How did YOU pick your surgeon and hospital?

[dwfreck]

Anyone,

I'd like to hear your experiences with selecting a surgeon and hospital to handle your valve surgery. I know that this is as much a personal decision as selecting a replacement valve, but I'm curious about how other people come to a decision. I'm not looking for reccomendations (yet), just relevant things to consider.

I've heard some people say you should find out how many procedures (similar to the one you're going to have) a particular surgeon or hospital has performed, often with a minimum threshold. Is there likewise a maximum threshold? At what point does a surgeon or hospital cross into the "McDonald's zone" (you know, "billions and billions served")?

I've heard some people say you should seek out the "best" (in a techinal skills sense) surgeon and hospital. That makes a certain amount of sense to me, but what criteria did you use for rating surgeons and hospitals (besides procedure count)?

How much did staying geographically close to family and friends matter in your decision?

What about interpersonal skills (communication, bedside manner, etc.)?

Are there any factors that affected your decision that I haven't asked about (besides life-saving, emergency urgency)?

 

[wweir]

Dale,

Let me tell you what I did.

I asked my cardiologist who he recommended I should use, of course he said all of them are great, but I pressed him until he told me about a very good surgeon, Dr. Kent Jex from the Nebraska Heart Institute.

Once I had a name I checked him out on the web, where he when to school, where he did his internship, etc. I then asked about his success rate and mortality rate. All reports were very positive.

I also asked him, face to face, which approach was he most comfortable with performing. We talked about the Ross procedure, the Bovine and the mechanical. I opted for the mechanical after I heard all the facts.

In seeking out the best I must tell you it came down to the fact that Dr. Jex was personable, relaxed, had very steady hands, (I looked) and it seemed to me that nothing would excite him very much. Very confident demeanor.

The hospital I had my surgery in was the best (http://www.bryanlgh.org/index2.asp) as far as I was concerned. The care was extraordinary and it is only five miles from my house. Subsequently the heart institute built their own hospital, which is even closer, and it is really something (http://www.nebraskaheart.com/)

You are asking all the right questions Dale and all I can tell you that when they wheeled me into pre-op I had the most incredible sensation of calm and that was prior to the happy juice they inject you with. By the way they don?t do the count backwards stuff; they just push the needle and ?bam? you are out like a light.

By the way, don?t let them put the catheter in until you are out.

Walter

 

[Nancy]

Joe asked his cardiologist. He wanted to stay fairly close to home. He also asked several other people he knew. All came back with excellent recommendations for Dr. Harry DePan of Albany/Schenectady Cardiothoracic Surgeons. He is Chief of Cardiothoracic Surgery at Ellis Hospital, Schenectady, NY, 20 minutes away from us.

Dr. DePan operated on Joe 3 times, 2 valves and one lung, and his partner did another lung. He also did a normal sternum valve surgery and a HeartPort procedure.

Everything went off without a hitch. It couldn't have been better We were both very happy that we didn't have to travel for Joe to get excellent care. The post surgery care was excellent as well.

His surgeries were far from easy. He's got a lot of damage and has many complicating problems.

 

[JimL]

Another source of information, at least about which hospital to go to, is people who have been in that hospital, preferably, of course, for a procedure very similar.

That's how I chose the hospital I went to. I had been to that hospital numerous times before, and had seen people who had undergone CABG surgery there. I was very impressed with the hospital.

The same would in my case apply to another hospital, which is overall probably a better hospital, but is difficult to get to. I thought about the difficulty not only of me getting to the hospital for surgery, but also of my family coming to visit. So I chose the hospital that is easier to get to (45 minutes of somewhat hassle-free driving) rather than the one that might be better but is harder to get to (over an hour of congested driving).

 

[Christian]

When we were told in 1998 that my wife would almost certainly need valve surgery someday, we asked our cardiologist to give us some ideas as to surgeons and/or other specialists. In the six months that went by before her next visit, we did a lot of research on our own and decided that because of our location (Pittsburgh) and their excellence, we'd see whether he'd recommend the Cleveland Clinic.

Our factors were as follows:

1. Find a facility that does a ton of mitral valve repair procedures;
2. Find a facility with reputation for excellence in heart health;
3. Find a facility that had both cardiologists specializing in valve disease and top-notch surgeons; and
4. (of less importance) Find a facility that was reasonably close to our house.

Lo and behold, before we had even a chance to speak, our cardiologist recommended that we visit Dr. William Stewart, a Cleveland Clinic valve specialist, with the intention that we'd later use Dr. Cosgrove at the Cleveland Clinic as our surgeon.

