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Old 07-13-2007, 08:31 AM   #1
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Have Any of You Had a Minimally Invasive Bypass?

My cardiologist says our goal is to keep me away from the surgeons. I have 4 stents in my LAD, starting at the beginning. I have another stent in my left circumflex.

The doctor said either restenosis or another blockage in my LAD would cause me to have to have bypass surgery. The last stent I had was to open a stenotic stent in my LAD.

I have extremely high total cholesterol and cannot tolerate statins. I had the last stent inserted 2.5 months ago and I am beginning to have angina. This is why I am asking this question. I went to the Cleveland Clinic for my last stent, and know or believe that this institution pioneered this type of surgery.

I live almost 900 miles from Cleveland, so I am going to have to somehow get prepared for this surgery. (Gee, I wish I had a good friend in Cleveland, lol. I would go move in...)

I would really appreciate any information from anyone who has had, or anyone who knows someone who has had this minimally invasive surgery. Supposedly I am a candidate for it, due to the location of the diseased artery (LAD).

Thanks very much in advance

 
Old 07-13-2007, 03:20 PM   #2
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Re: Have Any of You Had a Minimally Invasive Bypass?

Hi Huckfinn:

I underwent a minimally invasive bypass (MIDCAB)of the LAD on my birthday in 2006 after I had a heart attack 2 days earlier. The heart attack was caused by total collapse of the LAD which was opened up 20 years earlier via angioplasty with no stents. Did great until the inevitable happened again. It was always in the back of our minds that it will eventually reclose and the doctor said that the fact it lasted 20 years with no complications was a great result.

Anyway, this time after it reclosed (collapsed) they could not even reopen it by angioplasty; so they decided on the minimally invasive procedure which was done 2 days later by the only surgeon (at that time) in the hospital that knew how to perform that procedure. One day later they also angioplastied the RCA which was almost completely closed but was not involved in triggering the MI.

Compared to what I have read about the regular bypass surgery, the MIDCAB was much easier and much less traumatic on the whole system. You are not placed on a heart/lung machine and the heart will continue pumping during surgery. The aftercare also took much less time. The surgical incision was about 3 inches underneath the left breast, as opposed to cracking your chest open with the regular bypass, and right now you have to look very closely to even see the scar. They used the left mammary artery for the graft. There were no complications whatsoever and the pain was very minimal. The only thing I felt after some time passed was numbness and sensitivity (no pain) in the left breast area which eventually resolved.

The only issues I had with this whole procedure had nothing to do with the MIDCAB surgery itself but rather with taking the plavix for a prolonged period of time (one year) necessitated by the drug-eluting stent placed in the RCA.

From what you have mentioned in your post, it seems that you might be more prone to restenosis, so it is very important to bring the cholesterol levels down by whatever method you can i.e. diet, drugs, exercise etc. Lose any excess weight, of course stop smoking if you do smoke. Joining a rehab program after the procedure is very helpful.

If I were you, I would discuss with the doctor whether you should undergo the procedure preemptively, i.e. don't wait until the LAD recloses since that event may trigger a massive heart attack resulting in damage to the heart muscle or worse. Actuallly, I am surprised, given your history of restenosing and multiple stents, your doctor has not recommended that already. Best of luck to you

 
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Old 07-14-2007, 05:36 AM   #3
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Re: Have Any of You Had a Minimally Invasive Bypass?

Huck,

It sounds like you might be ideal for this surgery. MIDCAB is designed for someone with problems ONLY with single vessel disease in one of the heart's front arteries and that sounds just like you.

I would preempt the heart attack and get the bypass. With 4 repairs, you certainly gave stenting that artery your best shot.
I agree with nosa that waiting for a heart attack is not the best approach.

Gosh, isn't there ANYWAY to get your cholesterol down because it will just clog up your other arteries over time.

Hmmm, 900 miles eh...maybe you can find a good medical center closer? In any case it might likely just be ONE long visit (about 4 days) and home again.
Will you have insurance issues going to a hospital 900 miles away?
Why not give a call to Barnes-Jewish in St. Louis, MO...they are among the best hospitals and might be doping the MIDCAB...and a lot closer, although you might be hard pressed to find a better hospital than the Cleveland CLinic.

Good luck with your choice.

Last edited by Lenin; 07-14-2007 at 05:59 AM.

 
Old 07-14-2007, 09:21 AM   #4
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Re: Have Any of You Had a Minimally Invasive Bypass?

It is so kind of both of you to reply to my post. At this time it means the world to me. I am confused and slightly emotional I did not expect the chest pain to come back so soon.

