Need a Aortic Valve Replacement before year ends

[pellicle]

Im a bit scared about the cost since i have no international insurance, but i guess we will see,

I understood that OHS and heart valve surgery is pretty cost effective in India. Don't be scared off by "India" because they do have the capacity at the top end to do a good job.

I'd get prices (firmly) including "likely cost over runs" on "complication" and weigh that up. Personally I wouldn't want to be travelling by air for a long flight for 2 months post OHS so factor that into the equation.

Best Wishes

 

[Dunwanted]

Im in a weird spot as i live in Dominican Republic (caribbean island) and this operation is done very rarely personally i dont trust these doctors to preform it, my cardiologist suggested USA or Germany (i am half german).

will looking into it, thanks for the info.

 

[pellicle]

Im in a weird spot as i live in Dominican Republic (caribbean island) and this operation is done very rarely personally i dont trust these doctors to preform it, my cardiologist suggested USA or Germany (i am half german).

will looking into it, thanks for the info.

Hi
yeah, I checked on wikipedia where it was when you first mentioned it. I do understand why you'd not want to trust the surgeons there. I was just mashing-up ideas quickly for your dissection, analysis and generally folding into your thoughts.

I'm glad I just went to a hospital within 100km of where I lived (which as it happens did all my surgeries).

Best Wishes

 

[spartangator]

Just wanted to add another welcome, @Dunwanted. As you can see, you're in the right place with lots of supportive people.

 

[70sdiver]

In the USA the cost is gonna be high.

 

[Dunwanted]

Good afternoon everyone,

again thank you for all the information, going in tuesday for some tests in cleveland clinic so they can study my case more to have more information, while im there i will ask for an estimate cost for the operation and i will also look at options in germany as i am a german citizen and i have seen costs are more reduced in germany for this operation.

 

[Superman]

Good afternoon everyone,

again thank you for all the information, going in tuesday for some tests in cleveland clinic so they can study my case more to have more information, while im there i will ask for an estimate cost for the operation and i will also look at options in germany as i am a german citizen and i have seen costs are more reduced in germany for this operation.

I’m not going to say it’s not complicated, because it is heart surgery. I’ll fix my cars brakes, but I won’t replace my own valve. However, it’s not like it’s Cleveland Clinic vs everyone dying on the table everywhere else. If it’s covered for you in Germany, save your money and go there. I have no doubts there are plenty of competent surgical teams in Deutschland. I live five hours from Cleveland and chose the hospital 15 minutes from my house both times. Still alive to tell about it.

By the way, seriously, good luck getting an honest upfront price from a US hospital. The surgeon might tell you their charge. But not the anesthesiologist’s charge. Or the hospitals separate charge. Or the $10 a pill Tylenol. Or the random hospitalist who came by to check on you and now can bill you.

 

[pellicle]

Good Morning

...going in tuesday for some tests in cleveland clinic so they can study my case more to have more information, while im there i will ask for an estimate cost for the operation

from what I know, even here in Australia some frank financial discussions with the surgeon and clinic can make a huge difference between the "sticker price" and what you pay.

If it’s covered for you in Germany, save your money and go there. I have no doubts there are plenty of competent surgical teams in Deutschland

I would probably say that Germany is at least as good as the USA but I'm not sure about the flexibility of price.

with respect to travel don't underestimate how uncomfortable it will be in the first days after surgery and how you will need someone with you to carry everything for you in transit (remember no lifting) and you'll need a seat which is beside an exit so that you can get up ... really I (meaning me) would not want to be flying for weeks after surgery.

