Is resurgery that bad if one chooses a tissue valve?

[Nancy]

There are no guarantees no matter what you do. Joe has mechanicals, and he still has had three valve surgeries, an aortic, a mitral and a small repair on the mitral. He is now considered inoperable. But he has many, many issues that most folks never have.

On the flip side of the coin, he has had his aortic mechanical for almoat 29 years, and he is 75 years old. He has lived a long life in spite of it all, when his original cardiologist long, long ago told him to enjoy life because he wouldn't live beyond fifty. He had rheumatic fever.

He got his Bjork-Shiley in 1977. Mechanicals were not the norm then. Porcine valves were the ones that almost everybody got. Joe could not have the porcine valve, something in his system was not compatible with the porcine tissue. So, he got a mechanical and was very unhappy that he got that.

He is no longer unhappy with it. It's a big old clunky friend (by today's standards) that keeps on going

 

[Lynlw]

would also echo Nancy's suggestion that you seriously discuss the issues of Type II diabetis with your doctor and surgeon. My Dad was a Type II diabetic and had OHS for bypass surgery. He got an infection in his sternum and due to the lack of blood supply from his diabetis, antibiotics couldnot get to the sight of the infection. They ended up having to remove his sternum and some ribs. He was in the hospital for 2 months.

I realize that this is really a worst case scenario, and I don't mean to scare you when you are already scared about the valve surgery to begin with. But I did feel that this is something you should know about. My Dad's Type II was felt to be pretty controlled. At the time of his surgery he had no other diabetis-associated health problems that would have given the physicians a clue that he may have trouble. I should also let you know that he was on insulin shots and not the pills, so he was testing daily. It sounds like you take pills.
__________________
On the flip side of this my BIL is a diabetic and has had many different surgeries because of his diabetes, eyes,heart (I think heart diesease and stroke are some of the leading causes of death for diabetics) feet, toes ect, he has a really tough time and is now blind, and is in the hospital alot, he had heart surgery but not for valves, but I would ijmagine having all the additional diabetic related surgeries, COULD be harder if they had to deal with coumaden too. Lyn

 

[KMS]

Welcome

Welcome

Arny (just love that) -

The good news is that this surgery really has become routine, and regardless of what valve choice you make, odds are that you'll have a great outcome and a good recovery.

6 months ago I was sitting in your seat: trying to make a good decision about a valve choice. After lots of research and time spent on this and other sites, I chose to go with a tissue valve. I've had a great recovery and the only thing I take is an aspirin a day. Like you, I fully expect technology to improve even further by the time I'm ready for my valve replacement.

As many others have said, either way -- mechanical or tissue -- do your research, make your choice and move forward. Keep that attitude positive and you'll be in great shape.

Warm regards,

Kristine

 

[brendamarlene]

I vote for tissue

I vote for tissue

First, I had a homograph------lasted 15 years---no problems.

Now I have a mechanical, and I definitely vote for the tissue valve. My INR is always fluctuating, and I hate always having to worry about it and my diet.

This time I chose the mechanical, hoping to avoid a third surgery.

Hope this helps.

 

[Dustin]

So for these reasons all my dr's are saying this is going to be a piece of cake.

I wouldn't want to promote this view... Open heart surgery is never a "piece of cake" I think. It is one of the most invasive operations you can go through. No matter what your health is prior to surgery, you simply cannot tell how your body responds to surgical intervention. Even when you're an athlete, eat fruit every day, don't smoke and drink. It means nothing and recovery can be fraught with difficulties and setbacks. It is not my intention to put you off, but a reality check wouldn't hurt either.

Now, anti-coagulation does not control your life any more as brushing your teeth does: You still need to pick up that brush everyday and to take it with you on holidays. The trick is not to think about coumadin and INRs once you've taken the pill. Anyway, I'm going through an extreme kitchen makeover at the moment, banging my way through masonry and concrete with an INR around 3. My kitchen is starting to look good, just the way I like it.


Best wishes,

 

[mntbiker]

Let me just say: I love my Porcine valve! If I had to do it again I would make the same choice.

Now just to pile on with Dustin, I would nominate myself as having had one of the easiest surgeries and recoveries possible. I am late 30's (not for long ) I have always been very active from MTB'ing to Martial Arts and lots of other stuff and I was in just about as good a shape as I could have been (considering I had CHF and some other fun stuff that goes with a severely regurgitant valve). I was back to work part time in 10 days full time in 3 weeks, I was walking miles before I even left the hospital and I was back on the bike (trainer) at 3 weeks, like most I had good days and bad, mostly good though and I would still say this surgery is not a piece of cake. The recovery is hard and you never know how your body will react to what you have put it through, I dread going through this again but I will still pick tissue.