Nosa47, what a birthday gift you received last year! There are two ways of looking at it, it seems to me...."A bummer of a gift", or "geeze, they saved my life!" I do hope that you had, or will have a much better birthday this year. I had a heart attack for my wife's birthday in 2003.....

Was it pure luck that you ended up in a hospital so capable, or did you "search out" one? The answer to this is obvious, as your LAD collapsed...I still had to ask. Was it a prominent or very prestigious hospital? I know it was to you, lol. Anyone or any institution that saves your life and from having the nightmare CABG is very prominent and prestigious!

I have looked into the eyes of so many of these poor traditional CABG people, walking the hospital hallways. They appear pale and very frightened. I am not so courageous, in fact I am a big chicken.

I have had 9 cardiac catheterizations. The tiny scars are making it tough to deaden new entry points....You mentioned not liking the Plavix treatment... I have taken Plavix since a heart attack in June of 2003. I also had a CVA (cerebral vascular accident) with the mi. I have an extremely hard time tolerating aspirin. Did the Plavix cause you adverse side affects? Plavix is for stroke prevention for myself. I also have small vessel disease (SVD) from years of smoking. This was discovered after my first cath.

My nightmare is ending up in my small town hospital with a scar from my chin to my navel...Just for a single bypass. I think the info you guys gave me will help to prevent this from happening. Really, both of you have made me see that I really need to be proactive with this.

You don't know how much your descriptive information of your surgery means to me. Yes, now I see that I would be pre-empting a heart attack. That is the language that I will use with the medical people. Last March my "hometown hospital" wanted to do a CABG for a single bypass, after a catheterization. I asked if UAB hospital (University of Alabama) could stent it. The doc had a phone conference with UAB and they said they would try it. I rode in an ambulance for 100 miles to UAB. The did a procedure known as Rotoblational Arthectomy at the very proximal (beginning) of my LAD.

The little acorn shaped cutting head came off of the cath wire and I went totally rigid with fear, lol. I had read about this procedure and about the cutting head coming off the deal, which required emergency bypass. The "student" stepped out of the way and the Professor retrieved the cutting head. I stayed on the cath table for one hour and forty five minutes.

I could have had radiation burns...I was way too alert for most of my caths, especially this one, but I could follow there commands very easily like bear down as if to have a bm, or hold your arms up high, or take a deep breath and hold it.

Again thanks so much for your post. It is so appreciated and gives me so much hope. I need to get busy with the docs and I dread it

I hope you continue to have great health.

Lenin I have heard of the Barnes-Jewish hospital. A very famous hospital indeed. I think they do many valve replacements also, but the Cleveland Clinic hospital does the most valve surgeries (per a large sign at the entrance, lol) Can you believe that I flew to Cleveland, took a taxi to the CC ER and the rest is history.

I got to the ER on a Thursday night at about 6:00 pm and left the following Saturday at around 12:30 noon? I felt great....

My insurance covers any state that has bcbs, so it was like "in network". No extra out of pocket cost. I had it pre-certified over the phone before I left.

My local folks made me very mad. I went to a sinus doc whom I asked to listen to my heart. This guy is a smart doc. He said I had aortic valve leakage and to see my cardio asap. The cardio receptionist said the earliest I could be seen was about a month in the future....

Turns out = minimal aortic, tricuspid and mild mitral valve leakage, which is common for my age they say?

I am going to have trouble in having this minimally invasive or Mid-cab procedure done preemptively, I believe. Maybe not if I mention the angina, though fairly mild now, to my local cardio. Then maybe he can communicate with a CC doctor. I do have a cardio at the CC that I have seen. He was a genius, I swear.


Lenin I am taking Zetia and prescription fish oil, Omacor, lol, to lower the triglycerides (now > 800) (TC at 297). CC did not do a direct Ldl test. The Zetia makes me weak and sore, especially my feet (sore). I am also trying to lose about 20 lbs. That would put me at my normal weight. It is hard to exercise while taking all of the heart medicines that I take and now I am afraid to.

Lenin, thanks for being here for myself, and all of us. You are remarkable

*I wish you guys had time to read this question I wrote to a cardiologist, and his answer that follows I won't post my reply to his answer, only because it will add to this most gigantic post in which I must apologize for writing. I must say that I feel much better after reading your replies and writing mine.

The very best to the both of you

**************************************** ****************

*Question
I have 4 stents in my LAD starting at the "very proximal LAD". Dr. xxxxxx's partner inserted the last stent about 2 months ago. I also have one widely patent stent in my circumflex.

