Mitral valve surgery

[Geofd]

Hello brand new to this forum, just found out I'm gonna need surgery,I have severe regurgitation, and flailing???? I think,don't know all the terms yet,but need surgeryJust looking for insight on repair, replacement thanks

 

[Chuck C]

Hello brand new to this forum, just found out I'm gonna need surgery,I have severe regurgitation, and flailing???? I think,don't know all the terms yet,but need surgeryJust looking for insight on repair, replacement thanks

Welcome to the forum Geogd!

There are more aortic valve surgery folks here on the forum than mitral valve, but give it time and you should get some that come out of the woodwork to help give you guidance.

It will help others help you the more information you give, if you are comfortable doing so. Your age, your general location, does your medical team have an idea why you are having regurgitation? Have you been evaluated by a surgeon as to whether you are a candidate for repair?

Do you have any specific questions?

You will find lots of helpful folks here. Best of luck.

 

[Hyp2r]

Had my mitral replaced along with the aortic valve a few months ago. The main objective was to replace the aortic and repair the mitral valve, but when they opened me up and saw the condition of the mitral they replaced that also.
I believe flailing is referring to the chords holding the mitral valve in. These get broken and ‘flail’ around. Not sure if they can be repaired.

 

[Geofd]

Thanks for both responses,
I'm 60 years old in very good health I'm a plumber at northeastern university in Boston,I live in Framingham,20 west of Boston,
for a while now 10 years primary care Dr,has heard a heart mm murmur, so this last visit she said it was louder and scheduled me for an exam at newton Wellesley hospital, I think it was an ultrasound sound, she then contacted me said there were issues,so I saw the cardiologist who read the test,we could see by a coloured, video
That the blood was going the wrong Wayans a peice of one side had broken away it not off she called it severe mitral regurgitation,and flailing, she said this has been a life long condition,I feel fine,except a little short of breath at times,I do have asthma,so she schedulede for a stress test and I completed 88% of it,she said I'm in excellent health for my age,on 7/24 I have a surgical consult with a mitral valve specialist from Brigham e women's hospital in Boston ,so this is just the beginning stages, I'm not really worried about anything, the primary care Dr,and the Dr who read my test said I would need surgery, one said I was not a canidate for a mitral valve clip,I know there are two other ways it can be replaced and repaired,I have already read to much and haven't talked to this kind of group, sorry for the long winded story thanks

 

[carolinemc]

Hello brand new to this forum, just found out I'm gonna need surgery,I have severe regurgitation, and flailing???? I think,don't know all the terms yet,but need surgeryJust looking for insight on repair, replacement thanks

Welcome to the wall, Geofd. We have different experiences but we can only share person experience. I think your first step is talk to the Cardio or surgeon about what will be done. Then you get educated on terms and procedures you will go under before surgery and what to expect during and after. It makes things less scary when you learn what you can before surgery. There are those of us that has been in this since birth or just after, or during child hood, or at adult stage.
I was born with aortic valve defect and stenosis. Had repair at 8 years of age in 1973. It needed replacement on 09-13-2001. Did very well, the surgeon said the aortic was in the worst shape he had ever seen. I was a smoker at the time, I had quit back in February that year, but that was the damage done already. But still here, doing as well as can be expected with added feature, edema and weeping edema. But still alive. Good luck and never be afraid to ask questions, for the more you know, the more you will be informed and lessen the fears.

 

[MartinF]

Hi Geofd, I had my mitral valve replaced almost 9 years ago. The chords were breaking but they didn't call it flailing. Sounds like the same as yours. My surgeon tried to repair it but after he did it only lasted about 45 seconds. So he had to replace it. Lucky it failed so soon!
My surgeon also did minimally invasive surgery, going thru the ribs on the right side. So no zipper scar for me.

 

[gerrychuck]

I had a flail leaflet and had emergency mitral valve surgery in late 2012. Mine was emergent, and wasn't accurately diagnosed until I was in deep (intubated) trouble. So glad you have some time to adjust to this new reality. I ended up with a mechanical (St. Jude) valve, and therefore on warfarin for the duration. With replacement, the other option is a tissue valve that probably (but not always) does not require anticoagulation, but will probably need to be replaced in 10-15 years or so. Generally speaking, the younger you are, the more the choice tends to go toward the mechanical option, which requires anticoagulation, but should never require another OHS to replace. Repair may it may not be possible. My surgeon hoped to repair my valve, but found it too degenerated and had to replace. Often they don't know until they're in there.

