CABG recommended?

[syedjawadshah]

My father is 54 years old man with diabetes for 13 years now. He had angiogram on 17th April 2012 which shows
Left Main stem Normal: Left anterior Descending artery mid segment has  60-70% hazy lesion.
Left circumflex artery: circumflex has mid diffuse disease
Obtuse marginals: A. OM1: Ostial/proximal junction has 95% disease OM2: Ostial and mid segment have 90% disease.
Right Cornary Artery: Mid/Distal Junction has 60 - 70% disease.
Left Ventriculogram: Preserved LV Function.
Triple vessel artery disease  
ETT has shown negative Angina and Possitive Ischemia.
Doctors said he has small vessels so angioplasty may not be good option.
Most of surgeons has advised CABG while 2 cardiologist has said medical therapy is better option.
Now we are confuse in deciding? Shall we go for CABG or rely in medical therapy.

You answers will be highly appreciated...
I am very very concern on this decision.

Regards
Jawad

[syedjawadshah]

Thanks for information this will be helpful. I am looking for more good consultants for opinion.

[ed34]

Where I live, the cardiologists are the front line, not the surgeons. Cardiologists refer necessary patients to surgeons if bypass is felt necessary, and only then. If he has no angina, it doesn't mean that no damage is occurring to the muscle, not everyone feels pain. I know you have a very difficult decision to make and want to be sure it's the right one. I have to make it plain that I am not a Doctor and can only give an opinion for you to consider. I have had a journey of 5 years sorting out my arteries and now have a triple bypass and 10 stents. So based on my own experience and the knowledge I've gained from talking to many cardiologists, surgeons and other patients, my opinion is.....

I would first ask that they do a nuclear scan. This will show if sufficient oxygen is getting to the heart muscle both when the heart is at rest, and when working harder. This would be a good indicator if you can go for the medication/lifestyle change option. If the nuclear scan looks bad, then I would look at other options to bypass. My triple bypass lasted 3 months, so it failed before I was even recovered. I met many other patients who were in the same situation, some only lasted 2 weeks. Some patients are not good candidates for bypass, but there's no test to see if you are one of them. It's a lot of discomfort and recovery to go through just to find out.
I would push the cardiologists into finding other options, and tell them I refuse bypass. If the vessels are too small to stent, there are other options. The stents they use are coated with a special drug, to help prevent scar tissue growing, re-blocking the artery. If you look at a stent, it is like mesh, with lots of empty space between the strands of metal. So, when the stent is opened against the artery, very little contact is made between the stent and the artery, meaning not much of the drug actually gets to touch the artery. When a stent is opened, only around 10-20% of the artery actually gets to touch the drug. 80-90% is left untreated and is prone to growing scar tissue. Blockages can be ballooned without stenting, but around 75% of those re-block very quickly. This is why stenting became so popular. Now however, there is a drug eluting balloon. The surface of the balloon is covered with the magic drug to stop scarring, and when the balloon is inflated, 100% of the artery is touched, delivering the drug everywhere. This has been having a lot of success across Europe and means it can be used effectively in vessels too small for stenting.
If it was my heart, and knowing what I went through, simply because after my bypass failed, it was incredible how many options suddenly appeared on the table which were never mentioned before.

[LivingInHope]

Please see private message for info on study that demonstrated diabetics are just as likely to feel angina as non-diabetics.  Also, for info on the pros and cons of CABG.  I do not know what medical therapies have been suggested?

[syedjawadshah]

Well he is diabetic so according to doctors Angina is very rare to be felled. Well those 2 cardiologist are mist renown in town. One of them is the most senior cardiologist. On the other hand surgeons are all from same hospital but opinions are taken separately.

I really need help to finalize if he shall go for CABG. More preciously pros and corns of the both therapies will help best to decide.

Jawad

[LivingInHope]

Well, he has having a lack of oxygenated blood to an area (ischemia) which can lead to tissue death.  Typically, ischemia causes pain, so I am surprised he has no angina.

  You say most doctor have advised coronary artery bypass graft (CABG), while just 2 cardiologists suggest medical therapy is better.  If you are a Christian, I hope you pray for wisdom on this tough decision.  

I would think that you need to consider the schooling and experience of each doctor you saw for an opinion & who impresses you as seeming the most trustworthy based on your research on them and your experience when you saw them in formulating your decision.