What are the complications in Redo?

I am male 55yrs of Indian origin.

Medical History:

I had IHD but no DMM in 1991. Hence CABG in Mumbai in Aug 1991. 5 grafts. LSV - OM1, OM2. RIMA - RCA. LIMA - Diag, LAD. Uneventful Procedure and Hospital Stay. Lead a woderfully active life thereafter. In 1992, was diagnosed with DMM.

In 2002 noted reduced exercise capacity. Hence Angiography in Mumbai in Feb 2002. Diagnosis: Atherosclerotic coronary artery disease. LM is small, diffusely diseased. LAD: shows total occlusion at its origin and 90% lesion after LIMA graft. LCx: diffusely diseased. RCA: shows 100% lesion proximally. SVG is totally occluded. LIMA shows 90% lesion at its anastomosis. RIMA is normal. LV: LVEF 55%. Both carotid arteries and renal arteries are normal. Was advised Redo CABG.

However avoided Redo. Changed lifestyle. Enjoyed low paced fully active life therefter. Travelling extensively. Last year visited US.

Lately noticing drastically reduced exercise capacity. A brisk walk sets in angina. Problems get compounded by DMM. Need 2 shots of 40IU Insulin every day.

Present scenario:

Doctors are urging to get Redo done. I am told that in Redo the risks are much higher. Chances of Morbidity and Mortality almost double. The situation is complicated by possiblities of adhesion of sternum to tissue that might have developed over the heart. It creates problems for slitting open the sternum.

I am covered by Insurance if the surgery is performed in India. However the best place to get the Redo done is probably Cleveland. But in that case I will not be covered by insurance. It is very very expensive if one has to pay for it from one's pocket.

Some doctors are advising that Angioplasty could be less invasive alternative.
I am in confusion as to what is the course of action I should take. Hence I seek openion of medical experts if possible.

Arun

[ed34]

There are no Doctors on this forum, you would need the expert forum for that. However, there are many here who can give their opinions to help you decide on a course of action. A redo cabg is considered more risky than the first,Your grafts have lasted well, so I guess you have made good lifestyle changes.
My bypass lasted only 3 months, but I was already asking myself questions like "Do I want to go through this every 15-20 years" I was 47 at the time. Fortunately, with my bypass failing, the decision was easily made for me, never again. Some cardiologists agreed with my decision and some didn't. I think it basically depends on the condition of your current coronary vascular system. Are the grafted veins blocked or closed down? mine just totally collapsed which can happen, where as some simply form a blockage. If you choose the angioplasty route, you should remember that you only really get one go at it for veins. They are weaker than arteries and there is no room for error. This means you should make sure you find a cardiologist particularly experienced in treating bypass grafts. If your grafts are clear, and new blockages have formed in your native coronary arteries, there is still a risk but it isn't as high. There is the access problem to consider also. I would ask the cardiologist how easy it is to access your blockages. If he/she would have to access them by going through your grafted vessels, this adds to the risk and makes the job a lot more tricky, they are not easy to navigate. I think whichever option you choose, you would be wise to ask the experience of the cardiologist elected for the procedure.
If this was my body, I would be seriously investigating the angioplasty option, but asking lots of questions and seeking other opinions too. You will get a few contradictions but eventually you will find a cardiologist with a lot of experience. You mention the Cleveland clinic, I believe there is a Doctor there who has a lot of experience in angioplasty involving bypass grafts.