Should I have bypass surgery?

If you're willing to radically change your diet and exercise (assuming
you're on a "western" diet now) I'd suggest trying to avoid the
surgery. Blockage can be reversed in some cases. See www.niaspan.com
Also - great source of info (free) is www.medscape.com (note - this
is only my opinion - I'm not a doc)

[email hidden] (Albert Bester) wrote in message news:<[email hidden]>...

Quoted message said:

I know there are pros and cons concerning bypass surgery, but I'm
having trouble sorting out the decision for myself.

My recent angiogram (done as a followup to an abnormal thallium stress
test) revealed a totally occluded right coronary artery, a 70%
occluded LAD and a 90% occluded left circumflex. My ejection fraction
is 60%. I have very occasional mild angina on exertion. My resting
electrocardiagram is normal. I'm trying to decide on CABG. Since I
have mild symptoms, my motivation would be prolonging life (preventing
an MI). Some sources say that CABG is only indicated in three-vessel
disease if there is compromised left ventricle function, which is not
the case for me. Others (including my cardiologist) say that CABG is
indicated in my case.

My cardiologist told me that I have good collateral circulation (which
compensates for my occluded right artery), but says that the situation
with the LAD is dangerous.

I am 54 years old and work in an intellectually demanding job. I am
concerned about the recently verified widespread and lasting cognitive
side effects of CABG and would only want to do it if it will prolong
my life. I am currently on a medical program. Very much appeciate any
advise/guidance that others might offer. I am very confused about what
to do.

Albert Bester said:

I know there are pros and cons concerning bypass surgery, but I'm
having trouble sorting out the decision for myself.

My recent angiogram (done as a followup to an abnormal thallium stress
test) revealed a totally occluded right coronary artery, a 70%
occluded LAD and a 90% occluded left circumflex. My ejection fraction
is 60%. I have very occasional mild angina on exertion. My resting
electrocardiagram is normal. I'm trying to decide on CABG. Since I
have mild symptoms, my motivation would be prolonging life (preventing
an MI). Some sources say that CABG is only indicated in three-vessel
disease if there is compromised left ventricle function, which is not
the case for me. Others (including my cardiologist) say that CABG is
indicated in my case.

My cardiologist told me that I have good collateral circulation (which
compensates for my occluded right artery), but says that the situation
with the LAD is dangerous.

I am 54 years old and work in an intellectually demanding job. I am
concerned about the recently verified widespread and lasting cognitive
side effects of CABG and would only want to do it if it will prolong
my life. I am currently on a medical program. Very much appeciate any
advise/guidance that others might offer. I am very confused about what
to do.

I would suggest that you have your cardiologist convince you one way or
another. And, if you remain unconvinced, a second opinion from an
independent second cardiologist should be ok.

--
Dr. Andrew B. Chung, MD/PhD
Board-Certified Cardiologist
http://www.heartmdphd.com/

[email hidden] (Albert Bester) wrote in message news:<[email hidden]>...

Quoted message said:

I know there are pros and cons concerning bypass surgery, but I'm
having trouble sorting out the decision for myself.

My recent angiogram (done as a followup to an abnormal thallium stress
test) revealed a totally occluded right coronary artery, a 70%
occluded LAD and a 90% occluded left circumflex. My ejection fraction
is 60%. I have very occasional mild angina on exertion. My resting
electrocardiagram is normal. I'm trying to decide on CABG. Since I
have mild symptoms, my motivation would be prolonging life (preventing
an MI). Some sources say that CABG is only indicated in three-vessel
disease if there is compromised left ventricle function, which is not
the case for me. Others (including my cardiologist) say that CABG is
indicated in my case.

My cardiologist told me that I have good collateral circulation (which
compensates for my occluded right artery), but says that the situation
with the LAD is dangerous.

I am 54 years old and work in an intellectually demanding job. I am
concerned about the recently verified widespread and lasting cognitive
side effects of CABG and would only want to do it if it will prolong
my life. I am currently on a medical program. Very much appeciate any
advise/guidance that others might offer. I am very confused about what
to do.

Bypass does not appear to prolong life unless there is left main
disease or subpar LV function. That's what the canonical studies
show.

So if you do not suffer debilitating symptoms, a medical program
accompanied by diet and exercise will do just fine.

