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June 23, 2000

Other Illnesses

Question from Kingsford, Michigan, USA:

Shortly after having a heart attack and bypass surgery 19 years ago, my father-in-law (now age 73) was diagnosed with Type 2 diabetes. He has now developed congestive heart failure and has had a second heart attack. We have been told that he is not a good candidate for a second bypass because of his diabetes. Why does diabetes make him ineligible for a second bypass surgery?

Answer:

That’s not correct according to the cardiologist I asked for further advice regarding your question. What your heart surgeons probably were referring to was a recent scientific paper, concluding that, as a first therapeutical approach, angioplasty performs better than bypass surgery in diabetic patients suffering from coronary artery disease. What needs to be considered when looking at treatment options is, most importantly, the presence of congestive heart failure, and also the anatomical site of the obstruction of the coronary vessels.

MS
Additional comments from Dr. Bill Quick:

The decision whether to do a major surgical procedure (such as coronary artery bypass, which entails opening the chest) or a relatively easier procedure (such as angioplasty, which can be done in a “cath lab”) is dependent on many factors, one of which is the presence of diabetes. Any patient facing this choice should ask to have his/her options fully explained in terms of both risk and benefit.

WWQ