There are some significant differences between aortic replacement (far more common) and mitral. The mitral valve leaflets are tethered to the ventricular walls by the papillary muscles, and those guy wires across the chamber contribute to wall strength and ventricular function. Replacement of the valve is accompanied by excision of those muscles, and that does have an effect on left ventricle function over time. That is one of the factors that make repair the preferable option if it is viable.

Obviously lots to consider here! Get as much info as you can in advance so you can ask informed questions of your cardiologist and surgeon. Best of luck

 

[Geofd]

Thanks all for the info, will I be given a choice of replacement or repair, I feel if you only have to do it once even though more evasive, would be a better option for me only because I'm 60, and don't know what my health will be in 10 or15 years,although very health now you don't know what the future holds

 

[Zoltania]

Mitral valve repair is more common than replacement and usually has excellent outcomes. Repair is commonly done via a minimally invasive incision, though the surgery is still major and requires time on the heart-lung bypass machine. I don't know much about the MitraClip. I can understand the desire to avoid surgery, but surgical results are really good nowadays, and with a repair you are likely to only need a few months of anticoagulation therapy and no further surgeries.

 

[Geofd]

The Dr who did the ultrasound /
echocardiogram said I was not a candidate for the mitral clip because I was too healthy,,what I have read about biological valves is they have a life spans, I'm 60 and only want to do this once,I'm going to have a surgical consult at the end of the month so I'm sure I'll know my options and feel less clueless

 

[Chuck C]

,what I have read about biological valves is they have a life spans

Yes, they do have limited lifespans.

This study found that this particular tissue valve in the mitral position lasted 14.2 years on average.

"
CONCLUSIONS
In the selected patients aged 65 years or younger undergoing MVR with the CE PERIMOUNT bioprosthesis, the expected valve durability was 14.2 years."

https://academic.oup.com/ejcts/article/54/2/302/4851223
But, this is important:


"Conflict of interest: Thierry Bourguignon is consultant for Edwards Lifesciences. Pascal Candolfi is employee of Edwards Lifesciences, Department of Biostatistics."

Edwards Lifesciences makes this valve that was studied. This is not to say that we toss the study out, but it means that they had every motivation to present the valve in the best light possible and likely used selection criterial to maximize the life expectancy for the valve.

If you did as well as the average selected individuals in this study, that would mean a reoperation at about age 74 for you. Something to consider in making your valve choice, if repair is not an option.

This is also a very interesting comment from the conclusion:

"these findings suggest that bioprosthetic MVR using a PERIMOUNT valve may be a reasonable alternative to mechanical prosthetic valve replacement in fully informed young patients who wish to avoid the lifestyle limitations associated with lifelong anticoagulation."

The bold is mine. What they did not say is, perhaps, more important than what they did say, but they did choose their words carefully. What they did not say was that it is a reasonable choice for those who wish to have the longest life expectancy. Those that would benefit financially from repeat customers often play up the spookiness of anticoagulants, most of which turns out to be myth.

 

[Geofd]

Yes, they do have limited lifespans.

This study found this this particular tissue valve in the mitral position lasted 14.2 years on average.

"
CONCLUSIONS
In the selected patients aged 65 years or younger undergoing MVR with the CE PERIMOUNT bioprosthesis, the expected valve durability was 14.2 years."

https://academic.oup.com/ejcts/article/54/2/302/4851223
But, this is important:


"Conflict of interest: Thierry Bourguignon is consultant for Edwards Lifesciences. Pascal Candolfi is employee of Edwards Lifesciences, Department of Biostatistics."

Edwards Lifesciences makes this valve that was studied. This is not to say that we toss the study out, but it means that they had every motivation to present the valve in the best light possible and likely used selection criterial to maximize the life expectancy for the valve.

If you did as well as the average selected individuals in this study, that would mean a reoperation at about age 74 for you. Something to consider in making your valve choice, if repair is not an option.

This is also a very interesting comment from the conclusion:

"these findings suggest that bioprosthetic MVR using a PERIMOUNT valve may be a reasonable alternative to mechanical prosthetic valve replacement in fully informed young patients who wish to avoid the lifestyle limitations associated with lifelong anticoagulation."

The bold is mine. What they did not say is, perhaps, more important than what they did say, but they did choose their words carefully. What they did not say was that it is a reasonable choice for those who wish to have the longest life expectancy. Those that would benefit financially from repeat customers often play up the spookiness of anticoagulants, most of which turns out to be myth.

Yes that's what I have also understood from reading different posts from diffrent forums
Thanks