Confusion for choice of hospital for valve replacement

[mikekass]

Hi,

I am 47 years old male with bicuspid aortic valve. At this time, my valve has reached sever Stenosis stage. I have also developed Ascending Aorta aneurysm. I am an Engineer who leaves in northern California. I have two options for choice of Hospital. One is Stanford medical clinic and the other is Sequoia hospital. I have met the best surgeons from both hospitals (Dr Craig Miller from Stanford and Dr Vincent Guadiani from sequoia). Both hospitals are high volume centers. Because of the AA aneurysm that needs to be fixed during my aortic valve replacement (AVR), I have favored Dr Miller at Stanford clinic who is world famous for Aorta aneurysm.

I have seen two top cardiologists in my area, but one is actually at Stanford clinic, and the other one is more un-biased. Both have highly recommended to do my operation with DR Miller at Stanford. So I have scheduled the operation for July-14-06 at Stanford presently.

Then I ran into a website called "Healthgardes" http://www.healthgrades.com/
This company started 7 years ago and claims to provide independent data for hospitals and physicians for all type of diseases and procedures.

According to this website when I chose stand ford medical clinic, valve replacement surgery, they give this hospital a poor rating, where as they give Sequoia hospital good rating and Cleveland hospital best rating. You can see the detail of these rating for free by going to this website and choosing the hospital and the procedure.

When I mentioned this fact to Stanford, they claim the reason is probably because Stanford accepts high risk operations.

Anyway this has concerned me a lot even though I feel Dr is the best surgeon for me. Since Stanford clinic is a teaching hospital the assistant surgeon is always a last year resident from Stanford medical school. I am wondering weather this fact can make the difference.


I am sorry my initial thread is so long. But since my surgery is scheduled 3 weeks from now, I really need your help so I do not be confused about making the best decision.

God Bless you and Thanks in advance,

Mike.

 

[Kate]

Welcome Mike!
I don't have personal information about Stanford. However, I quickly looked it up on the US News and World Report rating (you can look at this by going to
http://www.usnews.com/usnews/health/best-hospitals/rankings/specihqcard.htm or, if this link doesn't work, just go to their main website and click hospitals on the left hand side) and found they rank Stanford as #11 in the country for heart procedures, which is very impressive. US News has been rating hospitals for many years and their ranking is well-respected. That combined with the recommendation of your Dr. and your own insticts when meeting the surgeon suggest that you will be in very good hands.

For what it's worth, I had the same procedures as you about 9 months ago at the Cleveland Clinic. Although not a walk in the park, it wasn't nearly as bad as I thought it would be. I hope you have the same experience! Kate

 

[Mary]

Mike,
We just had a discussion that explored why a hospital might have a lower ranking (they take more seriously ill patients) than another one.
You mention this was also Stanford's response, so I would give them the benefit of the doubt.
I truly believe the skill of the surgeon is the most compelling factor in most successful valve replacement surgeries. If Dr. Miller is the best surgeon, then his expertise would weigh heavily in my choice of hospitals.
Good luck to you and keep us informed as to your surgical outcome.

 

[Cooker]

Welcome Aboard

Welcome Aboard

Mike,

Glad you found us. This is a great place for info and support! I am 17 weeks post op and this place has made a huge diff. in my recovery and soundness of mind. As stated above it is not a cake walk but it is not near as bad as I thought. I had a cath on Monday, AVR on Tues. and home on Friday. I had a few small bumps in recovery but all in all things went great and I feel better than ever.

Ask all the questions you want. Many folks here that are a great sorce of knowledge(I'm not one of them ). I felt like a pest with all my questions but was rocked to sleep by folks who care and are eager to help.

Wishing you all the best.

Cooker

 

[Phyllis]

Welcome Mike. I too vote for the surgeon with the most experience. I put you on the calendar for July 14th and I hope you will get all your questions answered here in the meantime and will keep us up to date on your surgery. Best wishes to you!

 

[Marguerite53]

Hi Mike. Welcome! My AVR was 2 months ago. Severe/critical stenosis, BAV. I did not have an aneurysm. My surgery was under 4 hours... textbook.... uneventful. (lucky!! ) From what I've read and heard about aneurysms, they can be tricky. I would definitely, definitely go with the "world class surgeon" on that one.

I do not think that a facility as prestigious as Stanford would give you false information. Because of their prestige, I'm sure they do take many more risky patients.

