[HSF] angiogram and Denying CABG

[Ani Anyanwu]

What happens to the patients you refuse? Do they have medical therapy only or angioplasty? If angioplasty then maybe refusal is not right term as based on your assessment of the angiogram angioplasty is preferred (for whatever reason). In most settings now, however, patients sent for surgery are those unsuitable for angioplasty, so if you turn them down then it means end of the road (unless transplant), that is assuming there is indication for surgery.
 
What is the LV like in patients you turn down?
 
In the context of severe LV dysfunction in patient presenting with heart failure, I think it is reasonable to turn patients down who have poor targets as chances of benefit are low (as good targets is a prerequisite for achieving recruitment of hibernating muscle). That such patients can have 1 mm vessels bypassed and survive a CABG (the surgeon's usual criteria of success) means nothing as many still progress in heart failure (and present to us needing a reop transplant sometimes within a year of CABG proofing CABG was a futile operation). 
 
For patients with preserved LV function, however, it would be most unusual to have coexisting coronary disease of such severity that is deemed inoperable.
 
Ani
 



> Date: Tue, 9 Oct 2007 20:44:11 -0700> From: john_pj15 at yahoo.com> To: OpenHeart-L at lists.hsforum.com> CC: > Subject: [HSF] angiogram and Denying CABG> > Are there any guidelines about what type of vessels should be considered not suitable for grafting based on angiography> I think there is lot of variation between surgeons in interpreting and accepting patients for CABG. Many times we note that vessels which were considered small by angiography are not so when we look at them on table.> > We refuse about 20% of the patients referred for CABG based on angiograms.> I wish to know what is the situation with others.> > > ---------------------------------> Need a vacation? Get great deals to amazing places on Yahoo! Travel. > _______________________________________________> OpenHeart-L mailing list> > Send postings to:> OpenHeart-L at lists.hsforum.com> > To UNSUBSCRIBE, to CHANGE email address, or to view archives:> http://mmp.cjp.com/mailman/listinfo/openheart-l> > All messages transmitted by the OpenHeart-L are subject to the policies and > disclaimers posted at:> http://www.hsforum.com/listdisclaim> -----------------------------------------
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