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Question
Posted by: Des | 2005/07/27

Unstable Angina

Hi Doc,

My dad is 70 yrs old and has unstable angina. The doctor says he has 3 blockages and needs a triple bypass. He has never had a heart attack, he only had a mild stroke about a year ago and has blood pressure and diabetes. The doctor says his heart is good. Do people at his age go for this kind of operation and is it feasible at his age?

Thanks

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Dear Des,

Yes and yes. We have operated successfully for blocked arteries on patients up to 90, who are otherwise in good shape. If your Dad has good kidney, lung and liver function, and is in good general health, then there is no real problem. As regards the heart specifically, the feasibility of surgery will be assessed by the surgeon. The factors affecting his decision will be, amongst others, the actual anatomy of the coronary arteries, the functional capacity of the heart, the availability of grafts (ie. does he have good veins in his legs which can be used as grafts, or has he had varicose vein surgery before?) Diabetes is often associated with small coronary arteries : if his arteries are very small ( eg <1 – 1,25mm) then even if bypasses are done, the grafts may not remain functional for very long, as these small arteries have insufficient flow to keep them patent longterm. The cardiologist may then discuss other treatment options with your Dad, though clearly he feels that surgery is the best option. However, as already implied, the final decision re the possibility of surgery rests with the surgeon.

Despite his hypertension and diabetes, if he is well, then he should be assessed by a surgeon now rather than later, by which time his heart function may have deteriorated beyond the stage acceptable for good-outcome surgery.

I wish him well.

HeartDoc

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