Mortality rate after aortic root replacement (elective)

Hi,

Today I learnt that my application for life insurance has got declined, because they sent a letter to my cardiologist stating that the best case mortality risk after elective surgery for the replacement of aortic root, is 60% 5 year survival rate........

My cardiologist sent a letter back and told her that he does not know where she obtained the figures from, but this is extremely pessimistic.

Are there any articles to support better outcomes than this? As a possible future candidate for replacement, I got a bit anxious reading this, although I can see that my cardiologist has actually told her that she is talking rubbish.

havnt had it done so cant say but that sounds wrong to me, am sure others will come along and tell you more

themalteser said:

........My cardiologist sent a letter back and told her that he does not know where she obtained the figures from, but this is extremely pessimistic......

..... I can see that my cardiologist has actually told her that she is talking rubbish.

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I like the way your cardio put it.....rubbish. Sound like you got hold of a very new, very stupid insurance underwriteer. It is fact that heart valve patients may have a difficult time getting life insurance shortly after...or before surgery and policies will almost always carry a "rated up premium", but it is available. Often, you can get standard rated, guaranteed issue plans thru employers or fraternal organizations. You just have to spend a little time looking.

If her 60% 5year rule was even close to being true, there would be a lot fewer takers for this surgery.....and a lot fewer folks who have celebrated many anniversaries far beyond 5 years......What "RUBBISH". I like that word. Here in the colonies we would just say it was "BULL-****".:tongue2:.

Uninformed, ill trained and clearly wrong.......

She had no intention of allowing the insurance and one can speculate she pulled whatever dramatic number out of the air she thought would make her point.

However, it is more usual than not to be refused the coverage with any open heart issues. Best chance of through employer if that is an option for you.

http://asianannals.ctsnetjournals.org/cgi/content/full/14/6/462/F1
http://www.cardiothoracicsurgery.org/content/4/1/17
and from the UK http://circ.ahajournals.org/content/116/11_suppl/I-301.full
(... 1-year, 5-year, 10-year and 20-year survival were 85.2%, 77.1%, 70% and 59.3%, respectively.)
Google says....."bull!"

I like it, bullshit haha! That's good...... Well I do think that this is absolutely crap, I would love to complain against her, but feel like I'm going above my cardiologist head if I do..... her name is Alison turner and she is in LinkedIn as a senior medical underwriter with legal and general. I thought that the survival rate is the same as normal population, after such surgery..... I am p,eased that my cardio wrote back to her.....

Would you complain?

themalteser said:

I like it, bullshit haha! That's good...... Well I do think that this is absolutely crap, I would love to complain against her, but feel like I'm going above my cardiologist head if I do..... her name is Alison turner and she is in LinkedIn as a senior medical underwriter with legal and general. I thought that the survival rate is the same as normal population, after such surgery..... I am p,eased that my cardio wrote back to her.....

Would you complain?

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Can you appeal? If so I would, my guess would be her stats are outdated and came from the majority of people who had their surgeriers in their mid/late 60s and 70s and older, so it was probably pretty close to the ave lifespan anyway, and not young otherwise healthy individuals like your age group.

"so it was probably pretty close to the ave lifespan anyway"

In fact the 100 year mortality rate at birth is near enough 100% statistically to call it that!

themalteser said:

Hi,

Today I learnt that my application for life insurance has got declined, because they sent a letter to my cardiologist stating that the best case mortality risk after elective surgery for the replacement of aortic root, is 60% 5 year survival rate........My cardiologist sent a letter back and told her that he does not know where she obtained the figures from, but this is extremely pessimistic.

Are there any articles to support better outcomes than this? As a possible future candidate for replacement, I got a bit anxious reading this, although I can see that my cardiologist has actually told her that she is talking rubbish.

Click to expand...

(Side Point: "Elective Surgery" -- What a ridiculous description of valve replacement surgery -- though the definition many of us received from our insurance companies -- as if we had a choice in the matter. Besides, it's not a surgery you particularly want to wait to go through as an Emergency.)

Anyway, Maybe that "extremely pessimistic" information Might be true (or it might not be) over a certain age for the valve recipient. But not generally for a younger person with no other significant illnesses.

We also realize that valve longevity comparison studies can be inaccurately understood because of the age of the recipients. If a 90 year old gets a mechanical valves and then dies at age 92, that two-year survival rate is counted somewhere.

Yeah, I sat in the hospital libary reading up on all the clinical trials for my Bicuspid aortic valve issue and got pessimistic.
I would take the risks with a grain of salt but seek out the healthiest lifestyle you can find for your condition. Even if the mortality rate is true there are people in the medical field working to make the situation more hopeful in the long run. Stem cell treatment may be on the market sooner than we can blink.

I have had no insurance for a while and a third party "medical advocate" solicited me in the hospital gaining access to all my medical history without doing a thing for me. I ended up wasting months until I realized they weren't doing what they claimed when I signed the paperwork. Regardless of your insurance status demand the best possible care. I thought I was being looked after. Wrong. Paperpushers are vermin.

I'm now approved for MaineCare however, I could have used it when I was released from the hospital after a mild heart attack needing guidance from a physical therapist.

The paper shuffle is enough stress to kill a heard of elephants. People have offered to help and the suggestion to fight human services by appealing three times by my doctor and several other patients kind of shocked me. Why put a person whom is sick through this B.S. !!!

I wear imaginary sideshields to blind me from this type of behavior.

