Can anything else be done to help my husband?

[nancywppw]

My husband is 69 years old and has had a triple bypass operation (1999) that provided him no benefit at all.  The grafts collapsed right away.  Later he had 14 stents placed in his LAD over the course of a few years.  He has had scar tissue removed from the stents 25 times over the past 12 years.  His most recent visit to the cath lab on Oct. 31st revealed that his LAD is 100% occluded.  His doctor told him that collateral flow is keeping him alive, and that there is nothing more to be done.  My husband's energy level is extremely low, and he spends most of his time resting.  He can barely take care of the basic tasks of eating and showering.  He quality of life is greatly diminished.  Can anything be done to help him?  Whom should I contact for a second opinion?  

[CCF HeartMD6]

Your husband certainly has a very complicated cardiac history -- which by your descriptions, sounds as though he has failed most conventional therapies (bypass surgery, PCI, etc).  If his LAD is completely occluded and supplied by collateral vessels, it will be important to ensure those vessels supplying the blood flow remain healthy/open as they are the primary source to his heart. Further interventions from this point forward would depend primarily on a battery of test results (ejection fraction, stress/viability testing, metabolic stress testing) and his clinical history (presence/degree of angina, heart failure functional class, etc).  Potential options would include intervening on the LAD via a chronic total occlusion approach (CTO) (if viable) which is often only performed by a highly experienced operator, usually at a tertiary/quaternary referral center.  If he is having significant heart failure, evaluation for advanced therapeutic options may also be indicated (mechanical assist devices, heart transplantation) if there are no other available options to improve his symptoms such as optimizing his medications and/or strategies to improve his rhythm and/or LV function (Bi-ventricular pacing).  Evaluation for this would also be performed at a similar institution as mentioned above.  I would speak with your primary cardiologist/physician to determine whether or not these are options that should be pursued and for a referral to a center that can provide further assistance in the evaluation (such as Cleveland Clinic). Unfortunately, it is not only difficult, but impossible, to make that determination over the internet alone.

[nancywppw]

Thank you SO MUCH for taking the time to think about my husband's situation and give us such a thorough and thoughtful answer!  You are so kind!  Your answer gives me some hope that my husband could regain some of his health in the future if he gets the right medical care!  I am going to print out your answer and my husband will take it to his cardiologist appt. next week  when they will be discussing my husband's future medical care.  

One more question, if you don't mind...my husband was told that he is still alive because of the development of "collateral flow" to his heart.  Is it possible that his body will make even more of this collateral flow in the future?  We are hoping for that to happen, because we believe he could have more energy if he had more capillaries supplying blood to his heart.  Are we correct?  Thank you again and again!  :-)