Should I have bypass surgery?

I know there are pros and cons concerning bypass surgery, but I'm having trouble sorting out the decision for myself.

My recent angiogram (done as a followup to an abnormal thallium stress test) revealed a totally occluded right coronary artery, a 70% occluded LAD and a 90% occluded left circumflex. My ejection fraction is 60%. I have very occasional mild angina on exertion. My resting electrocardiagram is normal. I'm trying to decide on CABG. Since I have mild symptoms, my motivation would be prolonging life (preventing an MI). Some sources say that CABG is only indicated in three-vessel disease if there is compromised left ventricle function, which is not the case for me. Others (including my cardiologist) say that CABG is indicated in my case.

My cardiologist told me that I have good collateral circulation (which compensates for my occluded right artery), but says that the situation with the LAD is dangerous.

I am 54 years old and work in an intellectually demanding job. I am concerned about the recently verified widespread and lasting cognitive side effects of CABG and would only want to do it if it will prolong my life. I am currently on a medical program. Very much appeciate any advise/guidance that others might offer. I am very confused about what to do.

Thank you, Dr. Chung. I have seen four cardilogists. Three agree on the bypass but the fourth thinks a medical program is all I need.

Stenting is out because the blockages occur at bifurcations and I have been told angiloplasty is therefore too risky.

I recently had a rubidium PET scan that showed 40% ischemia of the LV.

What would you advise based on this info and your experience? Also, how much of a problem is the cognitive impact of surgery?

Do all four cardiologists also do surgery? If so, you may not be getting an unbiased opinion. I'd suggest searching for "cognitive impact" of bypass surgery on Medscape. You're an intelligent man and can do your own research.

If you're willing to radically change your diet and exercise (assuming you're on a "western" diet now) I'd suggest trying to avoid the surgery. Blockage can be reversed in some cases. See www.niaspan.com Also - great source of info (free) is www.medscape.com (note - this is only my opinion - I'm not a doc)