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Second bypass surgery risks
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Second bypass surgery risks


  My father, age 67, just suffered a second heart attack.  Of the 5 arteries that were bypassed 11 years ago, 3 3/4 of them are blocked... or 70-75% is blocked. The main mammory artery is open.  During the first bypass surgery, a defibrillator was implanted if needed.  However, it was not needed and never used.  Because of this defibrillator, another bypass surgery was considered "too risky" as the doctors feel that it is pretty impossible to successfully perform surgery since it is embedded into the heart and can't be removed.  Now my dad has failed his stress test and the doctors are re-considering bypass surgery and angioplasty of the one blocked artery.  Can the defibrillator be removed?  Can a second bypass surgery be successful with this defibrillator in the way? Has this been done? Are there any other options available?  What can his quality of life be if he doesn't have surgery and is on meds?  What meds can help him in this scenario?  I'm very concerned and confused.  I'd appreciate you shedding any light on this complicated situation.  Thank you for your help.
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Dear Jill,
A second bypass surgery is always more difficult than the first due to the scar tissue that has formed and due to the altered anatomy of the heart.  The defibrillator adds to the complication of the situation.  I assume that since he had the defibrillator placed 11 years ago it was done during an open heart surgery with the patches directly on the heart and the defibrillator itself in his abdomen.  Due to improvements in   technology defibrillators today are placed in the shoulder with the leads running through veins on the inside of the heart, similar to the way a pacemaker is placed.  
Although the defibrillator complicates the issues it is not necessarily an absolute contraindication to proceeding with surgery.  If he is really needs the operation and it will benefit him and his other medical conditions are not too severe then my feeling is that he should proceed with surgery.  I would have the surgery at a major medical center with a surgeon who has experience with redo bypass surgeries.
I will address your other questions one-by-one.
Can the defibrillator be removed? Yes
Can a second bypass surgery be successful with this defibrillator in the way? It would probably have to be removed.
Has this been done? I don
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