Coronary Heart Bypass Failure - Suggestions as to why?

Discussion in 'Professionally Qualified, RAMC and QARANC' started by Chalky, May 20, 2006.

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  1. My father has recently (December) had a triple bypass which, as you can imagine, was all fun and games.

    He's been feeling a bit tired and breathless again lately and as a result was given another stress test and angiogram combination which, we have now been told, shows that only one of the bypass grafts is working as it should and the other two are, well, not.

    They're now preparing to place a stent in one of the coronary arteries, but are unsure what to do about the other.

    Can any of you medical types suggest why the bypass did not work? The consultants and staff have closed ranks and dismissed it as 'one of those things' which I find a less than satisfactory explanation.

    Don't spare the details. I'm a molecular biologist by trade so I can pick up the vagaries of medical jargon.
  2. Hmm, could be many reasons for this.

    The graft may be the wrong way round! This means that the valves in the graft close against normal blood flow.

    The graft may become stenotic (an abnormal narrowing of the vessel). This is likely as the stent will be used to stretch the grafted vein/artery open again. A stent is basically a little ballon with a piece of "scaffolding" which when inflated pushes the scaffolding, which pushs the vein/artery open again and holds it there.

    The graft may form a keloid scar. This is essentially fibrous tissue that frms at the site of a healed injury. In this case it would be where the graft meets the original heart vessel. This may preclude a stent in the final vessel as you mention.

    Or simply the graft may just fail. Just like transplanted organs or any graft, the graft may not like its new home.

    N.B. these are just guesses as there are many factors that ave an effect.

    If you want to read more about it, nip down to your nearest uni or hospital library and find "Hurst's the Heart". 2 big volumes + index all about the heart, and the saviour of many a piece of coursework/case study for me in the past! Pick up this book and the ones next to it on the shelf and you can look for yourself. You would know your fathers particulars better. Is he elderly, overweight, have diabetes, etc. etc. All these potentially have a bearing on why the cabbage failed.

    Plus, if your arm yourself with a few "in the know" terms like "stenosis", "stent", "cabbage" etc. you cna walt it up to the docs and hope the give you a bit more info.
    Sorry, I couldnt help any more, its been a few years since I did any cardiology.
  3. Thanks a lot for you help, Cuchulainn.

    My father's in his late fourties and still runs marathons when he's not falling to bits.

    My family have a predisposition to heart disease and high cholesterol that takes some beating. All six of his brother's and sisters have had at least one bypass and his father died aged 43. Hurray for genetics!

    I'll get to the library and start my knowledge hoovering/med walting before mondays meeting.

    Thanks again!
  4. Just be careful with the walting bit though.

    The nurses where giving my parents the runaround over my grandfather one time when I popped up and started asking a few pointed questions. Before you could say "passing the buck so as to avoid litigations" in pops a harridan of a sister to interrogate me "where did you study? what did you study? where do you work?"

    She buggered off after 10 mins of "name, rank, number". Heh!

    Anyway, hope all goes well for your father. If he is as fit and young as you say, despite the family history he should have a good prognosis. A good, fit healthy lifestyle is great as a strong body can weather serious problems better. Even if you only start the lifestyle after any problems!

    I assume your about teens to 20s odd if your father is in his fourties, so you should have no trouble sneaking into a uni library. Look for a uni that has medicine or clinical physiology as courses. Clinical physiologists specialise in cardio, among others, so their libraries should have good source material. Even contact a lecturer and ask for a reading list on cardiology.

    Look for anything on CABG (coronary artery bypasss grafts), CABS (coronary artery bypass surgery), angiography (sticking things like ballons and stents in arteries) and myocardial infarction (technical term for heart attack).

    Failing that, the internet is a good source of info (ask any student) but, be careful as its not always accurate.

    Plus, these days, medical staff have to give out information to direct family, so as to preclude any chance of them being sued. Maybe by "one of those things" they just meant your father was in the percentage of cases that fail no matter what happens. That shouldnt preclude further treatment/surgery, though there is a limit to how many veins you can pull out of someones legs and tie them to their heart!

    Any other questions, fell free to fling me a pm.

