AVR #2 Update (Hockey Heart)

[Guest]

I had posted previously about my husband needing a second AVR surgery and Dr. McCarthy at Northwestern recommending a TAVR. After, testing and having the surgery scheduled, the team at Northwestern decided he is not a candidate for TAVR due to his anatomy, specifically the height of his left ventricle. Currently his velocity is 4.5, and Northwestern is pushing to have the mechanical valve surgery on April 8. As I stated previously, Dr. McCarthy did my husband’s first surgery and the recovery was uneventful. My husband played professional hockey in the minor leagues and the first time around McCarthy suggested a bio valve with the hopes of his continued hockey play and other lifestyle reasons.

This time around we have been less than impressed with the team and the suggestions we have received. We also met with Dr. Jonathon Somers from North Shore Hospitals. His opinion is my husband can put his work affairs in order and have the surgery the week after Easter. He is recommending a mechanical valve as well. We liked Dr. Somers and if he did the surgery he would be doing it from start to finish. At Northwestern, there is a good chance residents/fellows would be involved. Dr. Somers uses titanium plates as well as wiring to close. Dr. McCarthy uses wire. However, Northwestern is a top rated hospital for cardiology and obviously has a wealth of experience. So my question now is would you select McCarthy again just on Northwestern name and fact he did the first surgery or would you go with Dr. Somers who has provided us much more information and is more accessible. Any insight would be great. Thank you.

 

[ottagal]

Thanks for the update on your husband and I wish you both all the very best going forward. In my humble opinion, I would want to know who has the best track record and experience on a REDO AVR. Also, listen to your gut as to what makes the most sense to you and your husband and what will give you the best peace of mind. Take care,

 

[pellicle]

Hi

firstly I'd agree with Ottagal above, I think picking heart surgeon based on their "vibe" is fraught with problems. Surgeon personality or bed side manner is not relevant, his or her performance as a surgeon (results) and experience with redo surgery is primarily what you are interested (I doubt he'll be over for dinner much or having beers in the back yard ... so you're not picking a friend, your picking a professional.

Being an Australian I don't know your system well, but tom in MO has previously published links to hospitals and evaluations of surgeons which would be a good place to start.

...My husband played professional hockey in the minor leagues and the first time around McCarthy suggested a bio valve with the hopes of his continued hockey play and other lifestyle reasons.

which I'm sure was a sensible call at that time in the situation you were in. I've never faced those choices but my second OHS was my AVR which was when I was 28 and I got a homograft (I simply followed the surgeons advice as he'd been my surgeon since I was 10 and did my first repair).

However I'm encouraged to read that others who are professional in the area are now on this occasion recommending a mechanical for the redo ...

e also met with Dr. Jonathon Somers from North Shore Hospitals. His opinion is my husband can put his work affairs in order and have the surgery the week after Easter. He is recommending a mechanical valve as well. We liked Dr. Somers and if he did the surgery he would be doing it from start to finish. At Northwestern, there is a good chance residents/fellows would be involved. Dr. Somers uses titanium plates as well as wiring to close. Dr. McCarthy uses wire. However, Northwestern is a top rated hospital for cardiology and obviously has a wealth of experience. So my question now is would you select McCarthy again just on Northwestern name and fact he did the first surgery or would you go with Dr. Somers who has provided us much more information and is more accessible. Any insight would be great. Thank you.

I have no idea (and really what is your basis) of knowing if one hospital is better than another, I strongly suggest you pick based on results not (puffs chess and polishes fingernails) prestige.

As to wires vs plates I'm not sure there is much in it, although my surgeon on my 3rd OHS is renoun for using an extra blanket stitch at the high pressure point because he is concerned with dehisence (look that up) and sternal mobility after surgery (also a very bad thing). Plates are new so have less history but I believe that its likely with his build and activity that wire removal in the first or second year post surgery will be desired by him. I had my top two taken out in my late 20's (due to martial arts causing sternal flexing and it is a flexible bone by nature) and again in my last OHS due to infection.

The top two are gone now, but you can see what I mean about the blanket stitch

the valve is visible (just) in the left side as only the slim area where stitching is ...

Best Wishes

 

[DDT77]

Being in Chicago, I would look into Cleveland (or Mayo). 5-6 hour drive is not trivial, neither is a redo. It is not just the surgeon, but the entire crew inside and after the OP. PreOP is different than main stage and after, but similar culture likely exists among these three regimes.

