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Friday, July 12, 2013

A Funny Thing Happened on the Way to Cardiothoracic Surgery

So I had my appointment today at KU, Mid-America Cardiology. This was for a second opinion about my scheduled triple bypass to be done this coming Tuesday. I was pretty well resigned to the bypass, but I was frustrated that there didn't seem to be a better way. The interventionist who did my cath didn't think you could stent my blockages, and when I asked the cardiothoracic surgeon about a hybrid approach where you bypassed the LAD with a more minimally invasive procedure (MICS, I'd read about that online) and then stented the rest, he launched into a dog and pony show about how in my situation his fix was the fix.

I'm sure he's a very competent, experienced surgeon, but I needed to hear this story from someone independent. That old cliché about how when you're a hammer everything looks like a nail, well, he's a cardiothoracic surgeon.

So today's visit was with an interventionist, and he's another kind of hammer or maybe he's the screwdriver who's bound to see everything as if it were a screw. He told me the bypass by open heart was an entirely reasonable approach, he knew of the surgeon and thought well of him, that I'd be in good hands.

He also thought he could stent my blockages, and told me how you overcome the difficulties of bifurcations and whatnot. He also told me the percentages as far as the likelihood I'll be back for more in a few years, which isn't insignificant when you open up three or four blockages. So the bypass is more for-sure, but also much more invasive. I'm young enough to be a likely candidate for a second bypass later, so that's a reason against open heart, but there's a significant chance with just stents I'll be back for more stents or bypass again in two or three years.

In other words, nothing is perfect and I have options. Then he said there's a third option, a sort of hybrid where they'd do a bypass, hook my mammary artery to the LAD with a robot that goes in between the ribs, minimally invasive bypass, MICS; then after I've healed a bit from that, go in and stent me up everywhere else.

I was on guard against hearing just what I wanted to hear, but I wasn't prepared to have the second cardiologist actually propose my own idea.

Turns out the MICS thing is pretty new, so the drawback is there's not a lot of long range data for this method of bypass. The bypass itself is nothing new, the doc said he'd seen patients thirty years out that still had great results with that, but doing it by remote without splitting the sternum is only a few years old. But I'd get the benefits of the mammary artery bypsss to my LAD, likely a lifetime fix, but with a shorter recovery time. Stent the rest and with a little luck, if I'm careful about meds, diet and exercise, there's a good chance I could keep my sternum intact many years to come.

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