delay for triple meant quadrupal

[popeye57]

Opinion sought ?, i had a heart attack in 2003, my BMA was way above the norm & it was recommended i lose a considerable amount of weight to reduce the risk prior to surgery. In 2005 an angiogram showed i need a triple CABG, the hospital concerned mixed my records up with another patient causing a two year delay in my surgery, my angina increased drastically and after the delay i had a further angiogram which showed i now needed a quad bypass, after surgery when i went back to hospital for a review the operating surgeon told me that he was unable to perform the quad  because the area of my heart concerned was to badly damaged and that he eventually had performed the triple instead, this has now left me with a 50% heart function. Question is, in anyones opinion, would the delay because of the mix up have contributed to the further complications before/during/after surgery. Thanks.

[kenkeith]

Thanks.  I haven't heard there was a problem interrnal mammary artery.  When I get some spare time I will reseasrch.

[ed34]

I think I may have found a reason, if you search in google for "ITA malperfusion syndrome" it gives many sites which say how the internal mammary artery can give rise to problems and a backup vein seems to greatly improve a patients recovery and life.

[ed34]

Thinking further on this, St. Mary's London is known by cardiologists worldwide and is a research/teaching hospital. It is the forefront of advancements in the UK and shares its grounds with imperial college London where many professors work. I wonder if this was a procedure decided upon by them? using vein/artery for LAD. I would be shocked if it was unique to that one hospital because if it was showing a reduction in mortality rates, I would have thought the procedure would have been adopted virtually everywhere.

[ed34]

I can only go by what 2 cardiologist in St. Mary's hospital London told me. The only problematic blockage was the 100% in the proximal, just after the circumflex branch. My Lima was put just below this and a vein to the distal section of LAD. When I asked why they put 2 grafts onto one artery, they said this is normal practice for that vessel. They said the LAD is very important and it's unlikely that different vessel types, i.e. artery/vein, will develop a problem at the same time, causing death.
I had one other vein connected to a diagonal somewhere, but I have no idea where. So, in effect I had three vessels grafted, it was called a CABG x 3 but there was just 2 blockages involved. I suppose you could say both the vein and the artery bypassed the blockage in the LAD, so aren't they both really bypass vessels?

[kenkeith]

Doesn't triple CABG (that's an OP quote) indicate there were 3 occlusions and quad indicate there were 4 occlusions? The 3 lesions were bypassed and one lesion remains...there is no mention of the number of grafts by me or the OP, nor did I imply, and I am aware each occlusion doesn't always require separate grafts.  

But I wasn't aware of the SOP to bypass one lesion on the LAD, however, I would classify your experience with one occlusion of the LAD as a single bypass with dual grafts...I wouldn't say there were two bypasses!  But of interest, what was the significance of putting a graft to the proximal area of the LAD blockage?  I can't image a vessel configuration for any practical application of putting  a distal graft next to the blockage to be standard operation procedure for a LAD bypass.  Do you have any supporting source because I find that interesting?

[ed34]

"another angio showed you had quad occlusions and a triple CABG was done on 2007,and you were told a quad could not be done"

It doesn't actually state how many occlusions. I see where you are coming from but it doesn't follow that there is one graft per blockage. It is usual practice for example to graft both a vein and an artery if the LAD is involved, even if there is one blockage. In my case the LIMA was put to the proximal and the vein to the distal.

[kenkeith]

Jon didn't see your post prior to my post...I did have an interuption, but it doesn't seem 40 minutes.:)

[kenkeith]

QUOTE: ...."a review the operating surgeon told me that he was unable to perform the quad  because the area of my heart concerned was to badly damaged and that he eventually had performed the triple instead, this has now left me with a 50% heart function. Question is, in anyones opinion, would the delay because of the mix up have contributed to the further complications before/during/after surgery. Thanks".

Lets establish a time line here.  In 2003 a heart attack...no treatment due to BMA.  In 2005, you needed a triple bypass but your records got mixed up so there was a 2 year delay and now in 2007 another angio showed you had quad occlusions and a triple CABG was done on 2007,and you were told a quad could not be done.

Now in 2010, you are asking if a 2007 CABG was/is problematic for a medical condition that you may or may not have?  Where does the 50% heart function originate...what recent test if any?  An EF of 50% is not an abnormal functioning heart!

You have had 3 occlusions bypassed, and another occlusion remains partially blocked. Has there been a test to determine the degree of blockage?   What are your current symptoms? What current tests are you relying on? Before your questions can be answered requires more information. ...it goes without saying further blockages could have occurred, but you don't have an ABNORMAL functioning heart evidenced by an 50%EF.

You have CAD and ed has given good advice to prevent or slow any further lesions.

[erijon]

I have to agree, if the triple was done earlier it seems it would not have made too much of a difference and a quad was in your future either way. When you were diagnosed did you do anything to slow down the progression of your CAD by way of diet, cholesterol control or exercise? Did you lose weight and how much? If nothing was changed the results were not entirely unexpected. Also, as Ken has stated your EF is only on the low side of normal so the damage done is most likely too severe.

Just my opinion, good luck.

Jon

[ed34]

I think one thing to realise from this is that drastic lifestyle changes are required because your disease seems to be progressing quickly. In the two years delay, your triple decision turned into a quad, which means more disease had formed. This would have happened if you had the triple two years prior anyway. Having a bypass does not slow down disease or stop it, it's a measure to get more blood to the heart muscle and you have to alter your lifestyle to slow down the disease or hopefully stop the progression. You need to get your cholesterol down, blood pressure controlled, reduce stress levels, exercise, eat healthy foods, stop smoking and cut down on large alcohol consumption. Some of these may not apply obviously , but one or more are likely causing your disease to progress.

[kenkeith]

If the heart function is impaired based on (EF) ejection fraction (normal is 50 to 70%), this is the amount of blood pumped with each heart rate, and often surgery is not performed if the EF is too low. The risk is very high and the heart's functionality may not return to normal.

Yes, a delay can cause further injury and reduce the EF.  But your EF is estimated at 50% and that should not be a concern. The injury, if any, would be damaged heart cells that were not provided a sufficient flow of blood oxygen, and this would impair the heart's contractility, and a 50% EF indicates there may not be any severe heart cell damage.