 

[Nancy]

When the surgeon or cardiologist tells you that this surgery is going to be a piece of cake, you have to determine the point of view of the person saying that. For the surgeon or cardiologist it may be routine and a total piece of cake, even a "yawner", if they have done it hundreds and hundreds of time.

But for YOU, it won't be a piece of cake. Your recovery may be good or could have problems, but I don't think anyone here who has had this kind of surgery will tell you that it is a piece of cake.

I don't like it when docs tell a patient that. It would be better to be a bit more realistic and tell the person what to expect based on a normal recovery.

 

[catwoman]

When the surgeon or cardiologist tells you that this surgery is going to be a piece of cake, you have to determine the point of view of the person saying that. For the surgeon or cardiologist it may be routine and a total piece of cake, even a "yawner", if they have done it hundreds and hundreds of time.

But for YOU, it won't be a piece of cake. Your recovery may be good or could have problems, but I don't think anyone here who has had this kind of surgery will tell you that it is a piece of cake.

I don't like it when docs tell a patient that. It would be better to be a bit more realistic and tell the person what to expect based on a normal recovery.

Nancy:
I second your comments.

There's a post somewhere on the website about a device that allows doctors to experience virtual reality CHF. Wish there was one so doctors would know what we go through with OHS (valve repair, valve replacement and/or CABG). Medical professionals aren't the ones suffering through up to a year of total recovery.

Arnie:
Because of the cost of surgery, invasive procedure & lengthy recovery period (not just the initial sternum & scar healing), I went with mechanical. And I'd do it again "in a heartbeat."

 

[Susan BAV]

Someone mentioned post-op A-fib and that's a possibility where you may have to go on Coumadin anyway.

At 42, three years ago, I chose tissue for many reasons and I'm glad that I did. Interestingly, perhaps, my surgeon mentioned that he put something in just under my sternum, to help avoid adhesions, in consideration of the probability of another future OHS and another new valve.

In theory, Coumadin could be a breeze. I developed A-fib a week after AVR, however, and found that it was not a breeze; I was put on Coumadin for three months and experienced that there was a perpetual conflict with the doctors and the blood tests and the maintenance and I was only briefly within INR range during those three months. And I watched everything closely and tried to be right on top of the maintenance too! It should be easy for doctors and nurses to maintain but I found a lot of shocking ignorance in the field. Self-testing would be preferable.

 

[Arnold Ziffel]

OMG, My apologies for not replying.

OMG, My apologies for not replying.

Hi All,
Thank you to everyone for their replies, I appreciate every one of them. Let me give an update.
I am now just over 3 weeks post op, I went with a 29mm. Mosaic porcine Aortic valve (just got my world membership card). My surgery went extremely well, I was in and out in 2 hours, in fact my girlfriend thought something was wrong when they called so soon. I came home 5 days later.

My recovery seemed so well I felt guilty that I was not in any pain other than being weak as hell and my worst enemy was the Spirometer. Well 5 days after being home I stopped the pain pills, was able to walk almost a mile, so I stopped the spirometer too.
The next day I developed a persistant cough, I called my dr's and got the run around of what to do (another story that hasnt hit the fan yet) so 7 days later I had trouble breathing so I ended up in the ER for the night. They said I was dehydrated, have acute bronchitus and am still anemic from the surgery, Im doing much better now. The first month has had an array of ups and downs, so I hope the second month is much better. Every day is much better than the day before, I cant wait to get off all these meds they have me taking for 30 days and get my muscles back into shape.
But everyone had good advice on what to expect, thank you for the accurate information.
I am happy with my choice and look forward to living a happy life.

Some comments on resurgery and scar tissue, I asked that question and my surgeon said thats not an issue at all because if there were scar tissue, they would do a valve root reconstruction which would give the next valve a whole new base. Makes sense to me.
Thanks again to all, and to good health.
Arny (Steve)

 

[ddarsch]

Two time porcein mitral valve

Two time porcein mitral valve

I chose to have a porcine mitral valve in 1991 (age 34) and then again in 2003 (age 48). Open heart surgery is never easy and always risky, but for me the second procedure was much less stressful and painful than the first. While I have not ruled out a thrid tissue valve, I will make that decision when the times comes.

I have no regrets physically or emotionally with my decision.

 

[Karlynn]

Some comments on resurgery and scar tissue, I asked that question and my surgeon said thats not an issue at all because if there were scar tissue, they would do a valve root reconstruction which would give the next valve a whole new base. Makes sense to me.
Thanks again to all, and to good health.
Arny (Steve)

This may be the case with the actual functioning of the valve. But, I think most of us that comment on the possibility of scar tissue causing problems with resurgeries is the difficulty the surgeon may have in having to deal with it to even just getting to the valve, the time it would add to a surgery and the toll the whole procedure would take on the heart.

