My dad's upcoming surgery/Kaiser SF

[Jiddo]

Hi All.

My name is Jennie and my dad is having his 3rd aortic valve replacement surgery next week, most likely at SF Kaiser. For those of you who have had your surgeries there, I would appreciate it if you could provide feedback on the surgeons at Kaiser. So far, we met with one (Dr. Paul LaPunzina) and will most likely meet with a couple more before next week. My dad has his last surgery 14 yrs ago at Stanford and had an exceptional doctor; however, he no longer has insurance that covers Stanford so he has to have the surgery at Kaiser. My dad is 62 and had his first surgery at 35, as he had Rheumatic Fever as a child.

My dad is contemplating whether to have the mechanical or tissue valve at this point. So far, he has had 2 successful surgeries with the tissue valve so I think he's leaning that route again. The surgeon suggested the mechanical valve and due to the lifestyle change, I don't think my dad is convinced that's the best option for him.

I have to tell you that I am an emotional mess right now. My dad means the world to me and to see him go through this again is so painful. I also feel for my mom, who has seen him through the previous 2 surgeries and has been his rock over the last 35 years. In addition, I am 9 months pregnant with my 2nd son and am due to deliver any day now. I'm hoping to keep my little guy in my tummy until after my dad's surgery but the timing isn't completely my decision.

My dad's name is Mike and I would appreciate it if you could keep him, the doctors and my family in your prayers. Right now, his surgery is scheduled for next Friday, June 8th.

Any feedback, support, advice, etc. that you can provide is greatly appreciated. I would especially like to hear from those who have experience with Kaiser SF.

Thanks so much.
Jennie

 

[geebee]

Welcome, Jennie.

This is a really tough call. Your father is getting about 13.5 years out of each tissue valve. If he goes tissue this time, he will be 76 when he next needs surgery. Not an impossible scenario but tough considering it would be his fourth surgery. Some of the current tissue valves promise to last 20 years which would put him at 82 for the next surgery.

I am not suggesting any course of action other than to provide food for thought. If your dad is dead set against coumadin then the decision is done. However, I am not sure what you mean by "the lifestyle change". If you are referring to coumadin changing his lifestyle, I can assure you that does not happen to those of us who have good coumadin management. I have not changed one thing in the 27 years I have been on coumadin other than having the blood tests.

He will be in our prayers for a safe and uneventful surgery. Let us know how we can help.

Congratulations on your baby and I hope things work out well even if you can't keep him "inside" as long as you would like.

 

[aussie girl]

I can't offer any expert advice but just wanted to say prayers are being sent so that your dad makes the right choices for him and also for successful surgery and a smooth recovery ...Mary

 

[Phyllis]

Welcome, Jennie. I put your Dad on the calendar for June 8th and all my best wishes and prayers for a successful surgery and uneventful recovery. I know that welcoming your child into this world will be one of the best things to help your father to a full recovery!

 

[Jiddo]

Thanks

Thanks

Thanks for keeping my dad in your thoughts and prayers. It really means a lot.

Geebee, I had the same thoughts about my dad doing a fourth surgery in his mid-seventies. I just can't imagine going through this again, especially my mom. She is constantly worried about my dad, taking care of him and watching out for his well being. It's really taking a toll on her. I think both of their thoughts at this point is to get him out of surgery and home as soon as possible. The tissue valve is a known success for them, the mechanical valve is completely new territory.

In regards to the lifestyle change, both my parents are concerned about accidental "bleeds" that could impact my dad's health further. I think that my mom is especially nervous about my dad taking coumadin and having to monitor him daily to ensure he is not putting himself at risk for bleeding.
In addition, my dad has never really been diligent about exercise/diet (though this time he says he is going to change). If he takes coumadin, he has to be diligent about testing his blood, which I'm not sure he thinks he can do. He also has very sensitive hearing and thinks that the "tick" from the mechanical valve will impact his ability to sleep at night.

My parents are waiting for my dad's original Stanford doctor to return from vacation on Monday so they can get a 2nd opinion. Although he will not be performing the surgery, he will be able to take a look at all the test results and give my parent's an assessment. Since my parents value his opinion, I'm sure they will take it into consideration when they make their final decision.

Thanks.
Jennie

 

[ALCapshaw2]

Can you tell us what kind of tissue valves he has had in the past? I'm guessing a Bovine Pericardial since they tended to last longer than untreated Porcine valves of that generation.

The 'latest' Bovine Preicardial Valves come with an anti-calcification coating that will hopefully extend it's durability to 20 years or more, especially in patients over age 60.

For mechanical valves, I like the relatively new On-X valves which have better fluid dynamics and lower potential for clot formation. Studies are being conducted to evaluate their use with lower levels of anti-coagulation so that is an additional 'hope' for the future.

