95 % probability of repair

[westie]

in august 2006 i was diagnosed with mitral valve prolapse and moderate to severe regurgitation and was advised by the cardiologist that it was unlikely to be repairable.

in august 2007 the cardiologist advised it may now be repairable and that the regurgitation was now severe and referred me to a surgeon who advised that there was a 95% certainty of repair and that had always been the case; this guy having large experience in this proceedure.

both of them said mechanical valves and warfarin were terrible things which does not exactly fill me with joy as i may still end up with them in february next year.

so if my condition is so repairable, why do so many people end up with valve replacements? how many people here went into theatre with a 95% certainty like this and still came out with their valve replaced?

the practical consideration here is that i could get the operation 100% free in a public hospital but would have no choice in surgeon, i may get the best in the world or someone with very little experience in valve repair; and everythings points to the need for a suregeon with large experience. so i will pay nz $32,000 and go to a private hospital with the surgeon of my choice but still may wake up a full member of valvereplacement.com!

 

[Bridgette]

Hi Westie

I am a Kiwi too.

Your post is interesting - it's strange that the doctor initially said that your regurgitation was moderate/severe and had little chance of being able to be repaired, but now it is graded as severe but is highly likely to be repairable???

I would have thought that as your valve's condition worsened the LESS likely a repair would be?
Maybe they have new information on your valve eg a TOE?
Or, on rereading your post, it sounds like the surgeon knows a lot more about the valve than your cardio....

I have a mechanical On-x mitral valve, and am on Warfarin, and both these things are not "terrible" at all, in my experience.
Who is your surgeon? You can p-mail me if you like and I can tell you about my valve replacement experience.

Bridgette

 

[sknydave]

Not all surgeons think repairs are a good idea or even have the knowledge/skills necessary to perform such repairs.

 

[Karlynn]

If you are going to have a repair, you want a surgeon who has done hundreds, if not thousands of repairs. If you don't, you have a good chance of it not working and ending up back in surgery within months or a few years. Because of this, I don't know that you'd want to go the "luck of the draw" route with the free operation.

As far as mechanical and warfarin go - this just demonstrates to me the lack of knowledge of the doctors that told you this. I'd be very suspect about anything else they told you, including whether or not your valve can be repaired.

 

[betterway]

Also, all repairs are not created equal for the mitral valve. I did not know there was different types of repairs. My mitral valve was in bad shape..Barlows disease...borderline for repair. I didn't know this prior to surgery but I really wanted a repair over replacement. I did know that both leaflets needed to be worked on and that was more difficult. My surgeon used a repair that was called the Alfieri technique with an annuloplasty ring. This repair is probably going to last in the ten year area +- . Another type of repair for a less damaged valve is called the Carpentiers technique. This repair technique has been used much longer and has much longer lasting results...some lasting 20 years and going strong. This is the durability of the repair I went into surgery expecting and hoping for. I only found out this when I asked for a copy of the surgery report at my follow up with the surgeon. I then went on line to research the Alfieri techique. My surgeon did say 10 years ago a repair of my valve would have been doubtful without using this technique.

My point in saying this, looking back at the toll my surgery has taken on me, I would have would taken any option to postpone another surgery. I would now have highly considered a tissue valve with all the advancements that have increased their durability, since I was not ready for a mechanical. Be sure to ask your surgeon how he is planning to repair your valve; with what technique. B

 

[Adrienne]

Repair techniques

Repair techniques

Betterway, you have piqued my interest. Would you clarify to me what the Alfieri technique is. I presume that the Carpentier technique is the most common way, that is, cutting out a section of the posterior leaflet and attaching the other two sections together. If I am wrong, tell me.

I also have Barlow's Disease as well as calcification which the surgeon said is probably in large part because of my having endocarditis in 2004.

I am very interested in this because my surgeon was planning on doing the more classical type of repair. There was more calcification than he first thought though, so he did a type of repair where he used Goretex to replace ruptured cordae. He put on an annuloplasty ring right over the calcium on the annulus.

My surgeon told me that he explects this to last at least 20 years, but I don't know if he's saying this just because he is proud of his handiwork or what. In any case, I would be interested in knowing what the Alfieri technique is.

 

[Adrienne]

Answered my own question

Answered my own question

Betterway, I just found a few articles on the Alfieri technique. That is NOT what I had.

 

[WayneGM]

Welcome to the VR community. Glad you found us. I had severe regurg and had my mitral valve repaired. So far, so good. I hope they are able to repair yours. Best wishes.

 

[betterway]

Hi Adrienne Hopefully this link will work for you. It's an editorial about repairing mitral valves with Barlow's disease from 2003. I found it quite informative. I wish I had read it prior to surgery. My surgeon was pretty straightforward about the ten years so I bet yours was too when he told you 20 years.
Bob

http://www.ctsnet.org/sections/innovation/valvetechnology/articles/article-10.html

 

[Adrienne]

Thanks, Betterway. It is an interesting article. It's too bad your surgeon didn't tell you in advance that he was planning to do the Alfieri technique and that it was not expected to last over 10 years. I hope you are the exception and that it lasts a long time.