We now use a local cardiologist for the every-six-month appointments and visit the valve specialist once per year. She ends up with two stress echocardiograms every year and one MUGA. Fun, fun.

When we go for the visits (I typically accompany my wife), we bring a written list of questions and a copy of her medical records dating back to 1995. It always helps to have those papers handy in case we forget something. And the file is particularly helpful if you're trying to determine whether there's any change in a test result over time.

There are plenty of great facilities and surgeons in the United States. Do the best you can to find one that fits your needs.

 

[RickKiem]

When I relized that I may be getting close to my surgery, the first surgeon I considered (Dr. Hazim Safi)was the one who had performed two emergency MVR surgeries on my sister. The last visit I had with my cardiologist (when he recommended surgery) I asked him who he would recomend for my type of procedure and the only name he would give me turned out to be Dr. Safi. His statement was that in Houston this was the guy I wanted for my anuerysm repair.

When My sister was in the hospital, I could remember people asking who performed her surgery. When we would reply, "DR. Safi" everyone said that he was the best. The hospital staff seemed to have a very high regard for him. His team is also very good. They have been working together for many years. They work well together and while I was in the Hospital it seemed that one of them were constantly checking on my progress.

I'm not sure what I would have done without prior knowledge of someone. I am thankful that I have not had any reason to doubt that I was in good hands.

Rick

 

[catwoman]

Dale:

My first cardio suggested going out of state for surgery. I researched the internet and understood why he suggested the Mayo and Cleveland clinics.
However, being near home was important to me. So was being in network (Mayo & Cleveland either were not, or surgeons were not). Knowing my husband, I wanted him to be with family and friends during my surgery. He dislikes air travel and doesn't like car travel too much.
I researched places that were in network for me, checked out # of MV repairs/replacements, mortality rates, checked out surgeons, etc.
I had my PCP refer me to my dad's cardio, whose office is at the Heart Place, top floor of the Hamilton Heart Hospital at Baylor University Medical Center near downtown Dallas. Surgeon in same office did procedure. Never met him until night before surgery. By then, I assumed it would not be a repair even though surgeon said he would try. Chordae were repaired, but leaflets were too floppy to get a good repair on, TEE showed. So I have a St. Jude mechanical valve.
I was willing to take Coumadin instead of getting a tissue valve that might have to be replaced later.
Baylor's reputation was a big selling point. My family has been having surgeries & babies at Baylor since the late 1950s. I had no problems during surgery or hospitalization. A 3-hour bout with tachycardia while I was on blood pressure Rx after I left hospital, none since.
My surgeon was easy to talk to. However, I know that some of the best physicians may not have good communication skills or bedside manner, so that's not always a good indicator of a skilled surgeon.
I asked my surgeon post-op exactly how he did the replacement and he actually told me. Wish I had had one of those heart models to visualize it better!
Another thing I liked about Baylor: It has a fabulous volunteer program for heart patients. I called several weeks before my surgery and talked at length with a woman who had had bypass surgery (asked for someone who had been through valve surgery there, but never got a call from such). The woman sat with my family during my surgery and checked on me when I got to a private room. Several others volunteers either called me or visited me in the hospital. All volunteers have had surgery at Baylor and were able to tell me what to expect in the hospital and after.

 

[tommy]

Here's my story.

I did some internet searching and talked to friends at church that are active in the medical community. That led me to the four surgeons. It's no small coincidence that they are all in the same group. Each uses a different hospital.

At my cardio appointment to confirm the need for the aortic replacement, I was ready with my list. My cardio started to recommend the guy that was closest (he was on the list). the cardio has staff priviledges at that hospital. I asked him about the other three. He saw my list and smiled. "I see you've done your homework". He said that they were all great, and if I didn't mind going to a hospital where the cardio couldn't see me, I should start with Dr. Mack. That confirmed my top choice. It was also, the second closest to our home.

I went with my wife to visit Dr. Mack. He was very clear, thorough, and confident.

I gave a lot of weight to his ability to answer questions with confidence. For example, when we discussed tissue valves, I told him that I wasn't happy about another replacement 12-15 years down the road. He said that he understood my concern, but BTW, when he puts them in, they last 18-20 years. It may come across as bragging as I type it, but his demeanor was very professional and he seemed focused on me, not him. I took his confidence to the bank.

His clarity and thoroughness gave me comfort. Everything was explained. He anticipated most of the questions and concerns. It did not seam rehearsed or like he was selling me something. He had a scale model of the heart, and had a sample valve to look at. So with comfort and confidence the decision was made. We looked no further. I was impressed.