    EDIT- I am a dope, I see your a student AND a TA CMT. So you shouldnt have any trouble grabbing info from the uni. Plus, ask around your TA unit, maybe some bods there are med students, doctors or part of some other allied helath profession. They can help too!
  6. I hope not to sound rude or uncaring but when I first saw the title of this thread, I thought for a minute that someone was after some advice on how to perform a bypass. Bloody marvellous place this ARRSE site. Advice on any subjects ranging from sex aids to medical problems.

    Good luck to your old man btw. Hope all works out well.
  7. *laughs*

    It really is.

    Cheers, A_B. Really do appreciate it.

    And thanks again, Cuchulainn. Just been to visit him and spoke to one of the doctors on the ward, rather than the consultant. He believes that, as you suggested, the grafts had probably become stenotic so a stent should help that, but we'll find out for certain on Monday.

    Much obliged to you all.

  8. Good luck to your dad Chalky - hope all goes well.

    I had a quadruple abour 2 half years ago and the benefits are amazing. Before the Op I could not climb the stairs in our house or walk more than 50 yards.

    The Only downside(s) was that my lung collapsed just after coming out of Hospital only to be readmitted for another week.

    On the plus side, I found myself doing a hundred yard sprint for a bus a couple of months after.
    I reckon I could still do the BFT if I was 16 years younger! :)
  9. Sorry but Angiography = Coronary angiography is an X-ray examination of the blood vessels or chambers of the heart. A very small tube (catheter) is inserted into a blood vessel in your groin or arm. Angioplasty = a balloon is blown up, squashing fatty deposits and widening a narrowed artery stents may also used to maintain the opening.

    Having had a heart attack and due an angiography at the end of this month, when I will hopefully get to know which 3 option might be best for me 1 = stay on the drugs, 2 = Angioplasty which they can do at the same (catch 22 have to make choice there and then), 3 = Bypass (Waiting list).

    Having read this I am not sure what you want Chalky if you are looking for a reason as to why something's work and others do not, all I can say is:-

    After my heart attack I asked my consultant on a scale of 1 to 10 how bad was mine and should I be worried (nice to turn the table on them for once).

    As you can imagine they were not in a hurry to answer that I think it wasn't a case of not wanting to say, more like they could not say

    Quote "that’s why we want you to have the angiography" but in their defence on many of the web sites and in the books I have read the most common statement is "With the help of modern treatment, particularly if you are given 'clot busting' drugs quickly, a higher percentage of people now make a full recovery".

    Oh by the why I am 43 both my parents have had heart attacks and my fathers brother (he died a few years ago not because of a heart attack) and their father too as the number 5 child in a family of 6 children none of whom have had heart attack makes you think about the question of family history or gentics disorders.

    And before you start the “bet you was a smoker” yes I was but not as heavy as some my age, yes I try to keep myself fit, and my cholesterol was below the recommended level and I am not diabetic and to top it I have never suffered from angina.

    I would not have known I was having a heart attack, Since it did not followed the description or danger signals given on and in the many books and web sites, in fact I would not have driven my car for 12 miles or had a race (running) against my 9 year old son.

    I am sure that if your father’s consultant is worth his weight he will have some answer to your questions but don’t expect them to be rushed or detailed explanation sometimes the answer has to be WE DO NOT KNOW.

    Chalky I hope all goes well for you both tomorrow.
  10. Sorry, I was just giving it to him in broad strokes rather than information overload him. To explain that part more -

    Coronary angiography is where they stick a tube in an artery (e.g. your leg) and feed it into the hearts arteries. Once there they squirt out a radio-opaque dye into the blood which flows through the arteries that feed the heart muscle tissue. This dye is viewed and recorded in real-time X-ray pictures and forms a pretty christmas tree picture of the coronary arteries, allowing you to see any narrowing or occlusion of the vessels.

    Coronary angioplasty is exactly the same as above, but the tube has a balloon on it also. You put the balloon into the narrowing and inflate it. If you have a stent when you deflate the balloon, it stays up, keeping that area of the artery open.