My local cardiologist here in xxx, told me that I cannot have any more blockages or restenosis in my LAD. My cholesterol is extremely high and uncontrollable due to hyperlipidemia and intolerance of statins, so I am planning for bypass within this next year.

My question is, am I a candidate for the minimally invasive surgery (just based on what info I have given you, I am 54 and in fair health otherwise)? My LAD is very diseased, per the cath report.

Also would it be possible to bypass my RCA during this kind of surgery? It is congenitally small and insignificant per the latest cath report. It supplies the bottom of my heart, but not sufficiently.

I have a left dominant heart.

Thanks so much in advance.

******************************
*Answer
I understand you are very concerned about your coronary artery disease. At this point, however, the most important thing for you is to continue with good diet and exercise and to try to bring down your cholesterol. If statins are not the answer due to side-effects you should try other classes of meds such as fibrates or niacin or zetia. You must eat well.

As far as bypass candidacy, first you have to have an indication for surgery. The most important reason to do surgery in you is if you develop chest pain limiting your quality of life. A positive stress test (exercise stress test) would be a good way to check for these symptoms if you have none with regular activity at home.

Since you had a stent in the LAD, you have to wait at least a year, maybe longer, before you can have bypass surgery because you have to stay on plavix.

Based on the info you gave me you might be a candidate for minimally invasive surgery. That really depends on your body habitus, the type of surgery and other issues that your surgeon will discuss with you. The small RCA does not need to by bypassed. There is no benefit from that. The LAD and the circumflex can be bypassed only if there is severe disease in them.

Since you are not having chest pain, there probably isn't severe disease there. Bypass surgery will not work if you do it when there isn't severe disease because the grafts will not mature well and will go down over time.

Therefore, I don't think you should be planning for any surgery now. Stay on your meds, have a good diet, exercise and relax.

 
Old 07-15-2007, 07:28 AM   #5
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Re: Have Any of You Had a Minimally Invasive Bypass?

Wowser, huck,

Sounds like he talked right PAST you there:

Quote:
The most important reason to do surgery in you is if you develop chest pain limiting your quality of life.
and
Quote:
Since you are not having chest pain, there probably isn't severe disease there.
In his defense, you didn't mention the returning angina but if 4 stents in one artery isn't de facto evidence of "disese" I don't know what WOULD be.

Quote:
The small RCA does not need to by bypassed. There is no benefit from that.
"Small RCA"? "No need for bypass" He's making this stuff up as he goes along. My RCA was the largest artery in my heart, 3.5 mm. and MANY people have the RCA bypassed, although not with MIDCAB, you cannot get at it.

Quote:
Since you had a stent in the LAD, you have to wait at least a year, maybe longer, before you can have bypass surgery because you have to stay on plavix.
THAT strikes me as addlebrained thinking, so bizarre that I cannot comment... and all I can say is that I wouldn't let this "cardiologist" near me with a 10 foot pole.


I know you asked nosa about his problems with Plavix but let me add mine: my nose bled for 2 months straight...every day.

 
Old 07-15-2007, 09:42 AM   #6
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Re: Have Any of You Had a Minimally Invasive Bypass?

After dealing with this disease for over 20 years, I do try to look at the bright side of things. Although at the time (February 6 2006) it felt like: oh no, not again, in the end everything turned out alright and I thank God for every day I am on this earth. The doctor that did my surgery works at the hospital where my health insurance is (Long Beach Memorial Hospital) otherwise, most definitely I would have undergone the traditional bypass. Everything was done on an emergent basis after the MI, so there was no time to research and choose doctors or plan the course of action. In that sense, it might have been a blessing and in the end, the outcome was great.

I had some GI problems with the plavix in October of that year which was described on one of the reports I read as mild gastritis, not to mention the bleeding after every tiny nick or scratch. I do also take 325 mg coated aspirin so it might have been the combination of the plavix and the aspirin but I think it has more to do with the plavix since I have been taking aspirin for over 20 years. I feel a lot better in general after stopping the plavix over 5 months ago.

I agree with Lenin that the advice that was given to you regarding if and when you should undergo the MIDCAB is questionable at best. I think, especially now, since you are having chest pains, you should be a prime candidate for it especially since the traditional bypass surgery has already been recommended for you in the past. It seems that you already have researched a lot of the material you need regarding your condition and what has to be done. I suggest that you take that information to your doctors and discuss what course of action to follow based on that information and not wait until bad things happen since you cannot predict the outcome of a gradual reclosure or thrombosis resulting in sudden complete blockage. I hope everything works out well for you.

 
Old 07-15-2007, 12:24 PM   #7
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Re: Have Any of You Had a Minimally Invasive Bypass?