I had severe multi-vessel disease (all arteries) last November and was told
by a Cardiologist after an Angiogram , that there "was nothing they could do
for me" and that an immediate By Pass was indicated.
Yet...when the Senior Cardiologist in the hospital came to the Cath Lab and
had a look, he decided that the new Cypher Stents would do the job.
They put in 5 Cypher (sirolimus coated) stents into my arteries (4 in left
main and LAD and 1 in right main). That was a year ago this month and since
then...no restonisis (reblocking), no problems and recent stress tests,
blood tests, ECGs etc etc all checked out fine.
On a recent visit to the Senior cardiologist of the hospital (in Dublin,
Ireland) he told me that By Pass surgery was now pretty much obsolete...and
replaced by the new stenting procedure.
I had my first MI some 10 years ago...and at the time was told that I
needed an immediate quadruple by pass......and ten years later I have still
avoided the dreaded barbaric by pass......my advice is talk to your
Cardiologist about Cypher Stents or alternatively find another cardiologist
who isn't so knife happy.

Good Luck..

lpb
<[email hidden]> wrote in message
news:[email hidden]...

Quoted message said:

[email hidden] (Albert Bester) wrote in message

news:<[email hidden]>...

Quoted message said:

Quoted message said:

I know there are pros and cons concerning bypass surgery, but I'm
having trouble sorting out the decision for myself.

My recent angiogram (done as a followup to an abnormal thallium stress
test) revealed a totally occluded right coronary artery, a 70%
occluded LAD and a 90% occluded left circumflex. My ejection fraction
is 60%. I have very occasional mild angina on exertion. My resting
electrocardiagram is normal. I'm trying to decide on CABG. Since I
have mild symptoms, my motivation would be prolonging life (preventing
an MI). Some sources say that CABG is only indicated in three-vessel
disease if there is compromised left ventricle function, which is not
the case for me. Others (including my cardiologist) say that CABG is
indicated in my case.

My cardiologist told me that I have good collateral circulation (which
compensates for my occluded right artery), but says that the situation
with the LAD is dangerous.

I am 54 years old and work in an intellectually demanding job. I am
concerned about the recently verified widespread and lasting cognitive
side effects of CABG and would only want to do it if it will prolong
my life. I am currently on a medical program. Very much appeciate any
advise/guidance that others might offer. I am very confused about what
to do.

Bypass does not appear to prolong life unless there is left main
disease or subpar LV function. That's what the canonical studies
show.

So if you do not suffer debilitating symptoms, a medical program
accompanied by diet and exercise will do just fine.

I would opt for stents rather than a bypass. A 60% ejection fraction
is good.

I am not a doctor, but have had several stents installed.
--

Herb
Boulder, CO

<[email hidden]> wrote in message
news:[email hidden]...

Quoted message said:

[email hidden] (Albert Bester) wrote in message

news:<[email hidden]>...

Quoted message said:

Quoted message said:

I know there are pros and cons concerning bypass surgery, but I'm
having trouble sorting out the decision for myself.

My recent angiogram (done as a followup to an abnormal thallium

stress

Quoted message said:

Quoted message said:

test) revealed a totally occluded right coronary artery, a 70%
occluded LAD and a 90% occluded left circumflex. My ejection

fraction

Quoted message said:

Quoted message said:

is 60%. I have very occasional mild angina on exertion. My resting
electrocardiagram is normal. I'm trying to decide on CABG. Since I
have mild symptoms, my motivation would be prolonging life

(preventing

Quoted message said:

Quoted message said:

an MI). Some sources say that CABG is only indicated in three-vessel
disease if there is compromised left ventricle function, which is

not

Quoted message said:

Quoted message said:

the case for me. Others (including my cardiologist) say that CABG is
indicated in my case.

My cardiologist told me that I have good collateral circulation

(which

Quoted message said:

Quoted message said:

compensates for my occluded right artery), but says that the

situation

Quoted message said:

Quoted message said:

with the LAD is dangerous.

I am 54 years old and work in an intellectually demanding job. I am
concerned about the recently verified widespread and lasting

cognitive

Quoted message said:

Quoted message said:

side effects of CABG and would only want to do it if it will prolong
my life. I am currently on a medical program. Very much appeciate

any

Quoted message said:

Quoted message said:

advise/guidance that others might offer. I am very confused about

what

Quoted message said:

Quoted message said:

to do.

Bypass does not appear to prolong life unless there is left main
disease or subpar LV function. That's what the canonical studies
show.

