Mitral valve repair surgeon and cardiologist

[dong]

I am new to this site and have lots of questions. I have mitral regurgitation and need a MV repair surgery. I met two surgeons locally. Both of them said it would be an easy repair. But they gave me a repair rate at 90% and 95%. Is there any surgeon will give 100% repair success rate?
The surgeon told me that there will be a cardiologist do TEE before and after the MV repair during the surgery and he doesn't who will be the cardiologist on call on that day. Is this not good? Is this cardiologist's experience critical to the surgery success?
I am afraid of the complication caused by OHS.

Presurgery MVR

 

[ALCapshaw2]

Welcome Dong.

I suspect that NO surgeon will be able to say 100% for sure what they can or cannot do until they 'get in there', especially for repairs. Actually, those numbers sound pretty good for a repair estimate. I've seen lower.

I went into my AVR with an agreement to implant a Bovine Pericardial Tissue Valve but came home with a St. Jude Mechanical Valve because of what the surgeon found upon opening my chest / heart.

Bottom Line: You definitely want a surgeon who does a LOT of MV Repairs. ASK how many he does per year and what his results are. You would also be wise to have a Plan B 'just in case' the repair doesn't work.

Hopefully some of our 'repaired MV' people will come forward with their greater experience in this area.

'AL Capshaw'

 

[WayneGM]

Welcome to the VR forum. Glad you found us.

I had a mitral valve repair. While mitral valve repairs are quite common, I don't think any reputable surgeon will ever guanantee you a 100% success rate. I had Dr. Tirone David who is considered one of the best in the world on valve repairs. He was quite confident that my valve could be repaired as the diagnosis was a routine repair. However, he didn't offer any percentages (and I didn't ask). In fact, he cautioned me that he could never know absolutely until we has in my chest during the surgery. While he didn't anticipate any problems, I could wake up with a valve replacement, instead of repair, if he deemed it necessary during the procedure. As it turned out, my repair was textbook as planned, and my heart is fine now.

I placed my trust in the Surgeon. I have no idea who the other doctors and nurses involved were or their qualifications. I trusted that competent personnel were on staff, and I have no reason to think otherwise now. To the contrary, I was totally impressed with everyone at the hospital. My personal Cardioloigst was not involved with my surgery other than referring me to the surgeon in the first place and then post-op check-ups after release.

While there is always the risk of complications, don't let fear of this get to you. I know it's easier said than done but if your condition is such that you need OHS then the "what if's" of complications don't matter. Try to focus on the positives having OHS offers you. I had no symptoms going into my OHS so it was hard understanding how I could even need OHS when I was feeling just fine. However, I had it because I knew I needed it in the long run, before any permanent heart damage was done, and that was what I focused on. The risks of not doing it outweighed my fears of doing it. I have absolutely no regrets. It's not nearly as bad as your fears probably imagine.

Best wishes and good luck.

 

[Magic8Ball]

Is there any surgeon will give 100% repair success rate?

Is this not good? Is this cardiologist's experience critical to the surgery success?

Try going to a tyre repair shop with a flat tyre and ask for a 100% guarantee that they can fix it before they see it...it aint gonna happen.

I think the numbers are fine (repair was never an option for me) but from everyone i've listened to you need to both discuss the repair AND a fallback plan should the valve be worse when they get in.

Remember, these are the figures for the REPAIR....they are not saying those are the figures for the success of surgery...the surgery will be around 98-99 success rate...its just that you may not end up with a repair but a replacement.

eg. My surgery was due to the anurysm and they said i probably had 5 years left in the valve should i want to only have the anurysm fixed....i decided on both at the same time and the surgeon said that my valve nearly fell apart at the slightest touch when they went to replace it....they just never know.

Regards.


EDIT:
The cardiologist is not key to the success of the surgery, its nice to have a good one. I expect the cardiologist on the day of surgery is only going to be there to give an opinion on the numbers gained from the repair etc. Its all surgeon on the day.

 

[ALCapshaw2]

WELL SAID Wayne. I'm going to copy your last paragraph as a reminder to focus on the POSITIVE!

Magic, Good Catch!

YES, Dong, when a surgeon gives you a quote on a REPAIR that number refers to the chance he estimates that he can do a successful repair. It is NOT related to the Success of the Surgery which is typically 98 or 99% for first time surgeries. IF a repair does not work, they simply REPLACE the defective valve with Option 2, which is why it is wise to have a "Plan B" for the 5 or 10% chance that the repair did not work and you get a Replacement Valve instead.

