Aortic Valve Repair or Replace

[lildebkay]

I had my 2nd opinion cardiologist at Froedert in Milwaukee today. He said that he feels my first cardiologist is headed in the right direction based on my echo and TEE reports. He wondered though why my cariologist doesn't want to repair my valve instead of replacing it. He asked me if I knew if there was calcification on my aortic valve and I have no idea.

Later in the day I had my original cardio. fax me the last ehcocardiogram report. I think the 2nd opinion doc didn't read carefully enough to see that the report shows severe aortic calcification. Maybe that is why my first cardio never mentioned repair?? I also have severe aortic stenosis I guess.

I just am confused as to which cardiologist I should go with. My 1st one doesn't seem as thorough. He never mentioned anything about repairing the valve (but maybe it is beyond repair and the 2nd guy couldn't tell that based on the echo report???) He also wants me to go to a brand new heart hospital which is scary too. He wants me to have catheterization (hopefully I spelled that right) done the day before surgery. He also made it sound like I wouldn't meet my surgeon until the time of surgery.

The 2nd cardio would want to do another echo on me and the catheterization as outpatient. He said this cath. will confirm whether I need the surgery and it will also check my arteries. He said then I would get to meet the surgeon and then we would schedule it.

I have so many questions I hope someone out there will have answers. How do you find out the credentials of the surgeon to know how many of these surgeries he/she has done? And what do you think happens more often, repairs, or replacements?

Maybe sleeping on this will help. I just don't know. The 2nd guy did say I wasn't in an emergency situation, but he said he would handle the situation expeditiously. He also bragged of his Harvard credentials and how their facility reads many more echos than the cardio I am seeing now. He did say my 1st cardio. is a reputable doctor and that the new heart hospital is state of the art, but every chance he got, he was bragging up his own staff and their practices.

Ok, enough said. Any comments about any of the topics above would be welcome!!

 

[catwoman]

Debbie:

How new is this "new" heart hospital? They should be able to provide stats on how many AVR (repair & replacement) they've had since opening.
Your insurance company's website may have some of this info, but it's usually a couple of years old.

I'm sure others will come on and give you some feedback on how to assess your 1st and 2nd opinion doctors.

Many surgeons go in with the hope of repairing an aortic or mitral valve. Mine did, but couldn't. Too much damage to the MV.

Good luck.

BTW, I'm a "cheesehead." I was born in Milwaukee. My dad was in engineering school there. Mom says that winter was very very cold! They moved back to TX when I was about 8 months old. I've been up there once, very beautiful, particularly around New Glaurus.

 

[epstns]

Hi, Debbie, and welcome to VR.com. I'm also in the waiting stage before surgery (we call it The Waiting Room), and I also have aortic stenosis. From what I've been told by two different cardiologists, stenotic aortic valves are rarely, if ever, repaired. The calcification is not removable, so they remove the calcified valve and implant either a tissue valve or an artificial valve. Both types of valve are well proven and have excellent results history, of course dependent upon the condition of the patient prior to surgery.

I'm sure, if you've been reading the posts here, that you've been warned that it is important to monitor your condition and perform surgery before any permanent damage is done to your heart, so do keep in close touch with your cardiologist.

Hang in there, find a cardio you can trust and feel comfortable with, and welcome to The Waiting Room.

 

[ALCapshaw2]

I find it strange that the cardiologists aren't willing to refer you to a surgeon for an initial interview. You may want to pursue a referal or do your own search and make your own appointment.

You can find ratings for Hospitals by Procedure on www.HealthGrades.com There is a website that has reports on Doctors but charges a fee. You may want to ask your primary care physician if he knows of a surgeon he would recommend.

I would also recommend that you obtain copies of your Echocardiograms. Look at the 'effective valve area' and the chamber dimensions (LAD, LVD, etc). Typically, Valve Replacement is recommended when the valve area is 0.8 cm sq or less. If the chamber dimensions are increasing, that indicates that the heart is enlarging and permanent damage can result if the valve is not replaced SOON.

As Steve mentioned, Aortic Valve Repair is not very common.

'AL'

 

[Nancy]

Hi Debbie-

Welcome to the site. Maybe the first cardiologist didn't mention repair of your aortic valve because replacement is what has to happen. I always like it when the doctor has read and understood all of the reports before Joe gets there. This is the person who will be taking care of your health based on what your tests and reports show. If no one is reading them or interpreting them or if something BIG has been missed, it leaves many ????? in my mind.

