Advice on Critical Triple Vessel Disease and CABG

[sam900900]

Hi,
My grandmother (73/F) had some chest pain 10 days ago and was hospitalized. She also has diabetes.
Her Coronary angiography report shows following findings.
LMCA: Short Distal LMCA has 50% stenosis.
LAD: Type III vessel calcific 100% occlusion in proximal segment. Rest of LAD is seen filling retrogradely during RCA          injection.
LCX: Non dominant. Mild LCX has calcific 60% to 70% stenosis.
RCA: Dominant. Ostial RCA has 75% stenosis. Proximal RCA has 90% stenosis. Mid RCA has another 70% stenosis.

Diagnosis: Critical Triple Vessel Disease.
Advice: CABG (Coronary Artery Bypass Surgery)
Please give me your advice whether the above procedure is useful for the above findings and what are the complications at her age if CABG is performed?

[sam900900]

Thank You for sharing your experience with me and also for advice.
Certainly consult some more cardiologist before going for CABG.

[ed34]

Hi
    Obviously we are not Doctors here, and can only offer personal opinions based on our own experiences and knowledge. I have to say that if this was my Mother I am not sure that I would want her to have CABG, especially having seen the report. From what I can see, there is just one area which is causing her problems. The left artery LAD is totally blocked at the top, but this has probably been the case for years. It states that the LAD is retrofilled from the RCA. In other words, collateral vessels have opened up which are connecting the bottom of the right artery to the bottom of the left artery. She already has a natural bypass there. The problem is the right artery, it has a 90% blockage now which will reduce flow to the right side and the left through the collaterals. The 70% blockages are a higher risk for rupture, but a CABG will not do anything to improve this. If a CABG is performed, all the blockages will remain. So, what would I do. I would go back to the Cardiologist and say "given that the LAD is fed from the RCA, and that the RCA has a 90% blockage affecting this, why is it not possible to just stent the 90% blockage to re-establish a good flow to the collaterals? Do you not feel that there is a strong possibility that if the 90% blockage is treated, more collaterals will open into the LAD?"
I think it makes more sense to treat the RCA with angioplasty, and if possible, including the 70% and 75% blockages.
Given her age, what if the bypass only lasted 5-10 years? what will they do then? There is no guarantee how long a bypass will last. My CABGx3 lasted 3 months, and I was 47. I met many patients who had CABG failure after just weeks/months. The Cardiologist will probably argue, based on his own experience and knowledge in Angioplasty, and that's where I usually say "can you please refer me to a Cardiologist with enough experience".