cath today - now I need bypass as well

[buffhughes]

Well today was the new appointment for the cath that was cancelled last week. Arrived spot on at 7 am and was in the cath lab by 8:30. Cath itself was pretty uneventful aside from having to wait for ACT level to reduce after cath before they could remove the sheath. After the cath the interventionalist said that the valve is really tight and needs to be replaced now; he also said that I will require a triple bypass at the same time.

My cardio stopped in afterwards and said that I would be getting a mechanical valve and that they were planning surgery for sometime next week. I told him that I was still looking at surgery in Philly and that I wanted the On-X valve. He wasnt aware of the valve and said that they most likely would recommend a St.Jude - he counselled against going with a new valve with limited field data compared to the SJM. I really like the On-X (or the Medtronics) valves and limited field data doesn't really bother me.

I had pretty much decided on going to Philly to get the On-X valve and now they have set up an appointment with a local surgeon. I want to get it done but feel pressured to follow their path. I like the idea of being close to home (less than an hour by car) but is that enough to make a difference in a decision this big?

 

[Greg a]

Larry I dont know enough about valves as my mitral only required a dacron ring while I was having bypass or CABG x 5 it sounds like you will be a new man shortly keep us posted about dates etc.....Godspeed Larry

 

[epstns]

Larry - I got a similar surprise when I had my cath. I was told that I needed a single bypass. It was only a shock for a little while, as I aborbed the fact that as long as I need the bypass, we may as will do it all in one trip. I had, by then, decided on my surgeon and hospital, and the surgeon recommended the Edwards bovine preicardial tissue valve. As long as I was comfortable with my choice of surgeon and hospital, the rest just falls into place.

I would suggest that you make your own decision as to surgeon and hospital, then confer with the surgeon as to which valve(s) he/she would recommend and why. At least that's what worked for me.

 

[buncle]

Larry I would say go with your gut feeling on what is best for you long term.We have members that fly to Cleveland and other places for their surgery.I would say pick the best surgeon and hospital as most important.Welcome to the site.

 

[nngbwh]

Larry I would say go with your gut feeling on what is best for you long term.We have members that fly to Cleveland and other places for their surgery.I would say pick the best surgeon and hospital as most important.Welcome to the site.

I totally agree!!!

 

[Jkm7]

By all means, you should choose the hospital and surgeon of your choice. You are not sounding content with the doctors now attending you and this is too big a surgery to let them 'overly persuade' you. The final decision is yours. Of course, you do have to keep in mind you will need local doctors for your post op care and on-going care through the years.

They need to be doctors you trust and who listen to you and your preferences.

 

[joanie]

I agree with the others. I live in South Carolina and there was no way I would have my valve replaced here. I flew to Cleveland for my surgery and it was the best decision I ever made. You MUST have faith in your doctors and their staff.

It doesn't do any harm to talk with your local surgeon AND the one in Philly. See how you feel afterward and go with your gut.

Good luck!

 

[Mentu]

Larry, one of the intangible elements in this process that remains important for years to come is how you "feel" about your surgery. If it is possible, you need to go into surgery with confidence in your surgeon that he or she is going to do a great job working on your heart. With respect to your valve, it is the same, its best if it is one you feel comfortable with afterwords. If you are feeling pressured, you have options. One is to tell your surgeon that you feel pressured to accept something you are less confident in; else, you find another surgeon. How you feel about your surgeon, your surgery and your valve will effect how you feel about your experience in the future. You want that experience to be a good one as do we all. Don't let them push you around; it is your heart and you are paying the bills.

Larry

 

[Lynlw]

Well today was the new appointment for the cath that was cancelled last week. Arrived spot on at 7 am and was in the cath lab by 8:30. Cath itself was pretty uneventful aside from having to wait for ACT level to reduce after cath before they could remove the sheath. After the cath the interventionalist said that the valve is really tight and needs to be replaced now; he also said that I will require a triple bypass at the same time.

My cardio stopped in afterwards and said that I would be getting a mechanical valve and that they were planning surgery for sometime next week. I told him that I was still looking at surgery in Philly and that I wanted the On-X valve. He wasnt aware of the valve and said that they most likely would recommend a St.Jude - he counselled against going with a new valve with limited field data compared to the SJM. I really like the On-X (or the Medtronics) valves and limited field data doesn't really bother me.

