A bit fat cup of reality.......................

[JannerJohn]

Even in my woe and melancholy 'oh why me' posts I'm beginning to agree I need this surgery ( actually I have no choice obviously). I saw (somewhat unbelievably) my Cardiologist in person for the first time today (COVID restrictions), its been 7 months since diagnosis and I've seen the surgeons (Aorta vascular and valve) 4 months ago and I'm on their waiting list one is a Knight of the Realm. The irony is I asked to see the cardiologist face to face on the UK NHS and was told 10 weeks I said I would go private and saw him 10:30 the next day (Today). This was the first time I had actually seen the Cardiac CT Scans, Echo and Echo report and I must say it was very sobering seeing my aneurysm and calcified bicuspid-ish valve 0.94 area apparently but they are still not sure if its a bicuspid from birth or a fused tricuspid but the calcification shined out like a beacon from the echo. He gleefully told me these always get people in their 40s and 50s, "f#ck my luck I thought". The plus side is my ejection fraction is completely normal and there is no damage to the heart, the other valves are structurally normal and there is no coronary artery disease, he even said I could go to the gym and just not max out. The key fact is as he said the equation is 100% Mortality on one side or 98% success on the other and its a no brainer, ironically he had an infected emergency burst appendix surgery himself where he said the odds were a lot less.
So hears the rub I guess a. Be positive and mentally prepared. b. Be in the best possible physical / dietary shape pre-surgery these are what I'm in control of right? and c. Trust the surgeons and clinicians. I think my choice will be for a Carbomedics Mechanical valve the cardiologist said that should see me into my 90s (hmmmmmmmmm, well see point c. above). Somewhat interestingly the cardiologist said they no longer, at least for the last 4/5 years, fit mechanical valves at all in the over 70s as the preference is exclusively for tissue / TAVR or Valve in Valve solutions he said I'm in the most awkward age bracket and outside of explicit desire for a tissue valve or contradicting medical conditions for blood thinners mechanical was the logical solution. I did again ask about the Edwards Resilia valve and he as others have said to me reiterated that it is unproven I also asked about the On-x and he said that the UK regulators will not underwrite the lower INR and it is very bulky he also said during trials of the On-x with lower INR they had experienced several thrombosis events so stopped the trials. Its almost like he was implying that the valve manufacturers are praying on the fears of heart valve patients e.g. INR or tissue valve life.

Roger and out..................

 

[ATHENS1964]

Carbomedics valve were placed on me and as you can see in the link they give lower inr, my surgeon and cardiologist told me to be 2-3 with an ideal 2.5
https://livanovamediaprod.azureedge...a_bicarbon_family_ic0870001130-o.pdf?ext=.pdf

 

[BionicBuddy]

The key fact is as he said the equation is 100% Mortality on one side or 98% success on the other and its a no brainer,

Does anyone on this forum know of any studies that parse that 2% surgical failure into specific situations? You cannot compare a fatigued 75 year old with multiple co-morbidities (DMII, HTN, hyperlipidemia, etc.) with severe AS and aortic aneurysm, to a healthy robust 50 year old with no co-morbidities and only severe AS, for example.

Thanks in advance.

 

[pellicle]

Does anyone on this forum know of any studies that parse that 2% surgical failure into specific situations? You cannot compare a fatigued 75 year old with multiple co-morbidities (DMII, HTN, hyperlipidemia, etc.) with severe AS and aortic aneurysm, to a healthy robust 50 year old with no co-morbidities and only severe AS, for example.

I believe that the phrase "a paucity of quality studies" is used in almost every meta-analysis I've read.

I've got a good friend who used to make catheters for Cardiologists for a surgical instrument company. He and I regularly joke about studies. If the word medical comes up he usually says "oh, so N=1" or if I talk about some study in psychology he'll say "so, as rigorous as a medical study then".

Its sad ...

 

[Survived03]

"a paucity of quality studies"

In my field this was typically followed with “more studie$ will be required…..”. And around the circle we go. But a symbiotic relationship did benefit many.

