Aortic Valve Replacement for a 76-year-old Woman

[TBeats]

Hello,

My family and I need to make a decision on whether or not to give the surgeons an "OK" to perform this surgery on my Grandmother. She is 76 years old and had heart surgery 10 years ago. Neither me nor my family have ever dealt with such a huge decision like this before, and I thought that maybe you guys may have a few helpful comments, suggestions, or maybe some advice?

Basically, they say that the mortality rate is 10% (905 that she'll come out "OK") if she goes through with the surgery (doubting that a bit), and that if she doesn't go through with it, she has a 50% chance of living through next year. My parents are convinced that considering her age, and the fact that she's had heart surgery before, and from what she's heard from another doctor, that chances of her surviving the surgery are slim to none.

So is there anything you guys could recommend? I mean I know that anything can happen, but considering all I've mentioned here, would it be wise to go through with the operation? Would it matter if we got a second opinion? Any help with this would be greatly, greatly appreciated as we have to make a decision soon. If you have any questions (or if I've forgotten to mention something), please feel free to ask.

Thanks in advance!

 

[Karlynn]

It's really hard to say, since we don't know what your Grandmother's physical activity level is, nor her mental ability. I do know that the older I get - the younger 76 looks. My father-in-law is 90 and has just recently reached the stage where they do not want to do surgery on him. What heart surgery did she have 10 years ago?

Is there a reason the family feels they should make the decision for her rather than her making it herself?

And 2nd opinions when the choice isn't clear are a very good idea.

 

[BDMc]

I would get at least 2 opinions from surgeons. I don't know her condition, or have the knowledge to judge this kind of thing, but I can tell you there are folks in their eighties that have done well with OHS. All the best, Brian

 

[olefin]

It would depend on her present health. Heck, she's just 2 years older than me. I would try surgery again if I needed it. I would not have said that for the first five years after having AVR.

When I had AVR, I was only 55, my wife met several families of 80 year old men. They were going home after 5 or 6 days. I was there for 20 days.

Like others have said, get other surgeons opinions.

Wish you the best.

 

[Mary]

When I had valve replacement, my roomate was an 86 year old woman who had her valve replaced when she was 75. She was back because of an aortic anuerysm and was arguing that she DID want to undergo another surgery.

I know this doesn't answer your specific situation, but it does represent one edge of the spectrum.

What does your grandmother want done? I personally don't think anyone else should be allowed to make this decision for her.

 

[TBeats]

Wow, thanks so much for the quick replies.

It's really hard to say, since we don't know what your Grandmother's physical activity level is, nor her mental ability.

Her physical ability is extremely limited. She has a very hard time walking so she's pretty much confined to her home/chair for the duration of the day.

Her mental ability on the other hand seems fine. She understands (for the most part - 7/10) what you're saying and answers accordingly, but she is an immigrant to this country and also is not very educated.

What heart surgery did she have 10 years ago?

Bypass.

Is there a reason the family feels they should make the decision for her rather than her making it herself?

Well, I hope this doesn't come off the wrong way, but we feel as if we can make the better decision. She's scared to go through with it and we don't want her fear of an operation to be the cause of her early demise. We want to come to the best decision possible and then explain it to her in detail in hopes that she agrees to go through with it.

 

[TBeats]

I would get at least 2 opinions from surgeons.

How exactly does one go about getting a second opinion? Does my grandmother need to be with us when we get that second opinion or can we ask for the paperwork from the current hospital and take it to the hospital we want the second opinion from?

 

[TBeats]

I would not have said that for the first five years after having AVR.

According to the Dr., she definitely needs it.

Like others have said, get other surgeons opinions.

Thanks for the inside story and advice, we will most definitely get a second opinion.

Wish you the best.

Thank you!

 

[TBeats]

What does your grandmother want done?

She doesn't want to go through with it.

The surgeon says that she is (these are his --exact-- words) "very sick!" Are we to sit back and do nothing because my grandmother fears an operation? I don't know. If it was a simple root canal, fine, but it's life or death we're dealing with here and I'm not sure if she's understands the severity of the situation. And if she does, then I would assume her fear of the operation is clouding her judgment? I don't know. It's such an incredibly tough call. I feel helpless in a sense and don't know what to say or do anymore.