Also, our back door neighbor had taught Dr.Mack's kids in elementary (a top-nothc private school in Dallas). She and her husband had met Dr. Mack and said he was wonderful. A 'warm fuzzy" doesn't hurt either.

As a take-away, I suggest asking about the floor that you will recover in. This was not on my list of questions. The entire 10th floor at Medical City Dallas is dedicated to "normal" heart surgery recoveries. All of the nurses and staff have excellent routines and processes well focused on recuperation. Care was not assembly line by any means, but these folks were experts at the specialty of recuperation, wellness, teaching, coaching.

Dr. Mack's office is in an ajoining building on the same floor as the OR. He doesn't even have to go outside to see his patients.

Dr. Mack has a dedicated nurse that assists him. She was invaluable. She gave my wife updates during surgery. She helped manage my care in the hospital.

Hope this helps.

 

[Ross]

Ahh Man......Do I really have to answer this question?

 

[Rich]

Hi Dale,
Another avenue was referrals by friends and co-workers.
A good friend of mine insisted I get a second opinion from his cardiologist. My friend was also Italian and threatened to break my legs if I didn't listen(just kidding of course).
I did listen however and ended up with the best cardiologist in this part of Michigan.
He in turn sent me to the very best surgeon and also the best heart hospital in this state.
Everything went absolutely great and I never looked back.

 

[chilihead]

doctor selection

doctor selection

I think you should make your valve decision and then find a doctor and hospital that you are comfortable with to do that procedure. Things like Mitral valve repair are probably best left to the boys at the Cleveland clinic. However, there are numerous good surgeons that can do a good job on a mechanical or pig valve AVR. You will notice if you hit enough of these heart form sites that certain doctors names keep coming up in different parts of the US. I would pay a visit to the place you think you will use ahead of time and see how the place operates. Check out the ICU/CCU and the floor you will be recovering on. It will make it easier when you get there and you recognize the surroundings instead of feling even more disoriented than you already are on morphine etc.

I looked at how many procedures the surgeon I was going to use had done and I met with him. Many surgeons don't have the best bedside manor. In my opinion the cardiologists are more like car salesmen. They advise you what to do. Surgeons generally tell it like it is. They are the mechanics that fix you up and send you back to the cardiologist for followups. You can get a ton of info on most surgeons from the web. After a while you will be innundated and probably just flip a coin.

Good luck,

Jim
Ross procedure 11/18/03

 

[ALCapshaw2]

Here are a couple of tips about SCHEDULING surgery:

If possible, AVOID the week before and the week after the surgeon is on vacation or out of town on business.

IF your surgeon is a Heart Transplant Surgeon, be aware that if a Heart becomes available for transplant, THAT patient will get top priority. Ask to be put first for the next day if he performs a transplant.

'AL'

 

[Kathy]

Dale,

Great question!

My decision was influenced by a friend's experience. My friend is a nurse who had a pituitary tumor. It is a rare surgery and she decided to go to the Mayo Clinic where the surgeons had performed the procedure most frequently.

I have dextrocardia, a disorder that is relatively rare. I also have an extra vein coming from my brain, an extra bone in one toe, and malrotated bowels. With each surgery there has been a discovery of more surprises in my body. Therefore, I wanted to be at a place where they were used to surprises. I typed best cardiac into Google and got the Newsweek report rating CCF as #1. CCF is in network for me and a two hour drive from my home.

My primary care physician thought that I would be able to receive fine care at a local hospital. I told him I was concerned about the dextrocardia and the possible consequences related to an unusual surgery.

I did not go to a local card because I wanted to be referred to a surgeon by one of the CCF cards. I figured a doctor at the clinic would be able to make a good decision about who would be best for me. My card felt that two surgeons might be best. One was Dr. Cosgrove and the other was Dr. Petterson who specializes in congenital heart problems. He consulted with another CCF card and both surgeons and felt that either would be very good for my case. My husband asked this question: "If this were your wife, who would you pick? The card was taken aback, but answered that Dr. Petterson would be his choice because he felt his technical skills were equal to those of the other doctor, but that he would spend more time with us discussing options and answering any questions.

It was hard being away from home (for my family), but I felt that I had made the best choice for myself. I am not sure what I would have done if I felt I had a more conventional body!

 

[Tom F.]

I live in Chicago and have lots of good choices. My first was part of a suburban practice recommended by my primary care doc. When I got to the surgeon he only offered only a mechanical or tissue valve replacement as part of my aneurysm repair. He did not do the Ross or a "David" type valve sparing. I fired him and went to two of Chicago's largest heart centers, Northwestern Memorial and Rush University. I talked to the head of surgery at Northwestern, and a guy at Rush that has over 100 Ross Procedures under his belt. In the end I went to Rush, and at that point it was nothing but gut instinct. My surgeon was Dr. Robert March.

