Is angioplasty or bypass surgery advisable for my grandfather?

Question

Hi doctor,

My grandfather is 82 years old. He has diabetes as well as Alzheimer's. He had a heart attack before 15 days. Doctors are confused about whether to go in for angioplasty or bypass considering his age and diabetic history. He had congestion in the lungs and had breathlessness and sleeplessness when admitted to the hospital. Herewith I have attached his laboratory reports. Please suggest a suitable procedure.

Please help.

Answer 1

Hi,

Welcome to icliniq.com.

I have gone through all your grandfather's details (attachment removed to protect patient identity). Angioplasty above the age of 80 is not a good option. The patient is a subject for CABG (coronary artery bypass graft). The ejection fraction of the patient is 35 % only, and the lesion is very complex to cross. It is better to go for a planned CABG than to try angioplasty and abort the procedure at that time due to the inability to cross the lesion. However, the option to go for minimally invasive bypass surgery should be considered rather than open heart bypass.

MICS stands for minimally invasive coronary artery surgery. It is a new technique of performing coronary bypass for CAD (coronary artery disease). In this technique, the heart is approached through the side of the left chest with a small 4 cm incision. The chest is entered between the ribs without cutting any bones and by splitting the muscle. The advantages of MICS are no bones get cut, blood loss is almost negligible, infections are reduced, and the procedure lasts only 4 hours, unlike the conventional heart surgery that takes 14 hours. It is very good for old-age patients.

I hope this helps.

Thank you.