second open heart surgery

[viviane]

my father is 65 years old
he made an open heart surgey 10 years ago
last week he was kept in the hospital for a week for a chest pain
doctors says he need a second open heart surgery
this is the report the doctor give us:

Diagnosis: Recent Lateral CABG (10 Years) MI LIMA           LAD
                                                                          SVG             D1

Coronary Angiography


LMCA: Free

LAD: Totally Occluded after S1 and a small D1

Cx : Mid Total Occlusion

RCA: Large Dominant with proximal total occlusion & bridge collaterals showing very good caliber of distal RCA
LIMA to LAD: totally occluded at proximal LIMA
SVG to D1: Patent with good anastomosis to a sizable D1 that gives collaterals to the LAD via D2 and also gives collaterals to the distal RCA.

Conclusion :

o Occluded LIMA
o MOST of coronary segments are supplied by collaterals via the well patent SVG to D1 .

Recommended for Redo –CABG .


is it safe for him to go throught a second open heart surgery??
is there anyother treatment??

thank you

[kenkeith]

The LIMA is blocked.   LIMA (left internal mammerian artery ) was used for the orginal graft.  It is convenient to harvest, seldom present complications and it has excellent long-term benefit.  Unforutnately, a peripheral vessel harvest may be the only opttion and isn't as good due to possible wide spread artherosclerosis (hardening) and stenosis (narrowing). That would be the main concrern as there are a limited supply of grafts available.

I know a few people that have had to have a second by pass at the age of your father.  Brother-in-law has had three and was told there were no other grafts available.  A doctor would know whether current physical condition is adequate to have another surgical operation, and age wouldn't be a factor to not have another by-pass.

Your father is receiving good blood flow from collateral vessels.  Collateral vessels are nature's way of providing a growth of vessels to by-pass occlusions and supply blood  to areas that are deficit of good supply (anatomosis)..