Can I survive Bypass Surgery with a 15% Ejection Fraction

[Nealus]

This week's Heart Catheterization test showed that I have 2 - 100% blockages and 1 - 70% - but more importantly - an ulcerative artery.  My ECHO was - 15% EF

I've know that I've had CAD since my last Cath in '05.  Now it is a very serious problem with this ulceration.  I was not expected to survive - open heart bypass surgery - because of my low EF - back in '05..............Now - what do I do?  I'm in Bangor, Maine.  They won't take my case.

They suggest I go to Boston - where science might be better.  I'm on Social Security Disability..........since '03 with CHF.  My ECHO was 15% EF then.

Can I survive surgery with a 15% EF ???..........They are afraid that after being on a heart lung machine - they won't be able to re-start my heart.

So - how is it done?

Do you know of anyone - who has survived?  And can Surgeons help me?

I have Cardiomyopathy.........an enlarged left ventricule.  So even though I might survive bypass repair - I'll still have a low EF - but I've done well enough with that over the past 5 years.

I have: CHF, CAD, ICD, Atrial Fibrillation, Diabetes (Type 2) Insulin Treatment, Cardiomyopathy, Sleep Apnea, COPD, GERD
I had Pulmonary Edema - 3 times in 2008....Latest - January 8th, 2009

I am on: diltiazem, imdur, carvedilol (Coreg), lisinopril, furosemide, digoxin, NPH Novolin Insulin, Ativan, aspirin, prevacid    

Thank You all - for any and all input.

[nanaeliniko]

I would not trust anyone at Northeast Cardiology.  I unfortunately had a heart attack a couple of years ago, and because I am in central Maine Northeast Cardiology was the only game in town.  I was given three blood thinners and ended up back in the hospital bleeding internally.  My doctor also did not give me the medication I needed so within 11 months I had another heart attack, and almost died.  (The only thing that saved me was that I was in Lewiston so was taken to St Mary's, and they corrected my doctor's incompetence)  You need to seek help in southern maine or out of state.

[Jack54]

I am very humbled by your kind words. I also wish that I could send you the money for airline tickets to Cleveland. I wanted to add that there are 3 or 4 super hospitals in the NYC area for treating heart disease.

I failed to mention a life saving device that I am almost positive has been approved by Medicare. It is called a "left ventricular assist device (LVAD)" that was first developed for people awaiting a heart transplant. Now it's use has evolved into prolonging life and actually strengthening the heart. At first the heart weakened and became dependant on the device, but great minds fixed this problem to where it does strengthen the left ventricle. This could be a life saver for you, for sure. It does the work of your left ventricle which is known as the "big pumper". It circulates the fresh, oxygenated blood from your lungs to all of your body.

Again regarding finances; if you go online and book a flight 3-4 weeks in advance, the price of the ticket is really cheap. Round trip for you could be as low as ~$300. You can always change the "back to Maine" schedule, especially for medical reasons. Do you have a minister or have a close friend or a relative that has a minister? Churches often help people such as yourself. Try CASA, and all state and local services for help. Contact your local news, etc. Bug your relatives for a loan!!!

I also forgot to mention that the MIDCAB surgery is done through a small incision where a small part of your rib is usually removed. It is much different from the traditional Coronary Artery Bypass Graft surgery, or CABG where they completely separate the breastbone and sternum.

The LVAD or MIDCAB surgery could get your heart into much better shape, if later on you should have to have CABG. You need time now, and it is of the essence. You also need a cardiologist to do an inventory of all of your heart medicines to make sure none are conflicting. That is why I ask about your BP and heart rate, which are just great! That in and of itself means a lot. The latest and more expensive wrist BP monitors are much improved compared to the ones made a few years ago, but I think the ones that measure the BP on up the arm are more accurate.

Keep in touch, and I intend on reading your blog site :) Laugh and smile every chance you get! It helps to heal :)

My very best to you,

Jack

[Nealus]

Mea Culpa - Mea Culpa

Jack54.......You are a God Send.  Thank You so very much for your long post.  You realy are - an Angel in disguise.

