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Heart Disease (Expert Forum)
bypass risk
Answered by
Cleveland - OH
This forum is for questions and support regarding heart issues such as: Angina, Angioplasty, Arrhythmia, Bypass Surgery, Cardiomyopathy, Coronary Artery Disease, Defibrillator, Heart Attack, Heart Disease, High Blood Pressure, Mitral Valve Prolapse, Pacemaker, PAD, Stenosis, Stress Tests.
bypass risk
by karen23, Jul 27, 2005 12:00AM
My mother is 75 years old and has one previous MI at age 52. Admitted to hosp. one week ago with unstable angina. Takes maximum medication for heart (nitropatch, atenolol, cardizem, zocor, prednisone (for arthritic condition), avapro, furosemide and others that I can’t remember) She is a former smoker (quit 20 years ago). Right now, she is in hospital and has just had 2 angiograms – first had to be aborted – couldn’t gain access to a vein, after the 2nd the dr. said angioplasty would be too risky, due to possible stroke or heart attack. An artery in her abdomen was torn during procedure and she needed to be transfused, but bleeding finally stopped on its own. She has previously been told she is not a candidate for bypass, but now dr. says she should have it. I am wondering if she should have the surgery. Her quality of life is seriously deteriorated – she is having agina very frequently and is in a lot of pain from blockages in other sites as well. Her doctor said she has about a 5% chance of not surviving the operation.
This hospital visit has also determined that she has very high blood sugar and is in kidney failure. Due to long term prednisone use, her adrenal glands are no longer working – she will need to stay on the prednisone for the rest of her life. The doctor says as long as they can get the kidney issues under control, they could go ahead and do the surgery on this admission.
1. How can the doctor say she has a 5% chance of not surviving? Wouldn’t it depend on her condition, and not statistics? Isn’t she at higher risk due to all her other problems, as well as her advanced vascular disease?
2. Do you think without the surgery she will continue to progress further into disease, since she is already on the maximum medication that can be given. I guess I’m asking if the risk of the surgery is a good one.
3. Will the prednisone’s horrible affects on her body, especially her arteries, have a great effect on the outcome of the surgery? Also, her dr. said he would have to give her a lot of prednisone prior to the surgery due to her adrenal gland impairment. Why would that be done?
4. Why does the condition of her kidneys affect the ability to do surgery?
She is a really vital 75 year old. Her body has been failing for a long time but she really wants to live (who doesn’t!!). She wants the advice of her children on what to do, which is why I’m asking. Thanks for any advice you can give me. Regards, Karen.
This hospital visit has also determined that she has very high blood sugar and is in kidney failure. Due to long term prednisone use, her adrenal glands are no longer working – she will need to stay on the prednisone for the rest of her life. The doctor says as long as they can get the kidney issues under control, they could go ahead and do the surgery on this admission.
1. How can the doctor say she has a 5% chance of not surviving? Wouldn’t it depend on her condition, and not statistics? Isn’t she at higher risk due to all her other problems, as well as her advanced vascular disease?
2. Do you think without the surgery she will continue to progress further into disease, since she is already on the maximum medication that can be given. I guess I’m asking if the risk of the surgery is a good one.
3. Will the prednisone’s horrible affects on her body, especially her arteries, have a great effect on the outcome of the surgery? Also, her dr. said he would have to give her a lot of prednisone prior to the surgery due to her adrenal gland impairment. Why would that be done?
4. Why does the condition of her kidneys affect the ability to do surgery?
She is a really vital 75 year old. Her body has been failing for a long time but she really wants to live (who doesn’t!!). She wants the advice of her children on what to do, which is why I’m asking. Thanks for any advice you can give me. Regards, Karen.
Doctor's Answer
by Cleveland Clinic, Jul 27, 2005 12:00AM
, Jul 27, 2005 12:00AM
karen,
sorry to hear of everthing going on. Im sure its been trying.
1. How can the doctor say she has a 5% chance of not surviving? Wouldn’t it depend on her condition, and not statistics? Isn’t she at higher risk due to all her other problems, as well as her advanced vascular disease?
A 5% risk of mortality is relatively high compared to a healthy person undergoing first CABG. Risk numbers are complex and dont always take into account the entire picture but they at least give an idea of what a procedure involves.
2. Do you think without the surgery she will continue to progress further into disease, since she is already on the maximum medication that can be given. I guess I’m asking if the risk of the surgery is a good one.
Life aint worth living if you cant live it. It depends on what she deems her quality of life as it is now. She has about a 5% chance of dying, a higher chance of having significant recovery issues after surgery. If her symptoms impact her life enough where she cant do the things she wants and there is a chance that she might be able to do those things after surgery then she may say the risk is worth it. Its a personal decision and one that if able and compentant she should make. Whatever she decides, support her fully.
3. Will the prednisone’s horrible affects on her body, especially her arteries, have a great effect on the outcome of the surgery? Also, her dr. said he would have to give her a lot of prednisone prior to the surgery due to her adrenal gland impairment. Why would that be done?
Normally the body produces hormones in response to stress to help the body adjust to the stressor. People on chronic steroids lose this ability over time and need a supplemental 'boost' when under stress. The negative effects of steroids increase her risk of surgery.
4. Why does the condition of her kidneys affect the ability to do surgery?
People with kidney disease do worse after surgery. This is probably multifactorial and related to the underlying condition causing renal failure and also direct loss of the kidneys regulatory function in the body.
good luck
sorry to hear of everthing going on. Im sure its been trying.
1. How can the doctor say she has a 5% chance of not surviving? Wouldn’t it depend on her condition, and not statistics? Isn’t she at higher risk due to all her other problems, as well as her advanced vascular disease?
A 5% risk of mortality is relatively high compared to a healthy person undergoing first CABG. Risk numbers are complex and dont always take into account the entire picture but they at least give an idea of what a procedure involves.
2. Do you think without the surgery she will continue to progress further into disease, since she is already on the maximum medication that can be given. I guess I’m asking if the risk of the surgery is a good one.
Life aint worth living if you cant live it. It depends on what she deems her quality of life as it is now. She has about a 5% chance of dying, a higher chance of having significant recovery issues after surgery. If her symptoms impact her life enough where she cant do the things she wants and there is a chance that she might be able to do those things after surgery then she may say the risk is worth it. Its a personal decision and one that if able and compentant she should make. Whatever she decides, support her fully.
3. Will the prednisone’s horrible affects on her body, especially her arteries, have a great effect on the outcome of the surgery? Also, her dr. said he would have to give her a lot of prednisone prior to the surgery due to her adrenal gland impairment. Why would that be done?
Normally the body produces hormones in response to stress to help the body adjust to the stressor. People on chronic steroids lose this ability over time and need a supplemental 'boost' when under stress. The negative effects of steroids increase her risk of surgery.
4. Why does the condition of her kidneys affect the ability to do surgery?
People with kidney disease do worse after surgery. This is probably multifactorial and related to the underlying condition causing renal failure and also direct loss of the kidneys regulatory function in the body.
good luck
Related discussions
My mom is now being considered for bypass, and if she is a candidate, they will do it next week. I am very torn, but will support her fully no matter what.