So if you do not suffer debilitating symptoms, a medical program
accompanied by diet and exercise will do just fine.

Quoted message said:

[email hidden] (Albert Bester) wrote in message
news:<[email hidden]>...

Quoted message said:

I know there are pros and cons concerning bypass surgery, but I'm
having trouble sorting out the decision for myself.

My recent angiogram (done as a followup to an abnormal thallium stress
test) revealed a totally occluded right coronary artery, a 70%
occluded LAD and a 90% occluded left circumflex. My ejection fraction
is 60%. I have very occasional mild angina on exertion. My resting
electrocardiagram is normal. I'm trying to decide on CABG. Since I
have mild symptoms, my motivation would be prolonging life (preventing
an MI). Some sources say that CABG is only indicated in three-vessel
disease if there is compromised left ventricle function, which is not
the case for me. Others (including my cardiologist) say that CABG is
indicated in my case.

My cardiologist told me that I have good collateral circulation (which
compensates for my occluded right artery), but says that the situation
with the LAD is dangerous.

I am 54 years old and work in an intellectually demanding job. I am
concerned about the recently verified widespread and lasting cognitive
side effects of CABG and would only want to do it if it will prolong
my life. I am currently on a medical program. Very much appeciate any
advise/guidance that others might offer. I am very confused about what
to do.

Bypass does not appear to prolong life unless there is left main
disease or subpar LV function. That's what the canonical studies
show.

I have some trouble following you here...

Quoted message said:

So if you do not suffer debilitating symptoms, a medical program
accompanied by diet and exercise will do just fine.

This is far easier said than done, and woefully over-simplifies
individualization of atherosclerosis management.