Plates are great for the first few months. Had plates for my redo, and never felt any discomfort from coughing, sneezing, etc. Nice difference from 1st AVR with standard wires. Sternum often cracked (like knuckles) after first AVR, but for more than a year after second- no cracking, which would be uncomfortable. Started cracking again a few weeks ago, so all is well again... can feel plates distinctly, which can be odd.

 

[pellicle]

Being in Chicago, I would look into Cleveland (or Mayo). 5-6 hour drive is not trivial, neither is a redo. It is not just the surgeon, but the entire crew inside and after the OP. PreOP is different than main stage and after, but similar culture likely exists among these three regimes.

I want to vote that I totally agree with this, and since we are now discussing this post surgical (meaning in the hospital itself) infection rates are also something to examine too (I can speak a little to that myself).

Plates are great for the first few months..... can feel plates distinctly, which can be odd.

very interesting and informative feedback ... as I mentioned above the top wires were difficult for me in the first year (one of them started to pronate) and were eventually removed (talking about my 2nd OHS here). Now that you're at this stage do you feel the plates are more obtrusive (with the rest of your life) than the wires (given you've had both)?

This is only an abstract question as I'm pretty sure I don't want to be considering a 4th (a nice quick death might be preferable given all the factors in my case)

 

[Hockey Heart]

Thank you all for the great feedback! For those of you with titanium plates, does it bother you at all or have any long term I’ll effects?

i also sent a PM to Tom in MO asking about those links to evaluations of surgeons and hospitals. Does anyone know of any other resources for making comparisons of surgeons and hospitals related to AVR?

 

[tom in MO]

I don't know anything about ratings for doctors or hospitals other than the what is readily found on line. It's hard to find out statistics about a hospital that you can believe and is pertinent to your operation. I asked my surgeon how many operations he did a year and he didn't know, but estimated it was >100. I researched my surgeon and found out he was involved in clinical trials (TAVI) which was good but not a deal sealer/breaker.

Where I live there are two heart hospitals, and I chose number two based upon my past operations there, the fact they had a Quality System (Malcolm Baldridge Award), they are not-for-profit-religious, and past scandal in the heart group at the other hospital. The one I didn't chose advertises they are the best hospital in the area and are top rated hospital by USNews and World Report survey. Top rated though turns out to be a score of 67 vs. my hospital's 64. The hospital with the "better" ranking founded their current "state-of-the-art" program by attracting doctors from the other hospital. I also like hospitals that are not-for-profit over corporate or state facilities. Too much focus on money is not good for medicine. All hospitals advertise, but I like a hospital that advertises less.

I also searched my state medical records for the surgeon to see if there were any problems. I do that with any surgeon that will work on me.

I think Cleveland Clinic must be a "Mecca" but I know you can get state-of-the-art care at many other places. I wouldn't want to be 5-hours away for any operation, unless it wasn't possible where I live. I believe in the "non-tangibles" in health care and having friends and family near is helpful post-surgery in many ways. It keeps you motivated if things go south.

 

[DDT77]

very interesting and informative feedback ... as I mentioned above the top wires were difficult for me in the first year (one of them started to pronate) and were eventually removed (talking about my 2nd OHS here). Now that you're at this stage do you feel the plates are more obtrusive (with the rest of your life) than the wires (given you've had both)?

This is only an abstract question as I'm pretty sure I don't want to be considering a 4th (a nice quick death might be preferable given all the factors in my case)

For those of you with titanium plates, does it bother you at all or have any long term I’ll effects?

From my understanding there are wires in both cases (wires used to stabilize while plates are screwed in). Never had any issue or discomfort with wires 1st time around, even during sandlot tackle football. I think I have three plates, but can only notice one of them ('X' shaped), usually when one of nieces / nephews sit on me. There are other times where there is a tight feeling in this area. Only time plates bothered me is when trying to be a bit physical blocking out during basketball, did have a few bruises after one particularly rough episode in a few spots along sternum. It was not hockey...

Compared to sternum discomfort with wires alone, quality of life is much better with plates compared to wires. I think i could even sleep on side a few short weeks after 2nd OHS, couldn't consider same for months after 1st.