I had pretty much decided on going to Philly to get the On-X valve and now they have set up an appointment with a local surgeon. I want to get it done but feel pressured to follow their path. I like the idea of being close to home (less than an hour by car) but is that enough to make a difference in a decision this big?

IF you are considerring going to the local surgeon/hospital (or any surgeon) I would make sure they have done alot of what YOU need done. Ask how many Aortic valve replacment they've done ( and valve surgeries in general) and ask about BAV patients. It IS nicer for everyone you, family etc if you have surgery close to home, especially if you hit some bumps once you are home. BUT I would ONLY consider that if you believe the surgeon (and hospital ICU staff & floor) has alot of experience with Aorta's and valves, and you will do great at either center.
We were deciding between a couple centers for one of Justin's surgery and one was 5 hours and the other 20 min. so we did choose the closer one, but we were very lucky we live outside philly so the 2 hospitals we were deciding between were ranked 1 and 2 in the nation for Congenital Heart Defects. IF you don't have as much faith you will do as well locally then travel, I think alot of the recovery is mental and you have to have faith you WILL do well and in the surgeon and staff. You don't want to have to look back and think "what IF I went there?" Especially since travelling for the surgery really only affects you and your family for a week or so but how the surgery turns out could make a difference for the rest of your life.

IF it helps you can check the top hospital list and see if your local one is ranked http://health.usnews.com/best-hospitals/rankings/heart-and-heart-surgery They aren't based on just valves, but could give you an idea if they make the top 100 or not.

Have you contacted the surgeon in Philly and got that ball rolling? If not I'd be calling today and ask what they need sent down (CDs of the actual tests and cath, reports) to give their opinion.

 

[mainframe]

Larry, I'd call and cancel the appointment if it's something your not comfortable with. If you do go, make sure they know you will be seeking a second opinion from another surgeon.

I had the local guy my cardio recommended actually schedule the surgery without telling me. I got a call from his nurse telling me my surgery was scheduled for next week, when could I come in for the pre-op appointment. HUH? I said no thanks, that I was getting another opinion and that I would call should I decided to schedule surgery. Needless to say they didn't hear back from me.

Getting surgery away from home does have a few challenges but could be well worth it. I'm sure I wouldn't have survived had the local guy done the surgery. I almost didn't as it was.

 

[drivetopless]

If you are leaning toward the On-X, definitely seek out a surgeon known to work with them and to prefer them. You can actually call On-X and they can help you find a surgeon in your area or at least nearby. PM me if you want me to forward you the ON-X nurse rep, Catheran's email. She's very good at replying.

The St. Jude has been around the longest, but in several different models, I believe. The same person (Dr. Jack Bokros) worked on the design of the St Jude, Carbomedics, and ATS valves, and the On-X. The St. Jude is the gold standard as it is widely used. However, even its design is modified from time to time to try to make it better. It may have more data, because it is implanted more often, though. I had several discussions with Catheran at On-X before my surgery when I came across conflicting data on St. Jude vs On-X performance.

I think many doctors haven't heard of On-X yet, but that doesn't mean it is not a good choice to consider if you are leaning toward mechanical.

Good luck in your decision. You definitely have the right to find a surgeon/hospital that makes you feel confident in their skill level/offerings.

 

[ctyguy]

Don't be pressured. If you want an On-X valve then find a surgeon / hospital that will accomodate you. If you need to fly then so be it. My roomie when I had my AVR was 77 yrs old. He had a triple bypass, valve replacement and a hole in his heart dealt with. When his surgery was completed he spent two days in Cleveland at a hotel and then flew to California. I got an email from him and while he was exhausted with the cross country aspect of it he said it wasn't really a big deal.

Given what I know now I would be a little concerned if a Valve Surgeon didn't know what an On-X valve was. Maybe its just me but that would put me off. On-X isn't THAT obscure.

 

[buffhughes]

Well I did it...spoke with folks at Penn Medecine...they believe that it is likely time based on what I've been told (tho I havent yet seen a SINGLE report )...they think the On-X is a fine valve among many. I will see Dr. Pochettino next week and need to get the CD of the cath and studies tranferred before then. They are already talking about getting dental clearance and perhaps surgery in about 4 weeks. They want to get a CT scan to check the aorta for issues (yes!) before then but they seem ok with the studies done so far.

 

[epstns]

Good news! They will use all the tests to be sure that if you do need additional repairs, they can do them all in one trip to the OR.

Sounds like you're on track this time!