 

[Dunwanted]

I’m not going to say it’s not complicated, because it is heart surgery. I’ll fix my cars brakes, but I won’t replace my own valve. However, it’s not like it’s Cleveland Clinic vs everyone dying on the table everywhere else. If it’s covered for you in Germany, save your money and go there. I have no doubts there are plenty of competent surgical teams in Deutschland.

i its extremely complicated, atleast for usa i feel more safe since they have more information a many reviews of surgeons, plus all the comment i have been reading here, still have to wait for the tests to be taken since they do not trust the tests taken in the country i live in.
My cost wont be covered in germany, but what i have read it is much cheaper than US (since i have no interntional inssurance).

from what I know, even here in Australia some frank financial discussions with the surgeon and clinic can make a huge difference between the "sticker price" and what you pay.

this is a discussion i must have before my surgery for sure, since i dont wanna waste all my savings+parents savings on my operation i dont wanna be such a burden for them even after moving out and being 29 years old.

with respect to travel don't underestimate how uncomfortable it will be in the first days after surgery and how you will need someone with you to carry everything for you in transit (remember no lifting) and you'll need a seat which is beside an exit so that you can get up ... really I (meaning me) would not want to be flying for weeks after surgery.

I understand this, my plan so far (dont know if its the best) i plan to last the recovery time in the country i decide to have the operation done ( 4- 6weeks ) from what i have read if i need more time i will stay longer until i feel i can take the flight or when my doctor approves.
Good thing is my job has given me the green light to take as much time as needed.

 

[pellicle]

i its extremely complicated...
this is a discussion i must have before my surgery for sure, since i dont wanna waste all my savings+parents savings on my operation i dont wanna be such a burden for them even after moving out and being 29 years old.

you're a good lad Dunwanted ... I wish you all the best

 

[Unicusp]

i its extremely complicated, atleast for usa i feel more safe since they have more information a many reviews of surgeons, plus all the comment i have been reading here, still have to wait for the tests to be taken since they do not trust the tests taken in the country i live in.
My cost wont be covered in germany, but what i have read it is much cheaper than US (since i have no interntional inssurance).

this is a discussion i must have before my surgery for sure, since i dont wanna waste all my savings+parents savings on my operation i dont wanna be such a burden for them even after moving out and being 29 years old.

I understand this, my plan so far (dont know if its the best) i plan to last the recovery time in the country i decide to have the operation done ( 4- 6weeks ) from what i have read if i need more time i will stay longer until i feel i can take the flight or when my doctor approves.
Good thing is my job has given me the green light to take as much time as needed.

One of the positive things about Cleveland Clinic is that everyone is an employee and you get one bill. You can get a very accurate estimate after they determine what you need. I went back and checked the actual bills for pre-surgery testing and surgery. The total for aortic valve replacement with OnX valve was $180k (Edited) back in Feb 2021. I also confirmed that they charge the same amount to people with or without insurance. Good luck!

 

[70sdiver]

I think if your surgeon installs sternal breast plating you could easily fly at 4 weeks I know I could have, but every one is different. I'm just past week 8 and have been riding my motor scooter since about 4/12 weeks.

 

[pellicle]

I think if your surgeon installs sternal breast plating you could easily

this is a poorly adopted technology. Its been around for well over a decade and approaching two decades. I would be asking "why is it not common" (rather than looking to it being the saviour).

The sternum is an interesting bone which is (by necessity) quite flexible (think of one of those slats in a sail), it needs to move. Think also of the problems that exist with prosthetic implants and bacteria (yes even they are prosthetic implants as far as a bacteria is concerned).

Propionibacteria is a lover of such conditions and the chest is actually about the highest concentration of them on the body.

