Second OHS Surgery......

[Jkm7]

I've seen references here about special considerations/difficulties about having the chest opened a second time with a full sternotomy? I'm not sure I understand what makes for more problems? Is it because of possible scar tissue? Is there more risk? Longer or slower healing?

Thank you so much for all the help you have given me. I am so appreciative to you all.

 

[Georgia]

I suggest you take a look at the following: http://www.valvereplacement.com/forums/showthread.php?t=14330

Tobagotwo has offered several excellent discussions on choosing between a mechanical vs. a tissue valve.

I imagine others will be along to address this as well.

 

[geebee]

Speaking from my own experience, I almost died during my second surgery. There was so much scar tissue the surgeon had trouble opening a path to the heart. My pulmonary artery was cut during that process and it took 10 pints of blood to get me out of danger. He was a very renowned surgeon and knew what he was doing (over 500 surgeries/year) and he still had problems.
I was only given a 65% chance of surviving my third surgery due to this same danger. Luckily I had another very skilled surgeon who brought me through.
I also found recovery to be longer each time, although not more painful. It just took more time for my body to recover as the trauma seems to be compounded.
I am in constant a-fib due to atrium enlargement directly connected to the trauma of multiple surgeries. I think that covers it.

 

[Kate]

Hello!
Opinions about the risks related to second surgeries vary widely - partially because the risks themselves vary depending upon where you have your surgery, how experienced the surgeon is, your specific medical history and, to some extent, pure luck. The rule of thumb I was given at the Cleveland Clinic was that the risk roughly doubles with each surgery ( the risk of mortality I was given for my first was around 1% so, all things being equal, the risk associated with my second surgery would be 2%, third 4% etc.) However, the Mayo Clinic has recently published an article (I can probably track down the citation if you're really interested) claiming that their risk for second surgeries is no higher than their risk for first ones.

Of course, there are no guarentees with this. The problem with statistics is that someone has to make up the 2% (or whatever) that don't do so well. Also, I can't be certain what other health issues I may be dealing with for my next surgery. And there are other potential negative outcomes besides death (such as stroke or paralysis) which are unlikely but possible. However, that said, if you go to an experienced surgeon, your chances of doing well with a second or even third surgery are very good.

Regarding the actual surgery, my understanding is that it takes longer (do to the scar tissue) and that the time in ICU is also extended (two days or more rather than one). Hope this is helpful! Kate

 

[Jkm7]

Thank you for your responses. My first surgery was bypass. My second, if it keeps on the path I seem to be headed, will be mitral valve.

 

[Kate]

Hi again Jkm7!
I have a bad habit of forgetting that not everyone is an aortic valve person like me. Unfortunately, I think the base level of risk for mitral valve surgery is slightly higher than for aortic so don't pay too much attention to the actual percentages I mentioned in my post. However, I think the general concepts are the same for both. Kate

 

[Ross]

Kate is correct, it is slightly higher for Mitral's. Some people can go through repeat surgeries many times and don't really have a problem. Others such as Geebee and I, well it turns into a fight for our lives. Why this is, who knows for sure. If your first surgery went well, chances are good, so will your second. There just isn't anyway to forecast it.

 

[Andyrdj]

Recent improvements

Recent improvements

My surgeon informed me about 15 months ago that the risk for second surgeries was now around the same for first - although it does increase a bit for the third.

Given that Gina's op was around 25 years ago, I hope you feel more reassured!

I wonder also if there are techniques for determining possible complications for the individual? Can we use ultrasound to determine scar tissue, how well the heart has healed etc?

 

[RCB]

On more surgeries

On more surgeries

One thing a person can't avoid with more surgeries is that the older you are, the harder it is in general. My first and second were crude by today's standard, but I came back very fast because I was YOUNG. My third, surgery had advanced 20 years, but it was still difficult because of the scar
tissue. I was much slower to come back and I was only in my early thirty and in good shape. My fourth, done at one of the best heart centers in the world by one of the best heart surgeons in the world and they were put to the test by my case. Although, the parts were fixed, the plumbing was still
not up to par, because of all the re-operations.

One fact that always seems to be overlooked here, when considering "risk",
is what goes on day after day in the pre-surgery forum. There is where "the rubber meets the road!" In other forums I have heard people say that their own HVR surgery was "easy" or that they "wouldn't give another one a second thought"!
I just doubt that or maybe they have a unique definition of the English word.
Having been through 4 surgeries, I know the toll it exacted from me and all those that loved me (I know, it is hard for some of you to believe anyone could care about this curmudgeon) for months before and months after. I never thought I would die (but then I guess those that didn’t make it, probably didn’t think that either), but I knew there was a real chance; life is never taken for granted again, not be me anyway. HVR surgery before and after is one of those "events" that mere simple statistical calculations will never properly assess.