 

[Keithl]

I don't know anything about ratings for doctors or hospitals other than the what is readily found on line. It's hard to find out statistics about a hospital that you can believe and is pertinent to your operation. I asked my surgeon how many operations he did a year and he didn't know, but estimated it was >100. I researched my surgeon and found out he was involved in clinical trials (TAVI) which was good but not a deal sealer/breaker.

Where I live there are two heart hospitals, and I chose number two based upon my past operations there, the fact they had a Quality System (Malcolm Baldridge Award), they are not-for-profit-religious, and past scandal in the heart group at the other hospital. The one I didn't chose advertises they are the best hospital in the area and are top rated hospital by USNews and World Report survey. Top rated though turns out to be a score of 67 vs. my hospital's 64. The hospital with the "better" ranking founded their current "state-of-the-art" program by attracting doctors from the other hospital. I also like hospitals that are not-for-profit over corporate or state facilities. Too much focus on money is not good for medicine. All hospitals advertise, but I like a hospital that advertises less.

I also searched my state medical records for the surgeon to see if there were any problems. I do that with any surgeon that will work on me.

I think Cleveland Clinic must be a "Mecca" but I know you can get state-of-the-art care at many other places. I wouldn't want to be 5-hours away for any operation, unless it wasn't possible where I live. I believe in the "non-tangibles" in health care and having friends and family near is helpful post-surgery in many ways. It keeps you motivated if things go south.

So I am new here and 5 days from my surgery. I was diagnosed in 2007 with bicuspid aortic valve and aneurysm of around 4.2 then. At first they read the echo wrong and scared the crap out of me telling me I needed surgery ASAP. After the CT they changed their story. I have been tested every year since then and this year was my time. Since I have had over a decade to prepare for this I was pretty sure I wanted to go to Cleveland. When I looked at the scores for hospitals nothing in Atlanta got over a 52 out of 100. Sure I want to be near home and get home quickly from hospital, but I can’t argue with how good the reputation of Cleveland is. My surgeon in Atlanta had no good reason for me to do it here other than I should not trust the ratings.

I reached out to Cleveland and the initial interactions were first class white glove. They spent hours talking to over the last few months answering every question and walking me through the before and after expectations. The national mortality rate for this surgery is 3.9% and the last year Cleveland has stats from they were 1% and .3% the year before. Sorry my life is worth the inconvenience and I am fortunate that I can afford to travel there to have it done. My insurance covers it in network and Cleveland is a class act. All the billing is via them, not all these different bills from different organizations.

I am 58 and while scared, have accepted this has to be done. I am fortunate that I am in general good health, exercise and eat reasonably well. The aneurysm was 5.1 so it was the deciding factor as my valve is decent with an EF of 55%. I hope to share my experience here in a week or 2 as I recover.

As for valves this forum has been extremely valuable in me deciding on a mechanical valves as I want this once and only once and a fissure valve guarantees me another valve in 10-20 years and TAVR stats are not good enough to think I would trust that as my option when I am 68-73 years old.

From what I have read on this forum I am hoping they use the On-X, but clearly the St Jude has a stellar reputation as well.

Thanks to all those that have shared their stories here this has been amazing reading.

 

[user 16827]

5 days and counting.....

we will look forward to hearing off you from the other side
St jude here too ........

Best wishes, and enjoy the ride , honestly, drink in the experience

 

[Keithl]

What is surprising is how calm and collected I am. I am sure night before and morning of will be different, but I guess I will see.

 

[DachsieMom]

Best wishes. St Jude for me - I was 41, 4 years ago. Still going strong.

 

[ottagal]

Thinking of you and sending positive vibes and best wishes for a smooth recovery. It will soon be in the 'rearview mirror'. Hang in...

 

[Bikes!]

You are in excellent hands at Cleveland Clinic. Good Luck. Surgeons and Staff are very good.
And as you say, very low mortality rate at that hospital.

55 years old. Aortic Root Replacement at Cleveland due to 5.5 cm aneurysm - I did not need a valve, they re-implanted mine. Prior to surgery I had elected to have a mechanical valve if needed so that I would not (potentially) require a second surgery down the road to replace a bovine valve.

Last month did a 100K bike ride over in California. Planning a 100 mi ride on the anniversary of the surgery (June).

 

[Bikes!]