 

[TBeats]

Spoke with the surgeon and he recommended something new: The Balloon procedure. He said that the mortality rate was slightly less than that of the valve replacement (3% instead of 10%) and that it would allow her to 6-12 months before she encountered similar problems. Problem is, she will encounter the same problems again. So still a tough call.

My grandmother is hard of hearing and doesn't speak English, and one thing the Dr. said that really took me back was this: He said that someone needed to be there 24 hours a day to translate for my grandmother. They only have 3 surgeons/nurses in that hospital that speak my grandmothers language. Is this the way it's done? I told him that it didn't sound very practical and is probably impossible for us to do considering our schedules. Have any of you dealt with such a thing before? I don't expect them to accommodate our every desire, but a language barrier I would assume is a common thing that an established hospital should have control of? Or am I off on this?

 

[dick0236]

Hello,




Basically, they say that the mortality rate is 10% (905 that she'll come out "OK") if she goes through with the surgery (doubting that a bit), and that if she doesn't go through with it, she has a 50% chance of living through next year. My parents are convinced that considering her age, and the fact that she's had heart surgery before, and from what she's heard from another doctor, that chances of her surviving the surgery are slim to none. As you say, It's a tough call, especially if it will have to be frequently repeated.



!

You do not mention what type of surgery she had ten years ago or what type of surgery is being considered today. Is it a valve replacement, bypass or something else? How is her current health? If she is otherwise healthy and there are no unusual circumstances, she should do fine.

I think the 90% survival rate is accurate. Her age, if she is otherwise healthy, should not be a concern. I'm 73 and if I was told to have a reop today (my surgery was 42 years ago)' I would have no qualms about surviving surgery.

I had a golfing buddy undergo surgery (he had a valve replacement) two years ago at age 76 and he is doing fine.

And last, but not least, how does your grandmother feel about all this?

There were a number of posts that came in while I was typing mine, so I've added a little....
...you mention "balloon procedure". I beilieve they are suggesting a bypass operation. If so, I don't think its that big an operation and she should be out of the hospital fairly quickly.

 

[Lynlw]

Spoke with the surgeon and he recommended something new: The Balloon procedure. He said that the mortality rate was slightly less than that of the valve replacement (3% instead of 10%) and that it would allow her to 6-12 months before she encountered similar problems. Problem is, she will encounter the same problems again. So still a tough call.

My grandmother is hard of hearing and doesn't speak English, and one thing the Dr. said that really took me back was this: He said that someone needed to be there 24 hours a day to translate for my grandmother. They only have 3 surgeons/nurses in that hospital that speak my grandmothers language. Is this the way it's done? I told him that it didn't sound very practical and is probably impossible for us to do considering our schedules. Have any of you dealt with such a thing before? I don't expect them to accommodate our every desire, but a language barrier I would assume is a common thing that an established hospital should have control of? Or am I off on this?

Since a doctor is mentioning a ballon procedure I would ask about the trials for valve replacements by cath. Then she won't have the same problem in a year or less.

 

[ALCapshaw2]

Hello,


Basically, they say that the mortality rate is 10% (905 that she'll come out "OK") if she goes through with the surgery (doubting that a bit), and that if she doesn't go through with it, she has a 50% chance of living through next year. My parents are convinced that considering her age, and the fact that she's had heart surgery before, and from what she's heard from another doctor, that chances of her surviving the surgery are slim to none.

So is there anything you guys could recommend? I mean I know that anything can happen, but considering all I've mentioned here, would it be wise to go through with the operation? Would it matter if we got a second opinion? Any help with this would be greatly, greatly appreciated as we have to make a decision soon. If you have any questions (or if I've forgotten to mention something), please feel free to ask.

Without more specific details, it's IMPOSSIBLE to make a comprehensive recommendation.

It would be helpful to know exactly what her Heart Problem is.

I *assume* she has a valve problem since that is the focus of this website.

Which Valve is diseased?
What type of disease? (Stenosis, Regurgitation / Insufficiency)

Did she have an Echocardiogram?
If so, you need to get a copy of the report and read it until you understand it (we can help with that).

I see a HUGE disparity between the prognosis from 'the doctor' (what kind?) and the expectation of 'the family'.

What exactly lead your parents to believe that her chances of survival were "slim to none"? The 10% mortality / morbidity number quoted to you / family is pretty much a "standard risk factor" for second time Heart Surgery. It is usually LOWER when performed by Experienced Surgeons at Major Heart Centers, especially if the surgeon has experience with re-do's and the elderly.