Many thanks to you again Lenin

I felt the same as you about the answer this doctor gave me. At the time I wrote the question, I wasn't having any angina, so I must agree with you in that that may have been the key to his medical daydreaming, lol.

I do not doubt his sincerity, but I do doubt his sense of cardiology

My blood is really thick. My clotting factor is... well my blood clots fast. I guess that is why I still don't bleed much while taking 75 mg of Plavix, and 325 mg of buffered aspirin each day. So sorry about the nose bleeds...

Boy, you have a whopper of an RCA...During one of my caths the doctor showed me that he could not get the cath wire into it. I was of course watching the angio screen. I think because of my being left dominant plumbed (only 10% of the population), the PDA and PLA are supplied by my LAD and or left circumflex, which between them have 5 stents, lol, the RCA means less to me. Not really less to me, less to them that know this stuff

Best of health to you Lenin and thanks again

 
Old 07-15-2007, 01:22 PM   #8
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Re: Have Any of You Had a Minimally Invasive Bypass?

Nosa47, thanks for answering all of my questions in such a clear and concise way. I can actually understand all that you wrote. Nothing is "between the lines"

I know exactly what you mean in this quote "Oh no not again". It has special meaning for people with heart disease , CAD in particular, and probably all seriously sick individuals with what ever the malady.

20 years is quite a stretch of "good time", although I'll bet you made a few lifestyle changes to go that long, problem free. I definitely could be wrong here though.

Since June of 2003, I just finished my longest "hospital free" period of time. It was almost 14 months. I have had 9 caths so....I was in and out of the hospital for almost 3 years. Many times angina took me to the ER and a subsequent cath, which would find a blockage but too small to stent. I was also told that it could be coronary artery spasms causing the bad angina.

As far as research, I became obsessed after the mi and stroke. I could no longer work. I was forced into retirement and that made me really bitter. SO I got a computer and found the net. After a couple of years I realized that I was headed in the wrong direction and stopped the study. Now I find it necessary to read some more because the local cardiac care is lacking in using all of the latest innovations and developments. They are 100% traditional.

I will also have to go far away for this procedure if in fact it is required. Our largest hospital has a really overall high death rate. My wife and my best friend just died at the age of 47 from colon surgery which led to a pulmonary embolism. In between she developed peritonitis due to the colon leaking and a second emergency surgery...

My current cardiologist is hyper and not willing to talk to me as human to human. It is a one way conversation. He belongs to a very large and best (only) large cardiology group within 100 or more miles. I saw him for a follow up echocardiogram, which was recommended by the doctor at the CC, about 2 weeks ago. If this angina continues I will see him sooner than the next appointment he scheduled for me, which is in 4 months.

I will either talk to him or walk out, lol. I can find another doctor. I just need one that will listen to my proposal at least.

I have read that the combination of Plavix and aspirin increases the likelihood of internal bleeding. Actually it was like a trial I think. I have had ulcers many years ago that were caused by the abuse of aspirin and NSAIDS in general. I have taken the Nexium type medicines for going on 8 years and they do have their side affects for sure. It has been proved that they inhibit the absorption of vitamin B-12. I have to take B-12 injections.

Thanks so much for taking the time to write.

Thanks again and the very best of health to you

Last edited by moderator2; 07-15-2007 at 03:30 PM. Reason: Please do not post websites except as described in the posting policy section titled "How to share information".

 
Old 07-15-2007, 03:23 PM   #9
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Re: Have Any of You Had a Minimally Invasive Bypass?

huckfinn, I read you have an interest in Cleveland Clinic. Good choice. The Cleveland Clinic has a website and lists information to get a second opinion on a heart condition. The staff of experts will review your medical records, and their opinion may enlighten you to the best option going forward.

Often a medical center wants to do their own examinations, but if you are confident there is adequate and complete information for a second opinion, you can fax records and express tapes to the clinic. The expense may be worth the convenience and peace of mind to have that opinion.

 
Old 07-16-2007, 09:27 AM   #10
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Re: huckfinn

Kenkieth, thanks for pointing this out. At this point in time, I need all available options. My problem with records might surprise you. I carried all of my cardio records to the CC. They were all of the originals I had fought so hard to get, even though I paid for a lot of them. I even had a cd of one of my angiograms. Well, they lost all of them. I have contacted them 3 times and all they say is "we can't find them".

Some were from different hospitals. I will never have all like I did, even if I contact all of the record holders.

Thanks again for this second opinion option availability. Maybe I could tell one of these docs that they already have my records, just locate them, lol.

 
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