Jack - see my recent post at this afibbers.org board - where I say: " I'll thumb to Cleveland Clinic "
Re: http://www.afibbers.net/forum/read.php?f=7&i=19046&t=18897#reply_19046

Seriously - I respect your input and feel CC is excellent.  But I have a few hurdles to cross.

Maybe - I could try a fund raiser [don't know how to do one] from my site.... aninchfrommurder.com/blog/

JACK.................

Re: "The most important thing that I have to say is that you need to get to the Cleveland Clinic ASAP. This hospital is #1 in the world for the treatment of anything to do with heart disease. These doctors can perform miracles."

***** I'm on SS Disability.  Don't know - who will pay for or get me to Cleveland

Now, your history of heart disease is confusing. You mention that back in 2005 that you found out that you had CAD, and it was thought that you could not survive CABG due to your very low EF.

You state that you have had CHF, which can be chronic heart failure or congestive heart failure. It appears that you have both, due to your bouts with PE.

JACK................

***** Yes - I was diagnosed with congestive heart failure - in '05 - and yes - my recent bouts of Pulmonary Edema - indicate chronic heart failure.

You are entirely correct.  I have both.

RE: "Do you know what caused your CHF (chronic heart failure)?"

JACK.............

************* Last year I was smoking.  I no longer smoke cigs since June 16, 2008.............when I was airlifted and on life support - for the heart failure/Pulmonary problems.

Cigarettes and drinking has caused my chronic heart failure.

Cigarettes are now out of the equation - but the most recent flare ups of PE - occured because of drinking.  So..........don't DRINK stupid !!!!

RE: "What is strange is that you do not mention any attempts at stenting any coronary artery blockages, even if you have ulcerated lesions."

JACK.............

************ What is more strange is the incompetence of Northeast Cardiology - Bangor Maine - who have been treating me - since '05 - and I will add - mis-treating me.

Can you imagine - that I met a Dr. Alice Passer in 2005 - who is no longer with Northeast Cardiology - Bangor Maine.  She happened to have performed the Catheterization on November 2005.  Instructed me - that I had CAD and 4 blocked arteries and showed me a diagram - and advised me to see a surgeon.............a Dr. Klemperer.  I consulted with him Xmas of '05 and he proclaimed - that I was inoperable.  That because of my 15% Ejection Fraction - he didn't think that he could revive me after being on a heart/lung machine.  He gives Doctor Passer his report.  Nothing else further happens.  I have not had a personal visit with " a " Cardiologist - from Northeast Cardiology - Bangor Maine - since - I had an ICD implant in November 2006.  I have had no replacement Cardiologist assigned to me - since Dr. Alice Passer left Northeast Cardiology.

Here I am - in 2009 - with no Cardiologist.

My Primary Care Physician [PCP] a Dr. Nadeem Ali - who I hold in very high regard - told me - after the diagnosis of CAD in '05.....It is not the end of the world.

But - I am having complicatinos now - because of the ulceration.

NO ONE told me to get a second opinion.

RE: "You also do not mention which coronary arteries are involved. This is very important information that you left out, if you want any advice or help."

JACK.............

**************** The diagram and the film and all the good stuff are being faxed and send to my PCP and I will get to see them shortly.

***** You make so many valid points and you seem to be - such a highly educated person.  God Bless you for responding.

JACK - You ask...................

"You also failed to mention your average resting blood pressure and pulse rate, which is very important information to know, especially due to all of the drugs that you are on."

I check my BP and Heartrate a couple of times a day - using what I bought at Rite-Aid - a Omron cuff system etc and I am very unsatified with it.  It never matches - when I bring it in to my Doctors office.  Only the HR is the same.