Bottom Line: There is a 1% chance of Stroke and 1% chance of mortality on a national basis. Top Surgeons of course are even better than that. The chance of Death if you DO NOTHING is near 100%. When a valve fails, it's all over. Surgery wins, hands down.

I hope that clarifies the risks a little better.

'AL Capshaw'

 

[Curtsmum]

My son had his mitral valve repaired and although he had complications he came through it and is doing brilliantly, waiting for his next repair/replacement. I would say that 90/95% was good and i personaly would be happy with that percentage for my son. Whatever the outcome, if you ended up having a mechcanicl valve you will do just fine, i have learned from this forum that its not the end of the world and you can still live a nomal life. So best of luck, hope everything goes well, it is ok to be afraid its all part of the package but if you do lots of reading you will see just how many people are doing really well after ohs, take care

 

[dong]

Hi Al, Wayne, Magic8ball, and Paula,

Thank you for all your replies. They are very encouraging. I appreciated very much.

Dong

 

[MikeHeim]

Rachel pretty much nailed it. It's impossible to guaruntee a repair until the surgeon gets in and sees what they have to work with. Some questions for you:

1. Does one or both of your Mitral Valve leaflets need to be repaired?
2. If only one, is it the anterior or posterior (I believe anterior is more difficult to repair)?
3. Are your chordae (strings that hold the valve in place) intact?

The three questions above (there may be a couple others) dictate how simple a repair will be. There aren't very many surgeons that will do a repair if both leaflets need to be resectioned. If many or all of your chordae are ruptured, a repair is also much more difficult. You want a surgeon who will give you the best surgical outcome. Getting a repair doesn't do you any good if the repair is insufficient and you end up needing a replacement just a couple years down the line. I personally needed work done on both of my leaflets, and had to travel 90 miles to find a surgeon who was comfortable with performing those types of repairs. I was told later by my Cardio that all of the local surgeons would have just replaced the valve when they saw how bad things were. I'm keeping my fingers crossed, but I'm two years in without any issues whatsoever.

Best wishes.

 

[BillCobit]

I personally needed work done on both of my leaflets, and had to travel 90 miles to find a surgeon who was comfortable with performing those types of repairs. I was told later by my Cardio that all of the local surgeons would have just replaced the valve when they saw how bad things were. I'm keeping my fingers crossed, but I'm two years in without any issues whatsoever.

Best wishes.

Sounds familiar, Mike. I needed work on both leaflets, and the local guy my cardio recommended told me I was not a candidate for repair. I decided to go to the Cleveland Clinic where an MV specialty surgeon said he was 70% confident that he could repair it. Turned out the situation was trickier than thought, because I had leaflet perforations that hadn't been visualised on the echo. Nevertheless, I got my repair. Just had my 6 year check up yesterday - all is well. I emphatically agree that you want the best surgeon available to you, and that travel is well worth the inconvenience, expense and anxiety if that's what you need to do.

 

[JAJ99]

Welcome to the site. I found the information here extremely helpful and everyone's encouragement uplifting. It makes you realize that you are not alone even if we are only connected through the web.

I didn't have a TEE prior to surgery. I don't know who did it during/after my surgery, but I never saw my cardiologist the entire time I was at Mayo. It's the surgeon you need during that time.

A highly skilled surgeon should be able to give you a good indication if he thinks a repair can be made. I too traveled away from my home for my surgery and it was worth every hassle. I needed both leaflets repaired so I chose the place/surgeon I thought would give me the best chance of a repair. I was quite reassured prior to surgery that my valve would be able to be repaired based on conversations with both my cardiologist and surgeon. Having a backup plan that you're comfortable with helps your peace of mind as well.

Best of luck.
Jean

 

[Lisa in Katy]

As others mentioned, they can't guarantee a repair until they get in there and actually see the valve. I had talked with my cardiologist about a mitral valve repair, but after my cath, the surgeon said that there wasn't enough valve left to repair because of the damage caused by rheumatic fever. It would have been a total rebuild. This was almost 10 years ago and repairs have come a long way, but they still aren't 100%. As they say, nothing in life is guaranteed except death and taxes.

As far as the TEE, I have no idea who did mine. I think it was a radiologist. I don't think I had one before surgery, but had one immediately after and then sometime later while I was still out. It's just to make sure that the valve is working like it's supposed to and I know that the surgeon was there for both.

Good luck and welcome.