My cardiologist is a Stanford graduate.... med school, internship, residency, (fellowship). She is amazing! Just wonderful.

Whatever you decide, try your best to go with the decision and not look back. You can second guess yourself into a frazzle, and there's no reason to. Sounds like you have 2 excellent choices.....better, probably, than most people have.

Good luck. Keep us posted. We'd like to hear more about you when you're ready.

Marguerite

 

[traumahob]

Have you spoken with the Stanford surgeon about this? The key word is assistant. There are so many people in the room during your type of surgery you want the leader to be the best possible. My husband's surgery(which was the same as yours) was 6 1/2 hours and complicated. The lead surgeon called extra people in after 3 hours.His surgeon,Dr Arun Singh has his own team of perfusionists,Nurse Practitioners, and PAs that work only with him. No house staff. Have your surgeon fill in the details. Best wishes. I would definately go with Stanford. Deb

 

[jiniani]

My situation is similar to yours

My situation is similar to yours

Hi Mike,

I'm from San Jose. I talked to Dr.Miller as well. I personally met with couple of people that had surgery with Dr.Miller. They didn't have aneurysm though.

I'm 36 yrs old with aneurysm. I feel Dr.Miller is one of the best for this kind of surgery. My surgery is tentatively scheduled for July 20th.

Best of luck.

 

[mikekass]

What do I need to know about post-op ?

What do I need to know about post-op ?

Hi all,

Thanks everyone for your great feedback. It made me much much comfortable to go with my first instinct which was Dr Miller at Stanford.
My AVR and ascending and arch Aorta aneurysm resection is schedule July-14. The main reason is the limited availability of DR Miller. I can still postpone it to Oct/Nov, to avoid hot summer time during recovery but I am not sure if this matter that much? Any idea? Can you share what information I need to know for my post-op to get prepared for it.

Thanks,
MikeKass

 

[Georgia]

First, you need a recliner. Even if you don't have trouble sleeping flat on a bed after you get home (this is a problem for MANY), recliners allow you to sit/rest/nap in a good position that's comfortable.

Pay your bills before surgery; or write the checks and give them to someone reliable to mail on the correct dates. You do NOT want to mess with your checkbook for the first couple/three weeks after surgery. This comes from personal experience, and I'm not the only one who had this problem. You're very foggy after surgery.

It's best if you understand that recovery goes in fits and starts; you'll have good days, often followed by bad days (of course - you do too much on the good days and your body rebels the following day). Don't let it bother you; after sitting around resting on the bad day, you'll be much better. And so it goes.

You'll need a scale - you must weigh yourself every morning to monitor fluid retention. You'll get instructions from your doc what to look for. This is really important.

You'll need someone at home for at least the first week after you get home. After that you'll be able to mooch around pretty well.

I think you're better off having surgery sooner rather than later. Things can go south quickly. You'll just have to walk around inside if it's really hot. I had to because of constant ice on the ground. Nbd.

Glad you've made your decision. You'll feel so much better in a few months.

 

[catwoman]

I can still postpone it to Oct/Nov, to avoid hot summer time during recovery but I am not sure if this matter that much? Any idea?

Dunno if you're symptomatic, but if you're having severe stenosis AND have an aneurysm, I wouldn't wait. Your heart is in better condition now than if you wait 3-4 months, and that means your recovery should be quicker, less complicated than if you wait and the stenosis escalates and the aneurysm size increases. These conditions can take a nosedive very rapidly, surprising even the doctors. Been there, done that with my mitral valve.

Georgia's tips are great.
In addition, my surgeon asked that I check my BP & temperature several times a day, so I had to trudge through a Target the day after I left the hospital to buy a BP monitor. I had hoped to use my parents' monitor, only to find it wasn't working correctly. I also had to weigh myself every day to monitor any weigh gain due to fluid buildup.

I wasn't a vr.com member, so I didn't know about the recliner suggestion. We would not have bought a recliner because we have cats; too many fatal accidents with kittens & recliners. I bought extra pillows and found that I could roll out of bed easily while hugging a body (or king-sized) pillow.

Because I had my surgery during the summer, I drank lots of iced tea (carbonated drinks nauseated me for some reason). I found that glass containers were too heavy to lift filled with ice cubes & liquid. So I asked for drinks in foam cups in restaurants and at home. Some restaurants here in Texas have big Texas-sized glasses that seemed to weigh a ton! Pulled on muscles attached to the chest & sternum.

