Bypass or not?

[Fredxxx]

I am 78. I first noticed I had Angina 10 years ago. An angiogram showed two totally blocked arteries and the third struggling. It was not possible to stent them. The angina almost went away completely when I was put on Ranexa.

Since then I have been diagnosed with CHF somewhere between stage 2 and 3 with a EF of about 40%. They also have diagnosed arrhythmia problems and I was fitted with a CRD 3 wire pacemaker 6 months ago. A week ago I had another angiogram with the hope that the latest techniques could free up the arterial blockages enough to stent them. Sadly, that was not possible and they are now talking about a triple bypass.

I am not in bad shape, all things considered and at least don’t get angina any more. However, I am tired all the time and get fatigued after walking about 300yds. If I stop and sit down, I can keep it up for about a mile.

Basically, I am coping with a big reduction in my abilities, but at my age, living in Southern Spain, life is still pretty good with good friends an an active social life.

My concern is whether to have the bypass or not. Reading the posts on this forum, it seems that a bypass can be a miracle cure or alternatively end up with a long recovery time without a major improvement.

So far I have not seen any posts that refer to a bypass in an elderly patient also suffering from CHF. To add to the problem my kidneys are not in good shape - about 3.5 on a scale of 5.

Should I stick with what I have got or take the risk?

[Chappychap]

Your rational approach means you're a man after my own heart Fred, I also prefer to lay out all the facts and then make a sober, objective decision.

Only you can answer your question, but some critical factors might include the following.

Average life expectancy keeps increasing the older you get. The average 78 year old British man in good health can expect to live another nine years, reaching an age of 87. However, factor in a few cardio problems and that can easily reduce by four or five years. There are some good actuarial mortality tables on-line, adjusted for your parents/siblings age of death they will give you a reasonable base-line life expectancy.

The next question worth addressing are the risks of bypass surgery. In the UK there's a legal obligation on the surgeon to to gain the patient's informed consent. The key word here is "informed", the patient must be told the risks that they are running. But this usually results in the very bland statement that 2% of bypass operations have a poor outcome, which means the patient either dies on the operating table or suffers a stroke while under anaesthetic. The problem with this 2% figure is that it's an average, where as you want the risk that applies to you as an individual. You can't quite get that ultra precise risk, but you can get a lot closer than 2%. Bypass surgery risks are very age dependant, and the average age of a UK bypass patient is (as far as I can recall, please check) 68 years old. Risks also multiply significantly with co-morbidities. I would push the surgeon and cardiologist for better answers, but it wouldn't surprise me if your personal risk profile was closer to 10% than 2%.

After that there's the risk of the bypass surgery failing in the first year following surgery. This is generally a problem with the veins harvested form your leg or arm and then repurposed as arteries for the heart. This article is ten years out of date now, and surgical practises have improved, but it's still worth reading,

hopkinsmedicine.org/news/pu...

Again, you should push your cardiologist and surgeon for more up to date data, but when I was faced with bypass surgery I concluded there was at least a 10% chance that one or more grafts would quickly fail.

I'd also factor in the likely recovery period and the impact on your quality of life during that period. You'll be giving up perhaps three or four months of your current life as you convalesce and recover, is that a price you're willing to pay?

Finally you need to be clear about the expected benefits of surgery. A bypass is overwhelmingly a fix for angina, so if your angina is well controlled and your impaired mobility is chiefly down to HF, then you may not experience much practical benefit from the risks and discomfort of this major surgery.

I'm normally a big advocate for bypass surgery, in my case it gave me a massively improved quality of life, however I accept that the risk/reward balance will be different for each of us.

Good luck!

[Wooodsie]

Hi Fred, I couldn't attempt to improve on Chappychap's reply, that is a measured response, taking a number of factors into account.

However, it must be a personal decision to you. Is you present quality of life deteriorating fast? You mention struggling with walking, will the op reverse this? How would your body cope with the trauma of the operation itself? Is 4-6 months a small or large price to pay? In my opinion, I don't think it would be 4 months, you might have discomfort for at least 4 months, but that won't stop you enjoying a social life.

Basically, if you think your body can take it, then find out what the operation would do to improve your quality of life.

[Dralex]

Your situation is very similar to the position I was in some 9 months ago.

As another 78 year old male, I was experiencing regular angina attacks, which were being monitored by the cardiology unit in my local hospital. An angiogram revealed 3 seriously blocked coronary arteries, which were so narrow even their smallest balloon could not be inserted to allow stents to be fitted.

Preliminary arrangements were made with a specialist heart unit to carry out a triple bypass operation (this prospect did really worry me at the time), but before a date could be fixed I was contacted by another consultant who had seen all my results and was offering an alternative solution not requiring extensive surgery. He convinced me that using a process called rotablation, he could widen my arteries sufficiently to allow stenting. Rotablation involves drilling out the the blocked arteries with an acorn shaped drill bit rotating on a catheter at around 15,000 rpm.

After careful consideration, I elected to pursue this method, and after just 2 days in a major London hospital I came away with 5 stents, and as one doctor there remarked "blood is now gushing through your arteries"

My consultant is very satisfied with my progress, my BP is now 124/69 and heart rate 59.

Just wondering whether you could enquire if this process might be suitable for you?

[bowls12]

78 is not old, I was 78 when I had a mitral valve repair, which is said to be worse than bypass op.Go for the op ASAP you will be a new person after about 3 months slowly recovering

[Fredxxx in reply to bowls12]

Thanks, all of you, for your very helpful advice. I have an appointment with my cardiologist next month. I hope to have been able to have made some decisions by then as to where we go next.