Think through things very carefully.

Best wishes.

 

[Tom F.]

The "repair vrs. replace" decision is very much an art. Some surgeons have never and will never attempt a repair, others are more experienced in performing aortic value repair. Those who do not do it typically never even mention the possibility. It all depends on the doctor. I had my aortic valve repaired in Dec. of 2002, and I am very happy that I had it done and not a replacement. But the funny thing is that I saw two very high level heart surgeons in Chicago, one the then chief of surgery at Northwestern Memorial, the other a top guy at Rush. The guy at Rush said, after looking at the TEE, that he could repair my value. The guy at Northwestern said he would not try. Very confusing and very disturbing at the time. In the end I had surgery at Rush. My doctor was Dr Robert March. Milwaukee is not far from Chicago, therefore I would urge you to at least consider coming down here and seeing Dr March for another opinion. E mail me at [email protected] if you want further info.

 

[carbomedic]

Debbie
I do not know if a bicuspid valve can be replaced. I am from your area and it seems that there is some major competition for our heart care in Milwaukee. The 6 o clock news has at leasst 2 to 3 commercials for heart care. I'm sure you have noticed. My cardio was recommended by my GP and I am very satified with her. Like you it was not an emergency but needed to be taken care of so my choice of surgeon and hospital was research by me. I took reccommendations and I think my valve replacement went well and I am satisfied with my choices. It is my opinion the having confidence in you docs and hospitial is key to this experiance.
I would be glad to share with you my "local" experiance with via email.
And, as mentioned before, welcome to the site. The knowledge and support you can get here is fantastic.

carbo

 

[lildebkay]

Thanks again for replies

Thanks again for replies

I did some research later after posting my original post. I found that aortic valves are rarely repaired. I have decided to stick with my original cardio. and ask lots of questions.

I am still undecided about the new heart hospital. It has only been open since October of 2003. I will have to call them to try and get stats.

I do have a copy of my last echo, but I forgot it at my mother's house. I know that I have severe calcification though. I will check out the dimensions.

My cardio's office gave me the name of my surgeon, and I hope to meet him soon. I will be having surgery in about a month.

Thanks again for your replies.

 

[bvdr]

Debbie,

We do have one member, Pillar Paul, who had an aortic valve repair this past year. You are right though, they are few and far between.

 

[Tom F.]

I had my aortic valve repaired on Dec. 20, 2002. This is typically done where an aortic aneurysm is found, but the native aortic valve is normal or near normal. This is not a surgery generally done where the aortic valve itself is diseased. Having said that however, some doctors are now beginning to have success repairing biscuspid valves, according to a few things I have read.

The repair procedure now performed today in most places was developed by Dr Tyronne David in Toronto. If you perform a Google search for "valve sparing" and "David" you will hit on all of the many articles that Dr. David (and others) have published regarding this procedure. The success rate is very high, and the surgery seems to also hold up quite well, with minimal re-operative rates.

The repair procedure is a complex one, and for that reason it is, like the Ross procedure, generally only done at major heart center hospitals. I had mine done at the Rush University hospital in Chicago, and it went quite well. If this is an option for you, please do not dismiss it.

 

[Raverlaw]

Deb,

My aortic valve is stenotic and calcified. The area measurement is .9 cm2. The cardio and surgeon both said that repair was not an option and that the valve must be replaced. They told me this after the echocardiogram, and then performed an out-patient angiogram to confirm their diagnosis and check the arteries as well. I am now in the "waiting room" and counting down toward Feb. 20, when I will get a St. Jude Medical artificial valve.

A hospital that opened in October of '03 will have a state-of-the-art cardiac operating theatre and CVICU. What you want to know is how long the surgeon has been doing VRs and how many he has done.

Good luck - best wishes - and do your research. I'm pretty new to this whole thing, having only been diagnosed as needing the valve in November, but there's lots of help available here.

 

[pillarpaul]

Debbie,

I am one of the very rare aortic valve repair jobs. For a variety of reasons, aortic valves generally cannot be repaired as opposed to mitral valves. My surgeon said he had done only five in almost 30 years. Mine was able to be repaired because when they got in there they found I had a great big hole in a leaflet. They were able to sew some felt onto it and put a pretty tight seal on. It'll probably only last as long as a tissue valve but I'll take it! Also, I don't think they can repair any valve if the cacification is real bad.

Incidentally, I got my master's from UWM. Loved that area right around there.

Paul