 

[dwfreck]

Thak you all for your responses so far. They're very interesting reading. Please keep them coming.

Ross, no, you don't have to answer this question. Everyone knows your surgeon was Cindy Lou Who!

 

[Heather Fisher]

I didn't want to travel although I considered Cleveland Clinic. I have only lived in New Mexico for 2 years and was unfamiliar with the doctors. My cardiologist recommended a surgeon. One day, I was getting my hair cut and the beautician stated that her clients included a husband and wife. The wife was a cardiac nurse and the husband was the valve rep and was present in all of the valve replacement surgeries. I called them and asked for recommendations. I then switched surgeons and hospitals based on what they said. Everything I heard after that point from other medical professionals confirmed what they had told me. After meeting with the surgeon I was convinced I made the right choice and did not have to go out of town for the surgery.

Heather

 

[fisher6476]

Hey Dale,
The Doc that did my heart Cath came right out and said " I am going to get you the best Technician there is for your surgery. This is the guy I would get if you were my brother. So I did a little research on the man and was as impressed as you can be just by reading things. I have known a little about my hometown hospital here from haveing friends and relatives there over time and by reading in the local paper over the past few years how their new heartcenter would someday be one of the best in the nation. I also was thinking at this point that I was going to get a mechanical valve, so I made an appointment to see Dr. David Brown. As I said, I had read some statistics about mortality and morbidity rates at different hospitals, but I also understand that these kinds of figures can be "spun" based on lots of different factors like how many medicare patients were in the sampling. Obviously the older the group from which the sample come the higher those statistics. Any how at the first meeting with Dr Brown, I noticed that he was very blunt and to the point! Not cold, but very business like and he mentioned several time that what we were talking about was very serious business. I felt good about that. He brought in a model of the heart, and showed me what was wrong. He then asked me about valve choice, and because of what almost everyone had told me, (my family doc, two different cardios, and some other opinions I had drawn a conclusion on my own and I told him I was interested in mechanical valve, He said he woud do whatever I wanted but, he wanted me to consider tissue valve, I chose the tissue for my own reasons, but again for me I liked the fact that this doctor just didn't say "Ok whatever you want I'll do". Then I asked him while looking at him straight in the eye, " Why shouldn't I be going to Cleveland Clinic or to Columbus where so many people have reffered me. Dr Brown said " both facilities have very talented surgeons. I would be glad to get you a referral. But, one thing you may not get at Cleveland or Columbus is the kind of aftercare I can give you here in Mansfiled Med Centrtal. The support staff to patient is much greater here and I have my own people attend my patients based on the way I have trained them. also in the past 15 months I have operated on 585 people and I have lost 3 hearts. Understand that people bring me their hearts in all kind of disrepair and I just can't fix 100 % them." He then asked when the last time I had dental work done. I told him it had been awhile, and he told me he would not even do the surgery until I had been to yhe dentist and gotten a clean bill of health there. Don't know if every surgeon demands this, but I have learned evrry surgeon should!. Then asked if I had other questions , and I said not now. He said well call if you do, or if you want to see me again just call and set up appointment. I know you have a lot to think about but evem though I am the best Surgeon for you condition and I would love to have you as a patient, I don't need the work right now and I would be glad to give you a referral."
I left his office with my wife that evening and we already both had made up our minds. I was very comfortable with this Dr. , the hospital was 15 minutes from my home, and the part about what kind of care I would get Post Operatively made a lot of sense to me. I took a couple of weeks to attend to some dental matters and told my wife I wanted to talk to this Surgeon one more time. I guess I wanted a feel for what he would be like during a second interview, even though I had not hired him yet. The Dr. was glad to see me and I told him I had some questions. He went and got his herat model and virtually started all over with me, taking his time to make sure i understood eveerything. I the asked him this question. If this were you mother, would you do this surgery at this hosptal? Unflinchingly he said, "you know I would never operate on my own family member, but I understand your question nad the answer is if I had a surgeon as good as I am, I would recommend my mon heve her surgery done here." Needless to say I had the surgery done here in Mansfield and I could not be more pleased. Wow. A little long winded I think but you asked for decision making process. I am sure there are may similar stories from people who have had these proceedures done around the country.
1) I had MUCH faith in surgeon
2) I thought aftercare might be important and I liked what I saw here
3) 15 minutes from my home made this very appealing to me.
Steve

 

[Bob]

Since I had no symptoms I went froma routine physical to the cardio recommended by my PCP. The cardio recommended the surgeon and hospital. I just trusted them. It all worked out for me. Seriously, I think that when we go through this successfully we all rate our cardio and surgeon as expert. Perhaps there is some sort of rating system in existence but I dont think so. Yes Cleveland is top notch but that doesn't mean it is the only place to go.