I too was concerned about mechanical valve 'ticking' but find that my standard St. Jude aortic valve is inaudible most of the time. Even in a quiet environment, it only has a soft muted sound that I find comforting and reassuring. Even when quiet, I only hear it if I am in certain positions or inhale and hold my breath.

Living with Coumadin has been NO BIG DEAL with PROPER management. Home test equipment is available and slowly gaining acceptance. See Al Lodwick's informative website www.warfarinfo.com for more details about living with and managing anti-coagulation. He also monitors our anti-coagulation forum and frequently offers his advice and opinion.

Yes, consulting his previous surgeon is a GOOD idea. Perhaps he can recommend a surgeon at Kaiser. The main thing to look for is someone with lots of EXPERIENCE with re-do's and dealing with scar tissue. A surgeon I consulted trained at Stanford where he said their preferred method for re-do's is a Right Thoracotomy which is entry through the right side.

Best wishes to you and your Dad.

'AL Capshaw'

 

[Jiddo]

Thanks for your feedback, Al. I am pretty sure my dad had the Bovine valve inserted in his last operation. The doctor at Kaiser did not mention the new valves lasting up to 20 years. If I remember correctly, he said anywhere from 7-15 years. My sister met a patient at Kaiser yesterday who was 66 and going on his 2nd surgery after only 7 years, since his pig valve already started leaking. The patient decided to put in the mechanical valve with his second surgery.

My mom just called me and said she spoke with one of the Stanford surgeons (a colleague of my dad's former surgeons) who recommended the mechanical valve. I'll be doing some add'l research that I can present to both my parents so they can make an informed decision. Thanks for sending over the link to the website and for suggesting we look for a surgeon that has a lot of experience doing re-ops.

Jennie

 

[geebee]

Jennie,

The most important thing is for your dad to have surgery. The valve type needs to be the one your parents will be the happiest with and one they will not spend ANY time second guessing because that will just make them unhappy. Pehaps a tissue valve makes the most sense since they are so worried about coumadin. It could turn out that every issue that might crop up with coumadin will not allow them the opportunity to enjoy life and that is really what valve surgery is all about.

Get some good doctors, express all concerns, make a decision and never look back.

 

[Susan BAV]

Welcome, Jennie; glad you found the site. What you wrote about your dad really touched my heart. I lost my dad six years ago and still miss him terribly. And I hear you about the stress on your mom.

One other thing I thought I'd mention about valves is that I asked my cardio why some tissue valves fail so much earlier than others. Of course age apparently has a lot to do with it. But he also told me that taking care of teeth and gums is extremely important.

Anyway, I'll be hoping for the best for your dad. And congratulations on your upcoming happy arrival! Take care and post again.

 

[Jiddo]

Hi Susan.

Thanks for your response and sorry to hear about your dad.

In regards to age having an impact on tissue valve, are you saying that older patients have shorter or longer chances of keeping a tissue valve in? Thanks in advance for the clarification.

Thanks.
Jennie

 

[Susan BAV]

Hi Susan.

Thanks for your response and sorry to hear about your dad.

In regards to age having an impact on tissue valve, are you saying that older patients have shorter or longer chances of keeping a tissue valve in? Thanks in advance for the clarification...

Sorry. Older patients are usually expected to get a longer life from a tissue valve than younger patients.

 

[Ross]

Jiddo so long as Mechanical hasn't been ruled out completely, please see Al Lodwicks website at http://www.warfarinfo.com/warfarinfo.com2.htm and do some reading about Coumadin/Warfarin. Many of the myths and horror stories that are still in circulation to this day, will be dispelled. He's at the age where really, he can go either way. He just needs to figure out whats in his best interest for the long term.

 

[Lynlw]

Hi This doesn't have anything to do with tissue choice, BUT If your dad wants his origonal surgeon to do this surgery, I would try to get the insurance to agree based on "continuity of care" We don't have kaiser, I know they have a reputation for being pretty tough, but my son had surgeries/procedures at a few different hospitals, some were not in "network" BUt since Justin had heart surgery by a particular surgeon before, who really "knows' what he did/his work ect, and not just read the charts. That helped alot getting insurance to cover the surgery in a different out of state center. Lyn

 

[Lynlw]

Hi Susan.

Thanks for your response and sorry to hear about your dad.

In regards to age having an impact on tissue valve, are you saying that older patients have shorter or longer chances of keeping a tissue valve in? Thanks in advance for the clarification.

Thanks.
Jennie

Hi Younger people tend to go thru valves fast than, "older" (60s) this IS from a valve manufacturer, so always take that into consideration when reading articles, studies, but it is pretty good IMO at explaining where the 20 year lifespan is coming from, I also Believe this was the valve before the improved Anti-calcification the newer ones have, but I'm getting ready for my son surgery so my brain is a little 'off' right now http://www.edwards.com/products/heartvalves/perimountaorticcommuniquepdf.htm
Good luck with everything, I hope your parents can make a decision they feel comfortable soon, the decision making , who what when where to me is one of the more stressful times, lyn

 

[Jiddo]

Thanks for the feedback on the surgeon. My mom is supposed to talk to the original surgeon, Bruce Reitz from Stanford, tomorrow. We are hoping and praying that he will get involved in my dad's surgery, to at least some extent. That would be so great. He has surgery rights at Kaiser SF so there is a slight possibility that he might be able to perform the surgery there.

