be put in remission with aggressive cholesterol drug therapy and daily long duration mildly aerobic exercise.  I use Lipitor+Niaspan+Welchol and keep TC below 160 and have raised HDL from 30 to consistently mid 50's -- that's the key.

I'm fortunate to live near mountains and I walk up and down hills 3 miles per day during the work week and do some more serious hikes or x-country skiing on the weekend.  I can do pretty much anything - just not fast, because I have a limited blood flow.  I think that is how you build collateral vascularization and I'm sure it's the reason that I am active and in good health.

Also take note that Pfizer is in Phase III trials on Torcetrapib which will be a combo Lipitor + CETP inhibitor.  This should be a lifesaving drug as it will raise HDL levels significantly higher than NIASPAN which is not widely prescribed.  If you live near Columbus Ohio, you might consider contacting Ohio Health \ McConnell Heart Center to participate in the trial.  Unfortunately I couldn't get in because of the distance that I live from there.

I would say, just hang in there and keep doing what your doing.  Push up against the disease each day, keep those old plaques dry, and be happy.

Good Luck

[Jeff-67]

Your EF looks pretty good for your age.  Mine is 51% and I am half your age, and apparently my heart is normal.

[Erik36]

Do you know of any other locations doing studies on Torcetrapib? Maybe possibly in NY? I cannot wait for 2-3 more years until it reaches the market. Thanks!


Erik

[Healthyself2]

Hi Erik,

I'm going to search around the web a bit.  If I lived in New York as you do, I would contact them as it's not that far.  I think they want you in for a physical and perhaps followup lipid readings.

I do believe that the drug will be on the market next year, if no safety issues come up in their trials.

Any new drug is a risk, but I think that I would take this one if I could get it.

In the meantime, The Niaspan and exercise keeps me up in the 50's but I think that people with existing disease should go higher if they can.