We have SEVERAL members who have had 2 or 3 or 4 Open Heart Surgeries and are Still Kicking. We have several members who have had Heart Surgery in their 60's, some in their 70's, and every once in a while we hear of a patient in their 80's.

Member "Marty" had his Valve Replacement in his 70's, still works half-time (as a Radiologist M.D.) when he isn't playing golf.

It would help to know what part of the country your mother lives in so that we could direct you to some of the Better Heart Hospitals in your area. I expect that what your mother needs is "No Big Deal" for the Top Heart Centers. They see similar cases every week (maybe even every day).

'AL Capshaw' (CABG and AVR survivor)

 

[Lynlw]

Al, The first line says Aortic Valve Replacement for a 76-year-old Woman

 

[ALCapshaw2]

Al, The first line says Aortic Valve Replacement for a 76-year-old Woman

AH SO, Out of Sight, Out of Mind.

The Subject Line had scrolled off-screen when I focused on the posted text and questions from TBeats.

 

[Lynlw]

How exactly does one go about getting a second opinion? Does my grandmother need to be with us when we get that second opinion or can we ask for the paperwork from the current hospital and take it to the hospital we want the second opinion from?

Unless you are completely in charge (legally) of her medical decisions, I can NOT imagine a 2nd opinion doctor, letting you come to the appt and not the patient. Also For 2nd opinions you need actually CDs or tapes of the procedures doneand not just the paperwork. Once you decide who you want the 2nd opinions from, you contact them and see exactly what they need, and then the patient fills out the forms from the place that has the records and has them sent.
I've taken care of all my sons medical decisions since he was a day old and needed heart surgery, all of his doctors know we always get the records ect, BUT as soon as Justin turned 18 HE had to sign the forms not me, so I would imagine it works the same way for a parent, as long as they are legally in control of their lives THEY have to sign the forms. They also can sign HIPPA forms so you are allowed to talk to the doctors also, but they have to decide that

 

[TBeats]

You do not mention what type of surgery she had ten years ago or what type of surgery is being considered today.

Apologies for the vagueness everyone. She has Aortic Valve Stenosis.

She had bypass surgery ten years ago and is considering Aortic Valve replacement today.

 

[TBeats]

Since a doctor is mentioning a ballon procedure I would ask about the trials for valve replacements by cath. Then she won't have the same problem in a year or less.

What exactly does "trials for valve replacements by cath" mean? And how does that differ from a regular balloon procedure?

Thanks!

 

[abbanabba]

Her physical ability is extremely limited. She has a very hard time walking so she's pretty much confined to her home/chair for the duration of the day.

If she needs an aortic valve replaced, this could be largely impacting on her physical well-being... although that could also be due to her age (and any other physical impairments she may have additional to that, such as hip problems, etc).

I also agree you should seek out at least one or two second opinions (and don't be surprised if they vary) to help give you more information. If they all agree there is only a 10% mortality rate, then surgery is probably a good option - however, at the end of the day the wishes of your grandmother really do need to be considered.

Clearly she needs to understand the pros and cons of the surgery and if it will significantly improve her quality of life or not. If it is only giving her extra years without improved quality of life, is it something she should go through? This is something you need to find out from her surgeons and cardiologists. If she has other physical impairments, how will that affect her ability to recover from surgery? If she's not likely to be cooperative with this aspect, it will certainly make the whole process much more difficult for her.

This is obviously a difficult decision to make and I wish you good luck with it.

 

[TBeats]

Which Valve is diseased?

Aeorta.

What type of disease?

Stenosis.

Did she have an Echocardiogram?

She had an angiogram. Assuming that's different from an echocardigram?

What exactly lead your parents to believe that her chances of survival were "slim to none"?

All of the things I've mentioned (her age, not-so-good health, that she's had heart surgery before) PLUS the fact that a local Doctor told her so. Now they (my mother and uncle) are being a bit paranoid and thinking the REAL surgeons are "exaggerating" the survival rate "just to make money." Sounds like a really bad sitcom, but it's the truth.

It would help to know what part of the country your mother lives in so that we could direct you to some of the Better Heart Hospitals in your area.

That would be incredible, but would these highly regarded facilities accept medicare/medical insurance?

We are located in the Unites States. Chicago, IL, to be exact.