--
~~~
Patrick Blanchard, M.D., A.B.F.P.
Board Certified in Family Practice
http://www.familydoctor.org/blanchard

"Dr. Andrew B. Chung, MD/PhD" <[email hidden]> wrote in message news:<[email hidden]>...

Quoted message said:

Albert Bester said:

I know there are pros and cons concerning bypass surgery, but I'm
having trouble sorting out the decision for myself.

My recent angiogram (done as a followup to an abnormal thallium stress
test) revealed a totally occluded right coronary artery, a 70%
occluded LAD and a 90% occluded left circumflex. My ejection fraction
is 60%. I have very occasional mild angina on exertion. My resting
electrocardiagram is normal. I'm trying to decide on CABG. Since I
have mild symptoms, my motivation would be prolonging life (preventing
an MI). Some sources say that CABG is only indicated in three-vessel
disease if there is compromised left ventricle function, which is not
the case for me. Others (including my cardiologist) say that CABG is
indicated in my case.

My cardiologist told me that I have good collateral circulation (which
compensates for my occluded right artery), but says that the situation
with the LAD is dangerous.

I am 54 years old and work in an intellectually demanding job. I am
concerned about the recently verified widespread and lasting cognitive
side effects of CABG and would only want to do it if it will prolong
my life. I am currently on a medical program. Very much appeciate any
advise/guidance that others might offer. I am very confused about what
to do.

I would suggest that you have your cardiologist convince you one way or
another. And, if you remain unconvinced, a second opinion from an
independent second cardiologist should be ok.

Thank you, Dr. Chung. I have seen four cardilogists. Three agree on
the bypass but the fourth thinks a medical program is all I need.

Stenting is out because the blockages occur at bifurcations and I have
been told angiloplasty is therefore too risky.

I recently had a rubidium PET scan that showed 40% ischemia of the LV.

What would you advise based on this info and your experience? Also,
how much of a problem is the cognitive impact of surgery?

Thanks,

Albert Bester

Albert Bester said:

"Dr. Andrew B. Chung, MD/PhD" <[email hidden]> wrote in message news:<[email hidden]>...

Quoted message said:

Albert Bester said:

I know there are pros and cons concerning bypass surgery, but I'm
having trouble sorting out the decision for myself.

My recent angiogram (done as a followup to an abnormal thallium stress
test) revealed a totally occluded right coronary artery, a 70%
occluded LAD and a 90% occluded left circumflex. My ejection fraction
is 60%. I have very occasional mild angina on exertion. My resting
electrocardiagram is normal. I'm trying to decide on CABG. Since I
have mild symptoms, my motivation would be prolonging life (preventing
an MI). Some sources say that CABG is only indicated in three-vessel
disease if there is compromised left ventricle function, which is not
the case for me. Others (including my cardiologist) say that CABG is
indicated in my case.

My cardiologist told me that I have good collateral circulation (which
compensates for my occluded right artery), but says that the situation
with the LAD is dangerous.

I am 54 years old and work in an intellectually demanding job. I am
concerned about the recently verified widespread and lasting cognitive
side effects of CABG and would only want to do it if it will prolong
my life. I am currently on a medical program. Very much appeciate any
advise/guidance that others might offer. I am very confused about what
to do.

I would suggest that you have your cardiologist convince you one way or
another. And, if you remain unconvinced, a second opinion from an
independent second cardiologist should be ok.

Thank you, Dr. Chung. I have seen four cardilogists. Three agree on
the bypass but the fourth thinks a medical program is all I need.

Stenting is out because the blockages occur at bifurcations and I have
been told angiloplasty is therefore too risky.

I recently had a rubidium PET scan that showed 40% ischemia of the LV.

What would you advise based on this info and your experience?

(1) Aggressive medical therapy works to relieve angina but takes time (up to 2-3 months). However, risk reduction
for MI happens right away.

(2) Bypass surgery will work quicker to relieve the angina but would still require aggressive medical therapy to slow
or reverse atherosclerosis thereby preventing future heart attacks.

(3) External counterpulsation (ECP) plus aggressive medical therapy is yet another option that is intermediate to the
two above in terms of time to symptom-free or symptom-reduced state. This enhances the development of collaterals.

The main drawback with (2) is the upfront risks (death and morbidity including cognitive impact) which probably
offsets any survival benefits for someone with normal LV function. (1) and (3) have very little upfront risks and
you can always choose (2) later if (1) and (3) don't work to relieve your angina or in the unlikely event your heart
function worsens.

Quoted message said:

Also,
how much of a problem is the cognitive impact of surgery?

Can be a very real (big) problem.

Quoted message said:

Thanks,

Albert Bester

You are welcome.

Humbly,

Andrew

--
Dr. Andrew B. Chung, MD/PhD
Board-Certified Cardiologist
http://www.heartmdphd.com/

Before you do anything, I'd recommend you go to http://www.heartprotect.com/

Read Dr. Howard Wayne's book "How to Protect Your Heart From Your Doctor"

Thomas Payne

Quoted message said:

[email hidden] (Albert Bester) wrote in message news:<[email hidden]>...

Quoted message said:

I know there are pros and cons concerning bypass surgery, but I'm
having trouble sorting out the decision for myself.

My recent angiogram (done as a followup to an abnormal thallium stress
test) revealed a totally occluded right coronary artery, a 70%
occluded LAD and a 90% occluded left circumflex. My ejection fraction
is 60%. I have very occasional mild angina on exertion. My resting
electrocardiagram is normal. I'm trying to decide on CABG. Since I
have mild symptoms, my motivation would be prolonging life (preventing
an MI). Some sources say that CABG is only indicated in three-vessel
disease if there is compromised left ventricle function, which is not
the case for me. Others (including my cardiologist) say that CABG is
