How much experience is enough?

[teri]

Reading all of your posts has been very educational. Everyone stresses that finding an "experienced" surgeon for heart valve replacement is the key to success. The Indianapolis surgeon we spoke to performs 2 combination aortic valve/aortic root replacements per month, and has done so over the past 7 years or so. (That is in addition to many other procedures he performs.) So, that is around 150 of those surgeries alone. Is that enough? I know I need to look at infection rate, resurgeries, etc., but just in terms of numbers, is 150 very many to have under his belt? Then, I found another surgeon here who does the Ross Procedure. In the past 3 years, he has done about 11per year. How does that stack up against someone at one of the more prestigious hospitals? I know I need to also look at follow up and success rates, but for now, I'm just trying to decide where 11 per year is on the experience curve. If anyone knows anything about comparitive facts and figures from their own experience, and can help me properly interpret the numbers I am hearing both on the pig valve and the Ross, I'd appreciate it. Thanks!! Teri

 

[leecrowley]

Hi Teri,

The first surgeon I met was here in Tulsa. This was before I knew much about the Ross Procedure. When I met him, he sounded very competent, and I have no doubt he was a good surgeon. However, he said he only did 3 or 4 valve replacements per month. This was just not enough for me. I've read posts here that recommend a surgeon that performs at least 100-200 valve replacements per year. So I went looking for someone outside of Tulsa. I found my surgeon in Dallas. He specializes in aortic valve replacement and has well over 150 Ross Procedures under his belt. If he had done less than 75 or maybe even 100, I probably would have chosen something else.

Just my $0.02 worth. Good luck.

Lee
Ross Procedure (hopefully)
8/8/06

 

[Nancy]

Well, if you want to get the gist of how many surgeries surgeons typically do, take a look at this PDF file.

www.health.state.ny.us/nysdoh/heart/pdf/2000-2002_cabg.pdf

Scroll down to see each surgeon's name and the number of procedures during the time frame mentioned. Valve surgeries are in the list too.

Granted it is only in New York State, but your own state might have a similar list.

I just googled

"heart valve surgery" "New York State". Just add your own state or wherever you want to go.

 

[Bryan B]

Teri,

This is just my opinion...I don't think there is a "magic" number and there are other factors to consider besides just sheer numbers. My surgeon is the director of pediatric cardiac surgery at Duke Medical Center. Not only does he specialize in the Ross Procedure for children and adults but he also specializes in pediatric heart transplant, aortic valve repair, valve replacement, and multiple specialized pediatric cardiac procedures (he's a special guy in my eyes ). In his case he might be doing 10 different types of procedures in one week so his numbers for one particular procedure might be less than another surgeon. But I do know that he probably averages 2-3 complicated sugeries a day. I would be looking for a surgeon that does in the 100's of valve replacements a year, especially if he's doing a root replacement. For a RP surgeon I'd be comfortable with someone who's doing at least a couple a month and has done 100's over his career. (again...this is just my opinion). And if I was a BAV patient considering a RP I would only trust a RP surgeon that specializes in BAV patients.

 

[Ross]

As the others have said, there is more then numbers, but you'd have a jewell if he's doing that many in one day.

 

[Kate]

Teri,
This is just my opinion, but if your insurance will allow you to select who will do the surgery, I'd go to the most experienced person you can, ideally at one of the top rated heart hospitals in the country. I am lucky enough to live in Ohio and went to the Cleveland Clinic for my aortic valve replacement and aneurysm repair. Many of the people who I go to cardiac rehab with went to another terrific heart hospital in our area - Riverside in Columbus. Now, I don't have expert knowledge or the test results to say how our surgeries varied. However, just from looking at our scars, I am amazed at the difference. My chest tube scars are barely visible lines less than 1/2" long while their's look like bullet holes. Now, you may say, who cares about something as unimportant as that? However, if there is that much of a difference on the outside, how much difference is there on the inside?

I think this is particularly important in your case as you aren't just dealing with a valve replacement (which is relatively common place surgery these days) but with an aneurysm repair. Can you have successful results from a less experienced surgeon? Of course. But if your insurance allows you to go anywhere, why not go for the best? That said, I recognize that many people have extenuating circumstances like childcare, transportation costs, etc. that make this choice less available to them (and frankly, I am somewhat hesitant to make this post for just that reason). However, all else being equal, I see no reason to settle for a less experienced surgeon. Kate

 

[PJmomrunner]

Teri-

I wanted to speak to your question about numbers. The surgeon I will likely go with at the University of Michigan has done only aortas and valves for the last ten years. He does about 300 a year.

I'm definitely in the "more is better" camp. Arlyss has recently posted links that lead to studies that strongly support this. It would really stink to have your valve and root replaced only to develop an aneurysm in the ascending aorta two years from now and have to do it all over again...or something worse...because your surgeon wasn't experienced enough.

As for insurance, I found that my insurance (a PPO) specifies a local area network for me to stay within, but when I dug deep into their website, I found there is a national network as well where they will pay just as much. (U of M is not in it, but that's another story... )

 

[MrP]

For those really looking for an experienced surgeon with excellent track record.....including mine, my surgeon did FOUR valve replacements/aneurysm surgeries on the same day, and I'm told he's done several thousand of aortic surgeries. He's very good.