Which is more risky, heart bypass surgery or valve replacement surgery?

Oh, your father has coronary heart disease and myocardial infarction. Coronary angiography showed a wide range of lesions, and all three main branches of coronary artery had lesions. Of course, you also have some typos, such as lad, which means left anterior descending branch. Your father is the two main branches of the right coronary artery rca and the left coronary artery, lad and lcx, both of which have lesions. lm, the main artery of the left coronary artery, is ok. Even the branches are extensive, even the left-handed branch and its branches, and a blunt branch om are blocked.

Therefore, it is necessary to consider coronary artery bypass grafting (also known as bypass) in cardiac surgery. Interventional surgery is not suitable for such a large range of lesions.

At the same time, your father's massive myocardial infarction led to the formation of ventricular aneurysm, that is, the infarcted part was weak and partially protruded under pressure. This kind of ventricular aneurysm is an important factor that can lead to cardiac insufficiency, and it is also easy to form thrombus locally. In addition, the existence of ventricular aneurysm can easily lead to intractable ventricular arrhythmia.

According to the echocardiography, the cardiac function has indeed decreased, the left ventricular ejection fraction ef45% is lower than normal, and the left ventricular short axis shortening index fs has also decreased by 23%. In addition, the left ventricle is enlarged to a certain extent, and the diameter of the left ventricle at the end of diastole is 57 mm Therefore, this kind of ventricular aneurysm needs surgical treatment.

So for your father, it is coronary artery bypass grafting (heart bypass) and ventricular aneurysm surgery. From the simple description of your echocardiography, there should be no need to change the valve, because ventricular aneurysm itself is a factor leading to mitral regurgitation, which can occur at the attachment site of mitral papillary muscle and lead to mitral regurgitation. Therefore, only mitral valvuloplasty may be needed for reinforcement.

As for how to further look at the ventricular aneurysm itself, it should be decided by the cardiac surgeon according to the situation, whether it is a simple standard linear repair or geometric reconstruction surgery. As I have already said, your father has three lesions. Of course, it is generally necessary to bypass these three lesions. In addition, both your father and the branch of left circumflex artery have pathological changes, so the specific treatment depends on the specific heart surgery.

Because the left ventricle has enlarged, which affects the heart function, so I think this operation is still a positive measure. If treated conservatively, I'm afraid it's hard to work.