Dad needs triple heart bypass - please advise!

[DiamondsAndRust]

In a real quandary at the moment, so any advice at all would be gratefully received. After tests for mild chest pain and mystery weight loss, my 74-year-old dad has recently found out that he needs a triple heart bypass fairly urgently. Bit of a shock all round, as he has none of the risk factors for heart disease (smoking/obesity/diet etc) and other than mild 'indigestion-style' pain and the weight loss he had no symptoms - doctors were assuming it was linked to his digestive system rather than his heart. Turns out his heart's a bit of a mess, and it's only his underlying fitness that has prevented him from having a heart attack (he's had a few general health issues but is generally wiry and robust).

Today he received a letter with the date for the operation - 12th March. The very good, experienced consultant he's seen previously has a 3-month waiting list, and advised it might be better for dad to enter the 'pool' of patients to be picked up by other consultants. However, the consultant he's now been allocated doesn't appear on the hospital trust's NHS choices statistics (which run from 2009-2012) and, having down a bit of digging, it looks as if he only recently qualified as a consultant, and has consequently not done that many of these procedures. It also looks as though he did not train in the UK.

Mum and dad are now very unsure how to proceed. We're particularly concerned as my dad has an elevated surgical risk due a mild stroke 10 years ago, so for obvious reasons we're anxious that the consultant he ends up is competent and confident doing this kind of procedure. However, without the official NHS statistics it seems we have nothing to go on. We don't mean to be picky about the consultant, but obviously it's a major procedure, and we want the outcome to be as little of a gamble as possible.

Anyone been in a similar position re choice of consultants/hospitals? I'd really welcome any tips on how best to proceed, any further questions we should ask and any additional information or statistics we should look at in advance of the operation. The hospital trust is Bart's, with the operation taking place either at Bart's itself or the London Chest Hospital, so any advice on/experiences of either of these would be great too.

Thanks in advance for any help!

Bumping for you. Quite tricky and I have no real advice. My dad had a aortic heart valve replacement at 79 and is fit and well now at nearly 86.
For me it would depend on how urgently he needs the operation - as the risk of waiting is also high.

Thanks for the bump! I agree: it's a tricky one. My hunch is to hold out for a more experienced surgeon but it's hard to know really. The doctors have described dad's case as 'urgent' but also said most consultants have waiting lists of around 3 months. The fact that this one can do it in 3 weeks is good insofar as it reduces the wait, but doesn't fill me with confidence (short waiting list= less competent/sought after surgeon?)

One thing you may want to have a look at is theEuroscore, which is one of the tools cardiac surgeons use to quantify the risks of surgery. It gives you a bit of a better idea of how much your dad's previous stroke will have increased his risk.
The questions I would be asking are about:
1.the surgical method used(Off Pump CABG vs conventional on pump CABG). It is thought that "off pump" surgery has a lower risk of stroke compared with "on pump" surgery.

1. Does he need Carotid dopplers to establish the level of disease in the arteries supplying the brain with blood.

With regards to the level of experience of the pooled surgeon - ime "new" consultants are very cautious about preparation of their patients for surgery - after all it reflects badly on them if they have a v high mortality rate with such a small number of cases under their belts. They also are mentored by one of the more senior surgeons who would be available for an opinion if required.

Just saw your other post - a short waiting list isn't indicative of a lack of competency, more that he/she is new to the Trust and therefore hasn't had time to build up a waiting list.

Hi Diamonds, I have no advice about your Dads consultants etc. but just to say my Dad had a triple bypass when he was 78yrs old and that was 7 years ago and he's doing very well, he will be 85 in July. He was under the NHS but sent to a Private hospital in Dublin to get him off the waiting list, he was only in hospital for 6 days and discharged home.

I remember before the operation he was undecided about going for it as the Dr's had to be honest with him and say they couldn't guarantee a good outcome. I felt so torn as he was asking advice and I wanted him to make the decision himself to go through it, it was a very stressful time so I know how you are all feeling.

The British Heart Foundation were very good for me as I was looking for answers and advice, I gave them a call and got a lovely person reassuring me. I wish your dad all the best and I'm sure he will do well xx

DiamondsAndRust so sorry to read about your Dad, I know what a shock this is as we went through the exact same thing this time last year.

My Dad suffered a very mild heart attack, he actually thought it was indigestion at the time. It was only my DM insisted that she phone the GP and subsequently the hospital for an ambulance that this was discovered. Following tests it was found that he needed a triple heart bypass and maybe extra stents fitting at a later date as his heart was so bad .

I can't help you with regard choice of surgeon as my Dad was kept in hospital and told be would be sent to 1 of 3 hospitals, so no choice.

I can tell you that it has made the world of difference to my Dad. He didn't realise until after the op how ill he had really felt.

Please look after yourself and your family as it really does knock the stuffing out of everyone in the family

Hi Diamonds, so sorry to hear your dad has to go through this. My own dad is 73 and is also waiting for a triple heart bypass sometime within the next 8 weeks. He had one 25 years ago but I am much more worried now he is older. I know he is nervous too so I am being as positive as I can whenever we speak about it.

One think I will say is that the hospital care will be excellent I am sure - the surgeons who carry them out are so skilled in what they do. They see it as a routine op now, they told my dad this. That scared me as it is major surgery but also helped put my mind at ease a little that so many are done now and they really know what they are doing.

I will come back to this thread to check in how you are doing and we can keep each other company up until the ops!

Thanks so much for all the responses - greatly appreciated, as it often feels as if you're flailing about in the dark with these things, and reassurance/advice has not exactly been forthcoming from the health professionals we've been involved with - difficult to speak to get in touch with the same person more than once, and we haven't even managed to speak to the surgeon's secretary yet, despite having left messages.

As far as I can tell it seems to be a case of him turning up at Bart's for bloods etc to be taken this week, and then having the op itself done on the 12th March, assuming he decides to proceed with this surgeon. He won't have had any contact with the consultant prior to that, which seems a bit odd, but then I really have very little experience of the NHS. Seems very unlike what you see on TV, when everyone sits down for a cosy chat beforehand, but I suppose this is the real world!

Obviously no one can give 100% guarantees of a positive outcome, and we're not asking for them. I'm sure the consultant is appropriately qualified and skilled, otherwise they wouldn't be in the job, but all we're really after is a bit more information about his record, which so far doesn't really seem to be readily available. On the one hand people we've spoken to at Bart's (not the medical staff themselves, as they're impossible to get in touch with, but the ward managers/people who timetable the operations etc) keep telling us 'Well, if it was my dad I'd want to find out X, Y and Z', but on the other hand no one seems prepared/able to answer the questions we do have.

I've heard lots of people say that the op makes a real difference to overall quality of life, so I just keep thinking of that and looking on the positive side. Will check the Euroscore data (thanks for that eyestightshut) and will check back here if and when we have any more info. Thanks again for all your help - much appreciated!

OK, one last question - a friend of mine, who is a GP, advising me to search for my dad's consultant on the GMC. He's registered (here since 2000, originally qualified in India in the 1980s) - but he's not on the specialist register. What does this mean? I'd assume all fully-qualified cardiac surgeons would be registered as such? Might be way off, but it's ringing alarm bells to me.

Have you had a look on here? scts info