Today - I began at 124/76/83............................. 83 is my HR

JACK............... from what you say below - I want you to know - I have been given two choices.  Do the consult here in Maine and if they feel that they can't treat me - I can go out-of-state....................and - in as much as I grew up in Boston - and love the hospitals there.....I really should campaign - to get to CC.

I am going to post this at: aninchfrommurder.com/blog/

My website and blog

[Jack54]

The most important thing that I have to say is that you need to get to the Cleveland Clinic ASAP. This hospital is #1 in the world for the treatment of anything to do with heart disease. These doctors can perform miracles.

Now, your history of heart disease is confusing. You mention that back in 2005 that you found out that you had CAD, and it was thought that you could not survive CABG due to your very low EF.

You state that you have had CHF, which can be chronic heart failure or congestive heart failure. It appears that you have both, due to your bouts with PE.

Do you know what caused your CHF (chronic heart failure)? All of your data points to CAD as being the cause. CAD is the #1 cause of CHF (chronic heart failure, which can lead to congestive HF).

What is strange is that you do not mention any attempts at stenting any coronary artery blockages, even if you have ulcerated lesions.

You also do not mention which coronary arteries are involved. This is very important information that you left out, if you want any advice or help.

The reason being is that there is what is know as "minimally invasive coronary artery bypass surgery", called MIDCAB. It has been an option for a couple of years. This surgery is LIMITED to coronary arteries that are ONLY located on the FRONT of the heart. The most important CA is the "left anterior descending artery" or LCD.  We are so lucky in that it is located on the FRONT of the heart.

I have read that sometimes the left circumflex artery, or LCX can be bypassed also with MIDCAB, depending on the "target spot" and the CA anatomy of the heart.

This surgery is done many times without stopping the heart. Special "clamps" and drugs to slow down the heartbeat, beta blockers are used to minimize cardiac movement during this surgery. The heart can also be stopped while doing this surgery, by using the traditional heart/lung bypass machines.

These doctors are also able to insert stents when and where other doctors will not try it.

You mention 100% blockages. Obviously there is enough blood passing through these blockages to prevent you from having a heart attack. You may also have been born with, or developed "collateral" coronary arteries, that have prevented a heart attack.

If you could get just one blockage stented or bypassed, your EF would more than likely increase. You could spend some time recovering and work on getting your lungs to function better, by doing deep breathing exercises and using the device that you blow through to exercise the lungs.

You could use this recovery time to try your best to get into better physical shape for all out CABG (traditional surgery) if needed. You also need a new cardiologist to review your current medicines.

EF's do not always show how one feels overall. I have seen people with low EF's that feel good and work out regularly, and I have seen folks with almost normal EF's that cannot exercise.

You also failed to mention your average resting blood pressure and pulse rate, which is very important information to know, especially due to all of the drugs that you are on.

There is always hope for even the very worst cases of heart disease among us, but you must go to the CC where they are not afraid to treat you and save your life. I have been there two times, and I am from Alabama.

Attitude really affects your heart. The ativan may be suppressing your ability to achieve a mindset of healing. You must never give up.

[Nealus]

This place is pretty useless for getting any advice.

[Nealus]

Thanks Encephalomalcia

Your input is appreciated.

I see too - on WebMD - video of new procedures - relative to being awake during open heart.

Do Doctors/Surgeons actually visit this forum and make comments?

Nealus

[Encephalomalcia]

I am wondering if the surgeons could do your bypass through a catheter?  Open heart surgery would be an extreme high risk with the CHF, Diabetes, and COPD.  All organs have to be in perfect shape in order to be able to have the surgery and even then there is a risk.  The greatest fear would be to go into cardiac shock after surgery.  This is when the heart is not pumping blood to the organs and all organs shut down.  The patient is hooked up to machines and not breathing on their own.  If you do plan to have something done, have a living will in place so there is someone who can make decisions for you if you are not able to.  Check to see if you would be a good candidate for surgery through a catheter.  Surgeons I have spoke with have told me that in the future there will be no open heart surgery.