Minimally Invasive Bypass Surgery

[Jack54]

I have 4 stents in my LAD starting at the "very proximal LAD". Dr. Krasuski's partner inserted the last stent about 2 months ago. I also have one widely patent stent in my circumflex.

My local cardiologist here in Alabama, told me that I cannot have any more blockages or restenosis in my LAD. My cholesterol is extremely high and uncontrollable due to hyperlipidemia and intolerance of statins, so I am planning for bypass within this next year.

My question is, am I a candidate for the minimally invasive surgery (just based on what info I have given you, I am 54 and in fair health otherwise)? My LAD is very diseased.

Also would it be possible to bypass my RCA during this kind of surgery? It is congenitally small and insignificant per the latest cath report. It supplies the bottom of my heart, but not sufficiently.

I have a left dominant heart.

Thanks so much in advance.

[CCF-M.D.-PPB]

I understand you are very concerned about your coronary artery disease.  At this point, however, the most important thing for you is to continue with good diet and exercise and to try to bring down your cholesterol.  If statins are not the answer due to side-effects you should try other classes of meds such as fibrates or niacin or zetia.  You must eat well.  As far as bypass candidacy, first you have to have an indication for surgery.  The most important reason to do surgery in you is if you develop chest pain limiting your quality of life.  A positive stress test (exercise stress test) would be a good way to check for these symptoms if you have none with regular activity at home.  Since you had a stent in the LAD, you have to wait at least a year, maybe longer, before you can have bypass surgery because you have to stay on plavix.  Based on the info you gave me you might be a candidate for minimally invasive surgery.  That really depends on your body habitus, the type of surgery and other issues that your surgeon will discuss with you.  The small RCA does not need to by bypassed.  There is no benefit from that.  The LAD and the circumflex can be bypassed only if there is severe disease in them.  Since you are not having chest pain, there probably isn't severe disease there.  Bypass surgery will not work if you do it when there isn't severe disease because the grafts will not mature well and will go down over time.  Therefore, I don't think you should be planning for any surgery now.  Stay on your meds, have a good diet, exercise and relax.

[Jack54]

Again thanks so much for your answers. I really do appreciate the time you took to reply.

This is what you do not understand. Since a heart attack >4 years ago, I have had 9 cardiac catheterizations and watched as my LAD become diseased with lesions (plaques, blockages). I was supposed to have CABG X1 in March of last year. Instead I was sent to UAB hospital and had Rotoblational Arthectomy and 2 stents in my proximal LAD.

I was in the Boy Scouts and learned to always be prepared. I am preparing to have this surgery now, because I do not want to wake up in a small country hospital that just opened their thoracic surgery services two weeks ago, whereby they will saw through my chest and open it up like a cheap suitcase.

I plan to have the Cleveland Clinic do this surgery. The last thing my cardiologist said to me one week ago was "now we are trying to keep you away from the surgeons".

I have watched the progression of CAD in myself. It is relatively fast.

I do not understand, nor have I ever heard of what you said about BP grafts not maturing well, unless the native artery is diseased. If you have time could you point me to some info to google? I know that you do not have the time to explain it.

G-d bless you, and tell Dr. Krasuski that the "Wildman from Alabama says hello" and that the CC lost all of my records that I "brung from Alabamy with me. I forgot my banjo :)

Jack

[Texheart]

I have a comment. I am in a similar predictament and am researching minimally invasive surgery at texas heart instirtue.  I have 3 stents in the LAD  and have an area in the distal LAD that cannot be stented. (scarred) I am continually short of breath and went from a horse to a snail pace but cardio just shuffs it off as I am a woman. I want intervention ASAP. Question: What does having a recent stent have to do with a by-pass before a year is up....Makes no sense as by-pass is going to do just that...by pass the stented artery. Then one can get off Plavix.  This is my goal...Get off Plavix and start breathing again. Again, I do not understand the doctor's comments about having to be on Plavix for a year before by-pass.  Can someone explain. Thanks....

[tstubbs457]

not sure there are any "hard and fast" rules on plavix use.  it is probably best to continue it for at least a month post-stent.  longer periods of time, possibly up to life-long, may be advisable.  not sure the data is in as of the present day.  
with regard to minimally invasive intervention:  the anatomy must be amendable.  go for the most complete re-vascularization feasible if surgery is considered.  no sense in hobbling the ct surgeons. sometimes an open procedure is preferable.  

[KIMD3]

My Husband 4 stents put in in fall of 05 he was put on plavix. 8 months later he had a major heart attack and has a quadruple bypass. They waited 5 days off the plavix to do the surgery. His heart is now worse do to the use of the plavix. There is a class action law suit against the plavix company that my husband is part of. The surgeons and heart doctors said he should never had been on plavix for more than 6 months. So I dont get where the MD is coming up with a year on it.

[Texheart]

I am sorry to hear this about your husband.  I would like to join the class action suit also for the Plavix. I also do not know where/why the CC doctor said about remaining on Plavix for a year or long after stent before considering by-pass.  

I was told when I had these &*$%^%$*^$%^ DES stents placed in me in 2004, that I must remain on Plavix for at least 6 months and most likely year...OK...I can do that.  Well, it is now over 3 years and been told that all DES (drug eluting stents) patient's should be on Plavix indefinately.  Now, who else should I join in a class action, The DES stent manufacturers.  I also was on Plavix when in May of 2005, I had an Acute Cardiac Event.  A blood clot in the LAD.  My Enzymes were all elevated.  How could this be?  I was on Plavix.  2 and 2 do not add up to 4.  My life has never been the same since.  KIMD, I wish your hubby all the best. I feel his pain.