BTW, does anyone have any opinions about the Medtronic Mosaic Valve? My sister did some research and come across a Dr. David Ott, who provided some really good feedback on this type of valve for older patients. This was not one of the options that Kaiser gave us.

Thanks.
Jennie

 

[Lynlw]

Thanks for the feedback on the surgeon. My mom is supposed to talk to the original surgeon, Bruce Reitz from Stanford, tomorrow. We are hoping and praying that he will get involved in my dad's surgery, to at least some extent. That would be so great. He has surgery rights at Kaiser SF so there is a slight possibility that he might be able to perform the surgery there.

BTW, does anyone have any opinions about the Medtronic Mosaic Valve? My sister did some research and come across a Dr. David Ott, who provided some really good feedback on this type of valve for older patients. This was not one of the options that Kaiser gave us.

Thanks.
Jennie

IF you go to the "search" option and type mosaic there is quite a bit of info here
this is from one of the threads written by Togobog as a response to a member asking about the mosaic, (TW I'm not sure if you know one of the differences between the porcine and bovine for the most part is the porcine is a pigs valve, while the bovine are manufacturerd using the cows pericardial sac, It took me a while to realize a bovine wasn't really a cows valve0


The Mosaic is one of the Big Three - the premium tissue valves. The Medtronics Mosaic is an actual pig valve that has been carefully preserved and treated to reduce calcification. The Medtronic Freestyle is another preserved, anti-calcification-treated porcine valve with aortic root, which is stentless. The third is the Edwards Perimount Magna, a bovine valve manufactured from cow pericardium (the tough tissue that surrounds the heart). It is also carefully preserved and treated to resist calcification.

All three are great. The one with the longest track record is the Edwards bovine valve. There may be another on the way, a new entry from St. Jude, called the SJM Epic. However, it's still on trials for acceptance in the United States.

 

[Jackie]

Hi All.

My name is Jennie and my dad is having his 3rd aortic valve replacement surgery next week, most likely at SF Kaiser. For those of you who have had your surgeries there, I would appreciate it if you could provide feedback on the surgeons at Kaiser. So far, we met with one (Dr. Paul LaPunzina) and will most likely meet with a couple more before next week. My dad has his last surgery 14 yrs ago at Stanford and had an exceptional doctor; however, he no longer has insurance that covers Stanford so he has to have the surgery at Kaiser. My dad is 62 and had his first surgery at 35, as he had Rheumatic Fever as a child.

My dad is contemplating whether to have the mechanical or tissue valve at this point. So far, he has had 2 successful surgeries with the tissue valve so I think he's leaning that route again. The surgeon suggested the mechanical valve and due to the lifestyle change, I don't think my dad is convinced that's the best option for him.

I have to tell you that I am an emotional mess right now. My dad means the world to me and to see him go through this again is so painful. I also feel for my mom, who has seen him through the previous 2 surgeries and has been his rock over the last 35 years. In addition, I am 9 months pregnant with my 2nd son and am due to deliver any day now. I'm hoping to keep my little guy in my tummy until after my dad's surgery but the timing isn't completely my decision.

My dad's name is Mike and I would appreciate it if you could keep him, the doctors and my family in your prayers. Right now, his surgery is scheduled for next Friday, June 8th.

Any feedback, support, advice, etc. that you can provide is greatly appreciated. I would especially like to hear from those who have experience with Kaiser SF.

Thanks so much.

Hi Jennie,

I had my AVR at Kaiser in Oakland, Kaiser and Alta Bates share their facility for Heart Surgery. My surgeon is Dr. Dennis Durzinsky, I did not have a choice because it happened to be an emergency. I was sent from Fremont Kaiser to Santa Teressa Kaiser and from there to Alta Bates in Oakland. It turned out well, I really like Dr. Durzinsky, not sure if its because he saved my life or his bed sided manner or his expertise. The whole staff was great.

I have been on Warfarin for 14 months now and am not afraid of it anymore. When I first started I was scared to death but through this great group of people learned to live with it. I now have my own InRatio and test every week. I have learned not to panic if the results are too high or too low. Just make the adjustments in the dose. I eat what I want and do any activity that I wish. I cut myself now and then, but have never had trouble with bleeding. I am 67 and received a Mechanical Valve, I made my choice when Dr Durzinsky said his mother had been on coumadin for 8 years without any problems. I think that was his way of telling me the mechanical would be best.

Good luck