I did some of my walking inside shopping malls when it was really hot. I also had to remember that it was easy to walk to a point, but I might be wiped out walking back to my starting point (my husband had to bring the car to me once!). So, don't overestimate your stamina. Better to take several short walks a day, gradually increase your distance as your stamina improves than to just do once walk a day.

And, yes, you'll have good days and bad days. Don't overdo it on a good day -- you'll pay for it the next day. But all of us have done that. It's hard to tell if you're really on a permanent roll of good days or still recovering.

Do remember to use the spirometer once you leave the hospital. It can be a torture device, but it does help your lungs and heart to recover faster.

 

[Marguerite53]

If you choose to wait or not, that should be a decision you make with your surgeon and/or cardio. My guess is that the vast majority of us, here, would encourage you not to wait.

As far as the hot summer goes..... it depends on what you are considering. Will it be hot indoors? Perhaps you should invest in a better cooling system. (new fan, window AC, whatever). Will it be hot outdoors? Surely you can do your walking early in the morning before the sun is too high.

I'm 52 years old. I came home the first week, and as I had in the hospital, chose to sleep whenever there was nothing else to do! I had no trouble sleeping......however, many do. I used (and still, at 9 weeks!!) the recliner and the bed.

Please be sure to have some help the first week. (you shouldn't need help showering or with personal hygeine, but fetching things and laundry and food prep). Please say YES to whomever offers to bring you food (it is wonderful to be fed!). Look around your home now and bring anything you use regularly to within easy reach. You will be amazed at how uncomfortable it is to reach or lean down for things! And simple things, like opening jars (even pill jars!) will be tough at first. Not to mention opening a window -- you can't do that!

THere's plenty more suggestions, and I know others will be along. You can always start a fresh thread, too!

Ask away!!

Marguerite

 

[traumahob]

Dunno if you're symptomatic, but if you're having severe stenosis AND have an aneurysm, I wouldn't wait. Your heart is in better condition now than if you wait 3-4 months, and that means your recovery should be quicker, less complicated than if you wait and the stenosis escalates and the aneurysm size increases. These conditions can take a nosedive very rapidly, surprising even the doctors. Been there, done that with my mitral valve.

Georgia's tips are great.
In addition, my surgeon asked that I check my BP & temperature several times a day, so I had to trudge through a Target the day after I left the hospital to buy a BP monitor. I had hoped to use my parents' monitor, only to find it wasn't working correctly. I also had to weigh myself every day to monitor any weigh gain due to fluid buildup.

I wasn't a vr.com member, so I didn't know about the recliner suggestion. We would not have bought a recliner because we have cats; too many fatal accidents with kittens & recliners. I bought extra pillows and found that I could roll out of bed easily while hugging a body (or king-sized) pillow.

Because I had my surgery during the summer, I drank lots of iced tea (carbonated drinks nauseated me for some reason). I found that glass containers were too heavy to lift filled with ice cubes & liquid. So I asked for drinks in foam cups in restaurants and at home. Some restaurants here in Texas have big Texas-sized glasses that seemed to weigh a ton! Pulled on muscles attached to the chest & sternum.

I did some of my walking inside shopping malls when it was really hot. I also had to remember that it was easy to walk to a point, but I might be wiped out walking back to my starting point (my husband had to bring the car to me once!). So, don't overestimate your stamina. Better to take several short walks a day, gradually increase your distance as your stamina improves than to just do once walk a day.

And, yes, you'll have good days and bad days. Don't overdo it on a good day -- you'll pay for it the next day. But all of us have done that. It's hard to tell if you're really on a permanent roll of good days or still recovering.

Do remember to use the spirometer once you leave the hospital. It can be a torture device, but it does help your lungs and heart to recover faster.

Don't delay with that aneurysm.A firm foam like pillow for cough support is key, about 12" by 24". Some hospitals give them out but John's did not. Remember popsicles, they are fluids, cold and sweet which seems to appeal to most post op. Good luck and keeps posted, Deb

 

[Ozmercy]

Hospitals

Hospitals

Mike when i started this whole journey, some of my doctors thought I had Marfan syndrome and so I sought advice from them. When I talked with them, they said for Marfan patients (who have some peculiar problems with the heart) the only 2 places in California they recommended were Stanford and Cedars Sinai. I believe the doctor from Stanford they mentioned was Dr Miller. I just threw the information away since I do not have Marfan. Hope this is helpful along with what you have already heard.

Randy