We have members here (both tissue and mech valves) who have had repeat surgeries and did have complications due to scar tissue. So when the surgeon said it wasn't an issue at all, my guess is that he was referring to the actual functioning of the valve after he got done with it.

 

[temp69]

Echo what Kate says. This is not some simple in and out surgery, it's a pain in the...well you know where. I'm now about five and half months post op and am just now beginning to feel "normal," whatever that is.

Now, if you're going to have deep cuts and gashes, you should probably stay way from coumadin. For me so far it hasn't been such a horrible deal, just some getting used to.

personally, I don't want to have to go back in for another OHS. But who knows, I might have to anyway! You never know. I just didn't want to have that hanging over me, so I went with the On-x valve, which has some hope of not needing coumadin.

There's no wrong choice, you'll be fine. feel free to send me a private message if you like -- and keep a good positive attitude.

 

[temp69]

ok, so i jumped gun and didn't read you went in and out so quickly. good for you. you just have to keep smiling now and live life to the fullest.

 

[Arnold Ziffel]

So when the surgeon said it wasn't an issue at all, my guess is that he was referring to the actual functioning of the valve after he got done with it.

My interpratation was that the root base had to be replaced due to scar tissue if and when they went in and found this damage when they removed the valve.

This surgeon did an AVR on live OR tv and I read the text of the procedure and on this particular patient, they found valve root damage after they removed the valve and the procedure took an extra 12 minutes over the original 36 minutes to r&r the valve.
By this I took it as if they ever found scar tissue, it would not be a monumental task to repair or replace the valve root.

 

[Susan BAV]

Hi Steve -

Glad everything is getting better and better for you.

The adhesions I was referring to aren't within the heart but are between the sternum and the muscle behind/beneath. I guess after the first OHS, adhesions in that location can be a problem for a second OHS. That's where my surgeon put [something], to prevent adhesions. It makes me think of putting newspaper down in the bottom of a new flower bed and below the new soil and mulch to prevent weeds from coming up, a barrier of protection.

Hope you feel better all the time. Take care!

 

[Karlynn]

"Arny", I understand what your surgeon is trying to say, I think we are just addressing 2 different issues when talking about scar tissue and Susan highlighted some of what I'm referring to. The scar tissue problem doesn't always have to do with the immediate site of the VR, but in a wider area. We've had members who've reported the surgeon having a hard time getting to the valve site because of the scar tissue.

My point in responding to your post wasn't to intimate that your surgeon was wrong - for some people he's not. But I also wanted to point out that when talking about difficult surgery due to scar tissue, we aren't specifically talking about the valve and valve site, but also the general chest and heart area. Maybe some of our members who've had this experience will be along to clarify what I'm describing. This isn't to say that it's a glaring problem, just one that people need to be aware of the possibility, along with all the other possibilities related to VR.

I hope you are feeling better than you were 2 weeks ago.

 

[SteveK]

Scar tissue

Scar tissue

It will be three years in January since my AVR (porcine), and the only issue I still have is an annoying, itching scar. My scar is very pronounced, what they call keloid. Since I am 40, I will be having another surgery in the future. (unless something else kills me first) What I am wondering is: If I scar like crap on the outside, do I scar terribly on the inside also?

 

[CathyK.]

Good question SteveK. And to Arny(Steve), I am glad to hear that you are doing good. I, too am going to choose biological. PM me any pointers if you have any.

 

[Arnold Ziffel]

"Arny", I understand what your surgeon is trying to say, I think we are just addressing 2 different issues when talking about scar tissue and Susan highlighted some of what I'm referring to. The scar tissue problem doesn't always have to do with the immediate site of the VR, but in a wider area. We've had members who've reported the surgeon having a hard time getting to the valve site because of the scar tissue.

My point in responding to your post wasn't to intimate that your surgeon was wrong - for some people he's not. But I also wanted to point out that when talking about difficult surgery due to scar tissue, we aren't specifically talking about the valve and valve site, but also the general chest and heart area. Maybe some of our members who've had this experience will be along to clarify what I'm describing. This isn't to say that it's a glaring problem, just one that people need to be aware of the possibility, along with all the other possibilities related to VR.

I hope you are feeling better than you were 2 weeks ago.

I didnt realize that surface scaring would or could be an issue. Thank you for clearing that up, and I apologize if at first seemed ignorant on the issue. Happy Holidays to all.