Feedback appreciated - right time for surgery

Phil · Jan 14, 2013

Hi All,

I'm due to see my surgeon next month. When I saw him last time (October last) he indicated we would talk dates when I see him next. I want the surgery as I feel I now have mild to moderate symptoms, but equally I don't want to push for the replacement valve too soon. I'm concerned as this will be my third OHS (I'm 54) and from what I've read the process is harder each time due to scaring and the number of times the sternum has been opened and closed. I also don't want to wait until I feel really bad and the symptoms are more severe. My cardiologist believes I should wait a little longer, but I also understand sometimes there is disagreement concerning the right time for surgery between cardiologists and surgeons. My last AVR was 11 years ago with a human tissue valve. Have others been in this predicament and who ended up winning - surgeon or cardiologist and how persuasive did you have to be?

Responses appreciated.

Phil.

Jkm7 · Jan 14, 2013

In the end, it is always the patient that 'wins'. The patient has the very last say as to whether they will go forward with surgery or not unless, of course, the surgeon says No.

You've outlined the position many valve patients find themselves. It is very often that cardiologist and surgeon are not in agreement when 'it is time'.

Listen to your physicians, evaluate your physical condition and how it impacts your daily life and consider the mental stress.

It's a very hard decision but you will make the one that is best for you.

Best wishes. Let us know.

Gail in Ca · Jan 14, 2013

My cardiologist was conservative and had me wait until my symptoms worsened,such as severe leakage, or my left atrium, or was it ventricle, was severely enlarged. However, my body trumped his opinion when I got endocarditis at age 54, and even then, after 6 wks of IV antibiotics, I would've kept going with my mod to severe leaking mitral valve. But, I was staying severely anemic, they really couldn't figure out why, but decided I must have issues with my aortic and mitral valves caused by the bacteria. So, he had my surgeon come in during my last hospital stay for SOB, and he decided I needed surgery to replace my mech aortic valve, graft, and repair/replace my mitral. My cardio was totally on board with the surgeon's decision. Maybe it's insurance issues, now, which keeps them from doing surgery until you have the symptoms to justify it. Mention shortness of breath and they usually get going on surgery!
This was my 3rd surgery, as well. My surgeon was very concerned about scar tissue. It took 3 hours just for cutting through it at the beginning of my surgery! However, I came out of my surgery really well, totally alert. I felt good!
I did have my right lung want to collapse, but it was handled and I left the hospital 6 days after surgery. It's been almost 4 years and I've had some heart issues that I didn't have after the first 2 surgeries. Don't know if having the heart operated on 3 times opens us up for more heart problems, or if it's just age! I would imagine if a surgeon says it's time, then you will have the cardio's consent as well.

S Walker · Jan 14, 2013

I, too, am looking at my third OH surgery for a mitral valve replacement and a tricuspid valve repair. Like you both, my cardiologist and surgeon didn't agree about timings - the surgeon wanted to wait as I was quite well and he was concerned the surgery would be quite tough (in addition to the 'usual' scar tissue, I have no pericardium so there is concern about there being nothing between the sternum and the bare heart tissue). I have managed to put it off with drugs and lifestyle changes since 2007 but the time for me has now come - I have severe leakage in both valves, and now can only manage one flight of stairs. Walking at a good clip causes my chest to ache, and although it goes away when I stop, it is now impacting my life more noticeably. So I have been told that the time has come and I should expect the surgery within three months. It's all about risk vs 'positive outcomes' as I understand it. Until I got bad enough, it wasn't worth the risk. Now it is.
I will be getting a bovine pericardial valve so there is a chance I will have to face yet another surgery down the road. I should live so long!

Shamrocknj · Jan 14, 2013

Hi everyone....I had the AVR. even though I had no symptoms except one day when some of the calcification in my valve broke off and landed in my eye....a mini stroke and thank God, the emboli dislodged and my vision was unaffected. BUt my surgeon, Dr. Girardi, said I needed the surgery right away. I had it dec 3 and it is now 6 weeks and I feel wonderful.....full of gratitude.....love to all! Shamrock

Phil · Jan 16, 2013

Shamrocknj said:
Hi everyone....I had the AVR. even though I had no symptoms except one day when some of the calcification in my valve broke off and landed in my eye....a mini stroke and thank God, the emboli dislodged and my vision was unaffected. BUt my surgeon, Dr. Girardi, said I needed the surgery right away. I had it dec 3 and it is now 6 weeks and I feel wonderful.....full of gratitude.....love to all! Shamrock

Thanks for the responses. I too have experienced endocarditis 15 years ago and it was scary. Probably one of the most frightening experiences thus far. I see my surgeon on 25 February and hope he sets a surgery date. Last time I blacked out and surgery occurred soon after. This time it feels like a slow inch-by-inch journey or deterioration which I'm not enjoying at all. And it's hot here - some days 35-40 which are real killers. My heart does not like the heat one bit! Anyhow, again thanks for your responses and watch this space ...

Cheers.

Phil.

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