 

[pellicle]

In my field this was typically followed with “more studie$ will be required…..”

oh yes, rule 1 of research: "further research is needed"

;-)

 

[Chuck C]

Does anyone on this forum know of any studies that parse that 2% surgical failure into specific situations?

Please see the study linked below.
Of the 5 factors mentioned in this study, which increase operative mortality, 2 are beyond the patient's control. But, the last three can be mitigated by the patient and his medical team getting the procedure done in a timely manner.

Risk factor:

-elderly- obviously beyond our control.
-female gender- again beyond our control
-symptom severity- this is an area which can be within the control of the patient. Get surgery before symptoms become severe. Better yet, get it before symptoms.
-Ejection fraction- this also is a timing issue. Get surgery before ejection fraction drops very much. If it drops too much, you are on the way to heart failure and mortality can be significantly higher in this situation and you risk not having ejection fraction recover.
-urgency- By my estimation, this is probably the biggest factor and is related to the two previous factors mentioned, in that it has to do with getting your procedure done in a timely manner without delay. Don't wait until the situation is urgent. Mortality can be many times higher if aortic valve surgery is done as an emergency, verses planned with your medical team.

"There are several risk factors that can increase operative mortality [2]. These risk factors include elderly, women, symptom severity, ejection fraction, and urgency [2]."

https://www.ncbi.nlm.nih.gov/pmc/ar...operative mortality is approximately,-8% [6].

 

[Survived03]

I recently found this presentation very useful as well. Dr. Nishimura explains the follow up of asymptomatic patients. I had the funky drop in blood pressure during stress echo just as the 54 yo asymptomatic man did during his stress echo. I will post this again when I summarize my actions and information gathered over the last 5 months.

 

[nobog]

I recently found this presentation very useful as well. Dr. Nishimura ..... the last 5 months.

Love the stethoscope (that's sarcastic...)

 

[Survived03]

Love the stethoscope (that's sarcastic...)

Yes, nice touch. He could have been naked and it would not have bothered me.

Dr. Rick A. Nishimura is the Judd and Mary Morris Leighton Professor of Cardiovascular Diseases and Professor of Medicine at the Mayo Clinic College of Medicine. He is a Master of the American College of Cardiology and Master of the American College of Physicians. Dr. Nishimura’s research areas have involved the field of cardiovascular hemodynamics. He has an active clinical practice with a particular interest in hypertrophic cardiomyopathy, valvular heart disease and pericardial disease. He currently serves as Chair of the ACC/AHA Valvular Heart Disease Guideline Committee and has been on the ACC/AHA Parent Guideline Committee. He has received the ACC Master Teacher Award, the American Heart Association Laennec Award, as well as the Mayo Clinic Distinguished Educator Award.

 

[pellicle]

Love the stethoscope (that's sarcastic...)

when dealing with the general public (to maximise your message) you need to understand the basics (he clearly does or at least his team does)

if asked later most people would probably not have identified "he was wearing a stethoscope"

The most obvious version of this issue is presented here


There are other better examples which are more subtle but then that would miss the point ;-)
https://www.npr.org/sections/health...ists-can-miss-a-gorilla-hiding-in-plain-sight

 

[pellicle]

Yes, nice touch. He could have been naked and it would not have bothered me.

indeed, I've been in Japan and Finland long enough to be comfortable with that too ;-)

 

[Survived03]

indeed, I've been in Japan and Finland long enough to be comfortable with that too ;-)

And now we take a "Sow-Nah"

 

[pellicle]

And now we take a "Sow-Nah"

I'm not a sauna kinda guy (as you can imagine growing up in a place where 38C 99.99%RH summers are the norm) but my wife was (Finnish).

I can say that on one occasion sauna did in all probability take me from needing medical attention to being fine.

I got hypothermia skiing back from a family lunch to the island we were staying at (family island with a small summer cottage). It was a nice -15C day but in trying to keep up I got fully sweaty. I had to strip off my upper layers to prevent them getting soaked (which would have been worse) but still got the sickness.

Anita packed me into the Sauna and then lit the fire and I heated up gently for 40min.

amazing stuff. Simple, but amazing.

The Finns have a saying: if you can't fix it with tar, vodka or sauna then its probably fatal.