indicated in my case.

My cardiologist told me that I have good collateral circulation (which
compensates for my occluded right artery), but says that the situation
with the LAD is dangerous.

I am 54 years old and work in an intellectually demanding job. I am
concerned about the recently verified widespread and lasting cognitive
side effects of CABG and would only want to do it if it will prolong
my life. I am currently on a medical program. Very much appeciate any
advise/guidance that others might offer. I am very confused about what
to do.

Bypass does not appear to prolong life unless there is left main
disease or subpar LV function. That's what the canonical studies
show.

So if you do not suffer debilitating symptoms, a medical program
accompanied by diet and exercise will do just fine.

Albert,

Do all four cardiologists also do surgery? If so, you may not be
getting an unbiased opinion. I'd suggest searching for "cognitive
impact" of bypass surgery on Medscape. You're an intelligent man and
can do your own research.

[email hidden] (Albert Bester) wrote in message news:<[email hidden]>...

Quoted message said:

"Dr. Andrew B. Chung, MD/PhD" <[email hidden]> wrote in message news:<[email hidden]>...

Quoted message said:

Albert Bester said:

I know there are pros and cons concerning bypass surgery, but I'm
having trouble sorting out the decision for myself.

My recent angiogram (done as a followup to an abnormal thallium stress
test) revealed a totally occluded right coronary artery, a 70%
occluded LAD and a 90% occluded left circumflex. My ejection fraction
is 60%. I have very occasional mild angina on exertion. My resting
electrocardiagram is normal. I'm trying to decide on CABG. Since I
have mild symptoms, my motivation would be prolonging life (preventing
an MI). Some sources say that CABG is only indicated in three-vessel
disease if there is compromised left ventricle function, which is not
the case for me. Others (including my cardiologist) say that CABG is
indicated in my case.

My cardiologist told me that I have good collateral circulation (which
compensates for my occluded right artery), but says that the situation
with the LAD is dangerous.

I am 54 years old and work in an intellectually demanding job. I am
concerned about the recently verified widespread and lasting cognitive
side effects of CABG and would only want to do it if it will prolong
my life. I am currently on a medical program. Very much appeciate any
advise/guidance that others might offer. I am very confused about what
to do.

I would suggest that you have your cardiologist convince you one way or
another. And, if you remain unconvinced, a second opinion from an
independent second cardiologist should be ok.

Thank you, Dr. Chung. I have seen four cardilogists. Three agree on
the bypass but the fourth thinks a medical program is all I need.

Stenting is out because the blockages occur at bifurcations and I have
been told angiloplasty is therefore too risky.

I recently had a rubidium PET scan that showed 40% ischemia of the LV.

What would you advise based on this info and your experience? Also,
how much of a problem is the cognitive impact of surgery?

Thanks,

Albert Bester

Albert,

The following may reassure you: "Effects of Patient Characteristics on
Cognitive Function Following Surgery
Researchers from Dartmouth University, Hanover, New Hampshire, and the
University of Iowa, Iowa City, recently identified certain
preoperative patient characteristics that appear to affect the outcome
of coronary artery bypass graft (CABG) surgery.[1] Their study
included 529 patients and focused on such factors as severity of
cardiovascular disease and comorbidities (ie, obesity, diabetes,
chronic pulmonary disease, and peripheral vascular disease). The
researchers evaluated patient data obtained before and 6 months after
CABG and found that, at 6 months postoperatively, 73.2% of the study
patients showed improvement in physical function and 41.6% showed
improvement in mental function.

Negative outcomes tended to be more likely among patients who were
obese (body mass index > 35), had complications from diabetes, or
suffered from chronic obstructive pulmonary disease or peripheral
vascular disease." http://www.medscape.com/viewarticle/461597

[email hidden] (Albert Bester) wrote in message news:<[email hidden]>...

Quoted message said:

"Dr. Andrew B. Chung, MD/PhD" <[email hidden]> wrote in message news:<[email hidden]>...

Quoted message said:

Albert Bester said:

I know there are pros and cons concerning bypass surgery, but I'm
having trouble sorting out the decision for myself.

My recent angiogram (done as a followup to an abnormal thallium stress
test) revealed a totally occluded right coronary artery, a 70%
occluded LAD and a 90% occluded left circumflex. My ejection fraction
is 60%. I have very occasional mild angina on exertion. My resting
electrocardiagram is normal. I'm trying to decide on CABG. Since I
have mild symptoms, my motivation would be prolonging life (preventing
an MI). Some sources say that CABG is only indicated in three-vessel
disease if there is compromised left ventricle function, which is not
the case for me. Others (including my cardiologist) say that CABG is
indicated in my case.

My cardiologist told me that I have good collateral circulation (which
compensates for my occluded right artery), but says that the situation
with the LAD is dangerous.

I am 54 years old and work in an intellectually demanding job. I am
concerned about the recently verified widespread and lasting cognitive
side effects of CABG and would only want to do it if it will prolong
my life. I am currently on a medical program. Very much appeciate any
advise/guidance that others might offer. I am very confused about what
to do.

I would suggest that you have your cardiologist convince you one way or
another. And, if you remain unconvinced, a second opinion from an
independent second cardiologist should be ok.

Thank you, Dr. Chung. I have seen four cardilogists. Three agree on
the bypass but the fourth thinks a medical program is all I need.

Stenting is out because the blockages occur at bifurcations and I have
been told angiloplasty is therefore too risky.

I recently had a rubidium PET scan that showed 40% ischemia of the LV.

What would you advise based on this info and your experience? Also,
how much of a problem is the cognitive impact of surgery?

Thanks,

Albert Bester