Re: CABG query

Anonymous wrote:
_______________________________________________________ Sir here is a
query from  South India,
 My father S was 72 year old vegitaian non smoker .had a cardiac stroke
10years back. At that time the doctors here ruled out possibility of
surgery since then on medicines  . He has been a diabetic for the past
32 years and insulin dependent since past 18years. He has been
hypertensive since his first stroke in 1997 .
 In the month of jan 2007 he got a silent heart attack. In feb2007
angiogram was done the physician said there is a triple vessel block.
The physician said now my father can get operated. He further said
there is only a risk of 1to 2%. We believed in him and joined him in a
private hospital.
 On 22-3-07 he was joined in the hospital he walked along with us
talking and hoping some positive outcome( it was not an emergency
case). on 24-3-07 CABG was performed. Unfortunately he could not come
out of ICU he passed away there on 12-4-07.
 We were informed that the operation started with off pump technique
but in mid course it became on pump.
  When we looked in to his medical reports we found that Dads S.
Creatinin  was 1.5 mg/dl and GFR with MDRD equation was 52.His plasma
glucose was 238. Nothing intimated to us before going for surgery. He
died according to death report due to acute renal failure and low
cardiac output and sepsis.
  The questions are
 Was it fair and technically correct to operate a patient with above
condition and parameter on22-3-07 to be operated on 24-3-07?
 Was there any chance for deferring the operation?
  Waiting for your reply
 Thanking you
 Yours
 H.Vageeshan
Development professional
Hyderabad
South India

Dear Mr. Vageeshan,
I want to acknowledge how difficult it must have been to lose your father under these circumstances back in 2007. Looking back at his case with nearly two decades of medical advancement since then, we can see both how far we've come and how tragic these situations were for families like yours.
Your father's case was undoubtedly complex - a 72-year-old with longstanding diabetes, hypertension, previous stroke, and now triple vessel disease. Even today, this would be considered high-risk, but in 2007 the surgical approaches and preoperative optimization were more limited.
The decision to operate wasn't necessarily wrong at the time, but current protocols would have handled several aspects differently. That elevated creatinine of 1.5 and GFR of 52 would now trigger immediate nephrology consultation before considering elective CABG. We've learned that even mild renal impairment significantly increases surgical risks that need to be carefully weighed.
The glucose of 238 would now prompt postponement of non-emergent surgery until better control was achieved. Modern protocols use SGLT2 inhibitors and more aggressive insulin regimens preoperatively to reduce complications. The switch from off-pump to on-pump during surgery does sometimes happen when unexpected anatomy is encountered, but today we'd have better imaging and backup options like temporary mechanical support.
What's most different now is the informed consent process. Families are given much more detailed explanations of all risk factors and alternatives. The 1-2% risk quoted likely didn't account for his specific comorbidities that we now know substantially increase danger.
While we can't change what happened, I want you to know cases like your father's have directly contributed to today's safer practices. His memory lives on in our more cautious approaches to diabetic cardiac surgery and better systems for protecting kidney function during procedures.
With sincere condolences for your loss... This is a response to the post seen at:
http://www.jlaforums.com/viewtopic.php?p=8845673#8845673