    The major benefit of angiography is it allows the arteries to be assessed by reasonably non-invasive means (its just a wee tiny cut to insert the needle, and a reasonably short duration op), plus you can continue on to angioplasty right there and then, if the need to do so arises.

    In the OPs father's case angioplasty would be the best way to go (from what I gather from the info posted), as it would not require the open-heart procedure and this would allow the wound site of his previous op to continue healing. Though it should be remembered that there is an extra factor of trickiness associated with the bypass grafts. A good analogy is a bypass round a busy city centre, it may still be tricky getting on to the bypass. Or look at your finger, curl a finger on your other hand into a semi cricle, then stick it on top of your straight finger like this -


    If you imagine the tube travels up the artery then has to hang a right into the graft then hang a left back into the original artery you can see its trickier than normal. However this is nothing problematic to an experienced doc. They may want to wait a bit to for the grafts to heal better and become better anchored to the original tissue also, before stressing them.

    Think I have some pretty pictures somewhere in my files on this comp that might help you visualise the process better, I will have a look for them.

    Same point to the previous poster, angioplasty is a relatively simple operation and you can be up on your feet in a few hours in some cases. Personally, I would prefer it to just medication, but, thats just my mentality, "fix it now, dont give me anymore drugs"! Also, the chances of anything going wrong in an angiography/plasty, whilst they exist, are very small. Unless you have a really ham-fisted doctor who pushes the tube out your nose! Luckily they arent the sort of doctors employed for these ops, even in the NHS. Ive been in hundreds of them and have yet to see anything major go wrong.

    Also, try to shop around if you have several hospitals near you. It can be done. Look for a large cardiac investigations unit, large CCU ward, large cardiac theatre department and so on.

    Hope that clears everything up.
  11. Thanks for the info, Cuchulainn.

    I've assimilated a fair bit of information over the past few days on anything containing the word angio, so I'm pretty much up to speed on it now insofar as I need to be. We'll just have to see what tomorrow brings.

    To clarify, Seal_Master, I wanted information so a) I can do some research myself to quell my fears and take the whole situation out of the unknown a little bit and, b) so I can ask questions on monday to ensure I help my father get the best treatment options from the best staff.

    Thanks for the extra information you provided and thanks to you and Rackcatchplunger for your good luck messages. :)
  12. Glad to hear that you have been in hundreds of them and have yet to see anything major go wrong, okay are you saying if you local hospital NHS trust etc hasn't got a large CCU ward (mine only has 4 beds) a large cardiac theatre department (staff on CCU called it a box room) and any bypass ops are done in another town out side the local NHS trust around 1 - 2 hours away (subject to traffic).

    If this is the case should l have some major concerns about their ability to carry out the angiography let alone anythings beyond that?
  13. Nah, angiography is a pretty straightforward op. Its "keyhole" surgery. It can be carried out under only a local anaesthetic and it can be done as a day op. Its really nothing to worry about. There is always a very slim chance of something going tits up, but, you should only worry when you have won the lottery!

    What I said about the unit department is a good guide. Locally, I worked in 2 major cardiac units, the head of one was on a course at the same time as newbie me and came at the bottom (oops) the deputy head of the other came near the top, and the people from his dept where much nicer (especially the girls). I know which one I would chose.

    Like anything, its probably marginaly better to have someone who has done the procedure 1000s of times as opposed to someone who has done it 100s, but, for something like angiography/plasty I wouldnt particularly worry, it is very much "routine" in nature.

    In conclusion Im not saying that a small unit is useless (quite the opposite may be true, because it is small) but, like anything in life being forewarned is forearmed. Its not that difficult to question a few people about the time they have had in the same situation (loads of help groups out there) and there is always info about on various trusts.
  14. Just to update you all, my father had *three* stents put in today at Heartland in Birmingham and has been told with cautious optimism that the problem should now be fixed. He has another angiogram in 3 months time to reassess the situation, but he seems to be feeling better already.

    Thanks again for all your posts, Gents. Much obliged. :)

    I'm off to get two pizzas, a greasy kebab and a case of wife-beater to celebrate.
  15. Don't forget the Capstan Full Strength Chalky!

    Chuffed for you and your dad. He'll have to give up the skateboarding now!