Keep in mind western medicine isn't the end all and be all. Her is a quote from a White house commission in 2002:
“The White House Commission on Complementary and Alternative Medicine Policy states that conventional medicine is not addressing chronic illness and diseases (WHCCAM 2002). The focus has been on interventions and not wellness and health promotions that have been left to the individual. The Commission says the focus should be on physical, mental, spiritual, and emotional aspects of disease prevention, which are not being adequately addressed by orthodox Western Medicine.”

Certainly seek out groups that address your emotional well being albeit meditation, health related, acupuncture, massage or something that addresses positive outcomes for your emotional stability and stress levels. That is what is important. Your happiness and well being.

"Keep in mind western medicine isn't the end all and be all."
Not at all. It is the only medicine which deals effectively with plumbing problems such as we valve patients all suffer though. Where it falls down is in the associated treatment of concurrent problems such as anxiety and depression.

Even today, life insurance companies still deniy cardiac patients even without any procedure being done at the time of application. They can legally decline all cardiac patients. Even though there is more success rates on all procedures you could have done in a livetime and survive and life a normal live, life insurance never sees things the way we do. This has been a fact for many years. When I was a child back in the 70's, my mother tried to get life insurance on me after my bypass repair. They refused till she did manage to find one who took me. It is still a struggle to do so in this day and age of more advancements in medicine. So, you have to keep looking for one that will give what you want. Cardiac patients are not the only ones they can refuse. So we are all in the rock and a hard place for life insurance. Have a great holiday and hugs for today.

Yeah this is absolute rubbish. I've spoken to many many surgeons and cardios and they say that after avr replacement + root the survival rate in some studies has been just below the average population. In fact i was worried when my surgeon told me i was getting my aortic root replaced. He told me there were no difference in survival rates to Avr only surgery and some studies suggest the survival is higher than avr alone. Clearly endocarditis, stroke risk, post op issues bring the survival rate down compared to the normal population but if your op goes well with few complications and you maintain a healthy lifestyle there is no reason not to expect to live 20,30,40+ years. In fact for under 50s the 20 year survival rate is around 88%, slightly under the average population. My surgeon wanted me to have a mechanical valve because he said this would last forever and if I kept having tissue valves then I would need them replace every 5-10 years (he also noted this was a bad idea!). So he isn't expecting me to go anywhere soon.

Interesting! After my husband was laid off from being a general superintendent, he got insurance training and certified. He thought I could get life insurance, and I was amazed, as I have had 3 surgeries including 3 av redos and ascending aortic graft done twice. I didn't have life insurance at age 34 when I had my 1st surgery. Well, I have life insurance now, without a medical exam! I had never even tried to get it before because I assumed I would be turned down. But, I was wrong. And I even had to answer "yes" to one of the 5 questions, concerning heart rhythm irregularities.
So go figure.

This is from the extract I posted on your other post- this is o ly from a small study but when I email him he said this data was very true to his experience and that valve conduits are pretty much indestructible.
Results: Overall hospital mortality was 2.9% (n = 6), and stroke rate was 1.9% (n = 4). Risk factors for adverse outcome (death or stroke), which occurred in 4.8% (n = 10), were presence of clot or atheroma (p = 0.02) and age older than 65 years (p = 0.05). During a mean follow-up of 5.9 years (1,200 patient-years; range, 5 to 18 patient-years), no patient required ascending aortic reoperation. Long-term survival was 93% after 5 years and 89% after 10 years. Discharged patients enjoyed survival equivalent to a normal age- and sex-matched population and superior to survival reported for a series of patients with aortic valve replacement alone.

Conclusions: In patients with BAV, the Bentall procedure has an operative mortality no worse than that for aortic valve replacement, with superior long-term survival and a lower rate of aortic reoperation.

You have to separate valve-related mortality from over all mortality. Over all, patients whom undergo AVR may have the relatively poor survival noted by the insurance company, but that is because many are elderly, have other cardiac disease, such as CAD or other chronic diseases such as renal impairment, emphasema or diabetes that kills them while the valve remains perfectly functional and has nothing to do with their deaths.

Thank you all for your time to post, this is extremely helpful. Your data, mark, shows perfectly what my cardiologist keeps reassuring me about, that after heart operation, the survival rate is equivalent to normal. Thank you for posting that data. I didn't realise, as per Bill's post, that insurance companies don't only use cardiac related deaths after heart surgery, but include all other deaths! That is so, unfair!

I have wrote a letter of complaint against the medical underwriter, not because my application was declined, but I feel that she was extremely unprofessional in quoting outdated data. I hopeI did the right thing, but I was stewing on it since I received the letter from my cardiologist. My complaint went to the ombudsman who control insurance companies and all other sorts.

Yeah, I think on paper survival is lower because clearly more things can go wrong but at the same time a lot of what can go wrong is down to the patient. Although problems can still occur, good inr management, lots of exercise, healthy eating, dental hygiene and awareness of fevers etc lowers complications significantly. Id go on what your cardio has told you, he has no reason to lie to you and knows a hell of a lot more than an incompetent person sat at a desk looking at insignificant data.

The corrolary to my statement is they need to look at you individually. The aorta repair itself does not effect your life expectancy significantly. If you are otherwise healthy with no other chronic disease, you are going to have a life expectancy similar to other healthy people. If you have other chronic diseases, you will have a life expectancy similar to other people with those diseases. The problem is that the bulk of the population in studies of aorta repair or valve replacement have other underlying chronic diseases as well. Insurance companies are usually very expert at assessing risk and have actuaries who understand this and analyze out the various factors affecting life expectancy. Try another insurance company.