I had posted previously about my husband needing a second AVR surgery and Dr. McCarthy at Northwestern recommending a TAVR. After, testing and having the surgery scheduled, the team at Northwestern decided he is not a candidate for TAVR due to his anatomy, specifically the height of his left ventricle. Currently his velocity is 4.5, and Northwestern is pushing to have the mechanical valve surgery on April 8. As I stated previously, Dr. McCarthy did my husband’s first surgery and the recovery was uneventful. My husband played professional hockey in the minor leagues and the first time around McCarthy suggested a bio valve with the hopes of his continued hockey play and other lifestyle reasons.

This time around we have been less than impressed with the team and the suggestions we have received. We also met with Dr. Jonathon Somers from North Shore Hospitals. His opinion is my husband can put his work affairs in order and have the surgery the week after Easter. He is recommending a mechanical valve as well. We liked Dr. Somers and if he did the surgery he would be doing it from start to finish. At Northwestern, there is a good chance residents/fellows would be involved. Dr. Somers uses titanium plates as well as wiring to close. Dr. McCarthy uses wire. However, Northwestern is a top rated hospital for cardiology and obviously has a wealth of experience. So my question now is would you select McCarthy again just on Northwestern name and fact he did the first surgery or would you go with Dr. Somers who has provided us much more information and is more accessible. Any insight would be great. Thank you.

I had my surgery at the Cleveland Clinic about 10 months ago. My home cardiologist indicated that the sternal wiring is robust and the only time there is a problem is when the patient does not allow the breastbone to heal (i.e. doing pushups or bench pressing heavy weights prior to healing). My cardiologist felt that the titanium plates were falling out of favor due to them blocking areas during x-ray imaging. With the wires, you can see very well. Like many things there is probably more than one good answer.
I have had no problems with the wired sternum except I can feel the top wire (kinda gross!). Take it easy on recovery. I started back to the gym as soon as I was released but basically zero weight - just moving around to stretch and free up my chest. Over a period of 10 months increased the weight.
Lots of cardio.
I guess just saying that everything should be fine. Your husband is athletic and will recover well. My surgeon (Dr. Svennson) and I agreed on a mechanical valve if I had needed it (I had an aortic root aneurysm, not related to the valve). He knew I was an endurance bicycle rider and felt it would serve me well - I would not need another surgery to replace a worn out valve later on.

 

[Keithl]

OK so in am T-Plus about 33 hours since getting my valve and aortic Dacron replacement. My age and being internal good health. I spent 1 day in ICU, now in step down and they are all saying I am ahead on breathing, waking, etc. I am hoping to be discharged no later than Tuesday. Damn chest feels like a truck is larked in it,

I have full memory of being awake for the breathing tube. It felt lik about 10 min, but saying it was closer to 45 minutes

I have. 25mm On-x valve, my own aortic root and then Dacron tube for a few inches.

I do heard the valve clicking over any low,level noises, but then I do not here is where’s there are,large crowds, or higher noise levels.imcan deal,with the clicking as the thought of doing this again some day hoping for TAVR to last 15+ years


Cleveland Clinic is amazing and I would advice anyone needing going there if their insurance will cover the medical portions then a few grand for flights and lodging.

 

[ottagal]

OK so in am T-Plus about 33 hours since getting my valve and aortic Dacron replacement. My age and being internal good health. I spent 1 day in ICU, now in step down and they are all saying I am ahead on breathing, waking, etc. I am hoping to be discharged no later than Tuesday. Damn chest feels like a truck is larked in it,

I have full memory of being awake for the breathing tube. It felt lik about 10 min, but saying it was closer to 45 minutes

I have. 25mm On-x valve, my own aortic root and then Dacron tube for a few inches.

I do heard the valve clicking over any low,level noises, but then I do not here is where’s there are,large crowds, or higher noise levels.imcan deal,with the clicking as the thought of doing this again some day hoping for TAVR to last 15+ years


Cleveland Clinic is amazing and I would advice anyone needing going there if their insurance will cover the medical portions then a few grand for flights and lodging.

Great news Keithl! Wishing you a continued smooth recovery. One day at a time...Best wishes,

 

[pellicle]

So I am new here and 5 days from my surgery.

Welcome and best wishes for a smooth recovery

 

[afraidofsurgery]

Hope you have a smooth recovery! I had no problems with my wires (although I drove a car a week early my cardiologist almost stroked out when I told him). I have an ATS valve, the company was a spin off of st jude with the key engineers leaving to make a new company and improved valve. It's super quiet, softly clicking away. ATS is now owned by Medtronic