 

[RCB]

Surely you jest!

Surely you jest!

Some people can go through and don't really have a problem.

Can you name one? "repeat surgeries many times"

 

[Nancy]

Scar tissue, adhesions, tissue breakdown, being older, another time on the "pump", and possible additional medical problems can all add up as you go through subsequent surgeries. These are all things that vary from person to person.

Joe had three valve surgeries, two through the sternum and one using the HeartPort method, through his side.

He did well with all of them.

If he needed a fourth surgery, he would have to be in grave condition. He's been told that a fourth surgery for him, carries a morbidity, mortality rate of aomething like 80 percent to the bad.


Think of your heart like the small organ it is, and imagine having lots of scar tissue from cuts that have to be made. In spite of that all, a second surgery is usually similar to the first one.

 

[Ross]

Can you name one? "repeat surgeries many times"

Well let me look around here some. They "Say" they didn't, but I suspect that's hogwash.

 

[RCB]

Well let me look around here some. They "Say" they didn't, but I suspect that's hogwash.

To have a repeat, one has to have at least two surgeries- the second one is
a repeat. Many means more then several and several is at least three.

Who is saying they have gone "through repeat surgeries many times and don't really have a problem."?

I would like to personally shake their hand or at least send them a card!

 

[Ross]

To have a repeat, one has to have at least two surgeries- the second one is
a repeat. Many means more then several and several is at least three.

Who is saying they have gone "through repeat surgeries many times and don't really have a problem."?

I would like to personally shake their hand or at least send them a card!

Why you gots to get all technical and stuff and stuff. Your deliberately making it hard for me to come up with an answer aren't you?

 

[Jkm7]

Okay, folks.......you've got my head spinning. But I did ask for it, didn't I?

I suppose in the end what is the difference? What will be will be. Not like we do it for the 'hay' of it. We undergo these surgeries because we have to. If (when) this valve decides to gets to a level which requires surgery, there is 'No saying No', is there?

Keeping ourselves as strong and healthy as we can; taking as good care of ourselves as possible; enjoying the life we have and giving thanks is where it's at.

 

[Debbrn]

JKM7,

I have had 3 surgeries at this point and will most likely need a fourth in the next 5 years or so. I have meet a few on the achaheart.org website that have had more than that. I did not have any problems with my third surgery. I was a baby for my first surgery and was 6 years old at the time of my second.

One of the reasons that it gets riskier is the build up of scar tissue that they have to go through. The scar tissue increases that risk of bleeding.

Debbie

 

[Ross]

I suppose in the end what is the difference? What will be will be. Not like we do it for the 'hay' of it. We undergo these surgeries because we have to. If (when) this valve decides to gets to a level which requires surgery, there is 'No saying No', is there?

Keeping ourselves as strong and healthy as we can; taking as good care of ourselves as possible; enjoying the life we have and giving thanks is where it's at.

In a nutshell, you have this correct! There just isn't anyway to predict what the outcome is going to be. I wish they'd never ever started with percentages on this stuff. It's between your higher power and you.

 

[Nancy]

Absolutely. If it gets to the point that you need additional surgeries, then you need them. There is no substitute. Even in my husband's case. If he needs additional surgery, then he is willing to take whatever risk, since the risk of not doing anything could be even worse.

 

[Lynlw]

To have a repeat, one has to have at least two surgeries- the second one is
a repeat. Many means more then several and several is at least three.

Who is saying they have gone "through repeat surgeries many times and don't really have a problem."?

I would like to personally shake their hand or at least send them a card![/QUOTE

My son Justin had his 4th OHS last may when he was 17, I know we were blessed but it was one of his better experiences, his 2nd was when he was 18 months and he had fluid problems (pericardial) for 6 months, but that surgery and the way they had to reroute his heart is a tough one. last year he had his surgery on monday and went home on friday.

the who makes it thru surgeries and who doesn't i almost believe it's fate, but do say alot of prayers.

someone asked if they can tell if the chances of complications, some times you can many times you can't. we were 'lucky' enough to know beforehand that justin's pulmonary artery was fused to his sternum, (from caths the past few years)w/ scar tissue, so with a very good surgeon who was very careful Justin did well.
I know of another child whose heart was also fused to his sternum, but they didn't know it before so it was cut whele they were cracking his chest and he stroked and did not make iT
but you just don't know 2 people can have the exact same heart problems and be operated by the same surgeon and have completely different outcomes, Lyn mom to Justin the high school GRAD as of last night !!! new pic on homepage
www.caringbridge.org/nj/justinw in the journel history if you go to may 05 you can read about his surgery and what he could do when post op

 

[Lynlw]

i've wonderred

i've wonderred

Justin tends to make keloid scars, i often wonderred if there was a corelation bewttween big keloid scars on the outside and more scarring on the inside, lyn