I think that a physician who goes through the training necessary to be a certified cardio and surgeon has to come out as an technical expert. Those less than expert are weeded out on the way. Now recognize a technical expert might not have a good bedside manner and he or she might be blunt, arrogant and distant but what you need is technical expertise not hugs. You need a physician with experience, up to date training and one who keeps up with the published medical journals and research.

Maybe I am wrong but that is the way it was and is for me. Yes hugs and love are very necessary but get them from a non medical source. When you go into that cardio office or ride the gurney to the foot of the mountain you need what I described above. Good luck and Merry Christmas

 

[bvdr]

My cardiologist told me mitral stenosis was something he rarely encountered and had little experience with. I asked him who was the best in the area and he was going to research the matter and get back to me in one week- both for a cardiologist and a surgeon. When I called him in one week I found him to be out of town and had left no message for me. My PCP had already told me his preference was Dr. Chittwood at Eastern Carolina. I didn't want to go that far away since Duke was so much closer and has an outstanding reputation as a heart center.

I asked to hear from those on this board who had experience with valve surgery at Duke and one name kept coming back....Dr. Glower. I called and made my appointment, gathered my records, and went for a surgical opinion. He in turn sent me for an evaluation for mitral valvoplasty which ended up with a date for valve replacement. By the time I met Dr. Glower I had already researched quite extensively and felt comfortable with his expertise. It's nice for a surgeon to be "nice" but it sure isn't a requirement for me. I want him to be wise and talented. It was a bonus that Dr. Glower was nice as well.

 

[Harpoon]

There really wasn't much of a choice offered to me and my particular case had some extremely specific needs, such as doctors well experienced in dealing with complex congenital heart defects.

My primary cardiologist is in Buffalo, NY, Dr. Robert Gingell. he's a pediatric cardiologist and he was an intern when I had my Mustard proceedure (to "replumb" my transposition of hte great vessels) when I was a few months old.

When things started getting rough he just refered me to the Cleveland Clinic, no questions asked. He set up the referal and a preliminary evaluation for heart transplant (it's an exhaustive physical that tells them exactly what's going on, everywhere, not just within the heart)

That evaluation lead to the option of a valve repair or replacement for my bad tricuspid valve.

I saw many many doctors including Dr. Cosgrove, Dr. Rosenthal, Dr. Mee, Dr. Prieto... It's a long list.

I never complained about the decisions because for one, I've always known that Cleveland Clinic is the best of the best when it comes to cardiac care. There just aren't that many other facilities like it across the world and I would have suggested that on my own if I had the chance. Furthermore, Cleveland is kind of a "second home" to me. My father grew up there, I visited my grandmother for years on the south side, my aunt lives on the west side and I spent two years attending art school just a few blocks from the Cleveland Clinic complex.

I spent my time in the children's hospital, that's where they treated any patient with a congenital heart defect, regardless of age, but it's a great place for adults with acquired heart conditions as well. It's a very strong transplant facility and there happened to be a child there in the "step-down" unit where I spent my last few weeks who had been waiting most of her life for a new heart and got it while I was there.

They have a lot of facilities and services for patients and family, everything from transportation to and from hospital, airport, hotel, to a special concierge service which will help organize all your testing schedules, meals, overnight rooms. Family members can get hotel rooms for nights, weeks, or even months if neccesary. There are actually a few hotels which service the hospital, plus a large commisary and another deli/pastry shop near the cancer wing (it's a seperate set of buildings conected to the main complex via long glass corridors)

It made sense for me because I had family there where my father and fiance (we're married now) could stay and because I was familiar with the place and they were familiar with the conditions I have.

When your needs aren't THAT specific there are other options that open up which are just as good for treating acquired heart deseases. There are many surgeons and cardiologists that spent time on the front lines at Cleveland that have since moved on to build strong cardiology facilities elsewhere in the county.

Ask about their backgrounds, training, who they worked with and for how long (that's an important question because if someone like Dr. Mee didn't like your skills -or at least your ability to learn-, you just didn't stay with him too long.)


Go with your gut, where you feel the most comfortable. If you have the option, check out facilities in person before choosing.