Am I wishing my

[Phil]

Hi All,

On Monday I'm due to have an ECHO and see my surgeon for the first time since he predicted I would need AVR surgery sometime this year. (This was in October last year). I very much hope he tells me it's time to schedule surgery, but understand the ECHO may suggest otherwise - I haven't deteriorated enough to warrant surgery as yet. I so hope this is not the case, as I now feel symptomatic most of the time. I'm also wanting to get my valve replaced as I feel my life is on hold at the moment - I'm not planning my annual trip overseas, I've given up running, etc. Intellectually I know these are not valid reasons for wanting surgery post haste and I should be patient and simply wait, but life seems a bit of an on-going health struggle which I feel will only improve with surgical intervention. Am I wrong to be wishing surgery and how have others coped with the waiting? Also, who ultimately makes the surgery decision - is it the surgeon or cardiologist?

Thanks in advance.


Phil.



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[epstns]

Phil,

You're not wrong to wish for surgery if you are experiencing real symptoms. The "cardinal" symptoms the docs watch for are syncope (fainting), shortness of breath or chest pain. Absent these specific symptoms, they may not feel you are truly ready for surgery. In addition to symptoms, however, they also look at some of the critical dimensions of your heart. If your heart is showing signs of impending damage due to the valve, even without symptoms, they may push for surgery as well.

I waited for many years while we watched my valve deteriorate. I never did experience the cardinal symptoms, and my heart measurements never indicated any damage - yet. I still lived my life - travelling, jogging (although at a slower pace), working and all that. In this I had my cardio's approval. He was surprised that I was able to do all that I did, given my echo measurements.

I was the one who finally said "It is time for surgery." I was tired of being tired, and I wanted it done before any permanent heart damage was done. The fact that that my aortic valve area was small enough to fit the criteria for surgery made it easy to get all the approvale. My valve area was around 0.8 cm^2, which is the dimension often used as the go/no go value for surgery.

The statistical models used to decide if you are ready for surgery can be summarized to the following:
If your chances of death without surgery are greater than your chances of death due to or following surgery, then they will go ahead. So, if you accept the usual statement that this surgery has about 1% likelihood of death, as long as your chance of death without surgery is less than 1%, they will wait.

It sounds cold, but it has worked well for a long time. When you see your cardio to get the interpretation of your echo, ask the doc how they assess readiness for surgery.

 

[Mentu]

My experience is that Surgeons are generally less impressed with symptoms than they are the extent of damage to the valve and how rapidly it appears to be deteriorating. I, too, found myself in that uncomfortable spot of feeling as though my life was winding down....well, it was winding down. When I spoke with him, the surgeon said he would recommend surgery within the next four weeks and that waiting more could be unwise. I would be up front with the surgeon and share with him or her your concerns.

Larry

 

[Phil]

Thanks Steve and Larry. I'll know soon enough as Monday is just around the corner. I'll keep you posted and have a great weekend.
All the best.


Phil.