https://www.hindawi.com/journals/bmri/2013/804391/

3.2. Cardiac Device Infection​

P. acnes infective endocarditis remains rare, although its prevalence is probably underestimated due to diagnostic difficulties [25]. Infection mostly involves prosthetic heart valves [25], annuloplasty rings [52], and pacemaker/ICD leads [53]. Bacteremia or skin wounds are the most frequent port of entry of microorganisms [12]. P. acnes infective endocarditis often develops on valve prostheses and embolisms are common. To the best of our knowledge, less than 50 cases of infective endocarditis have been described on prosthetic heart valves, usually the aortic valve prosthesis [25]. Due to subtle symptoms and slow growth of the microorganism, the diagnosis is often late, when valvular and peri-valvular destruction is significant [54]. Antibiotic therapy and surgical intervention with change of the valve are typically needed, and the mortality is high (15–27%) [12, 55]. The diagnosis of P. acnes infective endocarditis using Duke criteria is challenging [56], since echocardiography can be normal and the dysfunction progresses slowly over weeks and months leading to cardiac insufficiency [25, 57, 58]. Fever appears only in approximately 25% of these patients, and the incidence of neurologic symptoms is higher than that in general complication of infective endocarditis [25, 55].

Feel free to ask me how I know this or indeed discuss why its still something I research.

 

[70sdiver]

so I take it you had sternal plating and had infection?

 

[pellicle]

so I take it you had sternal plating and had infection?

no, I've never had sternal plating and no surgeon I've met with in Australia supports it and the ones I've asked just glance at me and say "too risky" and move on.

I have had an infection though and I can see a case for and against.

However I can say one of the things I have against it comes from my experience with wood working and doing "patches" as this is over things which are intended to be flexible.

I've assumed your question related to sternal plating not my infection and details about that. A starter and some off shoots can be found on this rather lengthy thread.

PS: I tend towards being conservative in my choices, risk averse as it were. So a technology and a technique which looks bulky and protrusive to have underneath your skin that has no significant track record is not something recommend without having some reasons.

 

[Chuck C]

Cleveland Clinic

Rough estimate around $300k.

My bill for UCLA was closer to 200k, for aortic valve + aortic root + ascending aorta replacement. A couple of rounds of afib in recovery added in for bonus. This was not the retail sticker price. My carrier has a policy of pre-paying for major surgery, for which they get a significant discount.

Edit: I would add that I would expect the price to be significantly lower in Germany, but this is just a guess

 

[tommyboy14]

Good afternoon everyone,

again thank you for all the information, going in tuesday for some tests in cleveland clinic so they can study my case more to have more information, while im there i will ask for an estimate cost for the operation and i will also look at options in germany as i am a german citizen and i have seen costs are more reduced in germany for this operation.

Hello Dunwanted.

I am also a German Citizen. This surgery is much cheaper in Germany than in the US. IT will cost you around 30k Euro (so like a bit less than 30k USD), including everything.

There are several world class places for this surgery in Germany. The hospitals are not as fancy as in the US. But the surgery outcomes are excellent. I.e. you can get any surgery done that you want (Ross, Ozaki, Mech valve), you name it.

If you still want Cleveland Clinic at a fair price, I paid £29k for a redo aortic valve at the Cleveland Clinic London (this is a retail price since my insurance only covered this after an extensive fight with me, so I had to pay upfront). This all inclusive. The hospital is second to none in the UK and likely Europe, given that it is brand new, it is staffed by Cleveland Clinic US nurses and they had the funds to hire the best surgeons in the UK for this facility.

I would highly recommend this. Its a fantastic hospital.

If you have any other questions or need help/advice, please feel free to PM me. Wir koennen auch Deutsch sprechen wenn du willst.

Finally, there is a German equivalent of this forum: Die Herzklappe - Das Forum

The forum participants there are very frank with respect to the different hospital options in Germany.

Good luck and PM me if you would like to discuss.

 

[Unicusp]

Cleveland Clinic


My bill for UCLA was closer to 200k, for aortic valve + aortic root + ascending aorta replacement. A couple of rounds of afib in recovery added in for bonus. This was not the retail sticker price. My carrier has a policy of pre-paying for major surgery, for which they get a significant discount.

Edit: I would add that I would expect the price to be significantly lower in Germany, but this is just a guess

Hello. I went back and checked the totals and edited my original note. Total came to $180k.

 

[vitdoc]

Probably the most important point in having medical insurance aside from the insurance paying the bill is the fact that the insurance company has a contract with the medical providers that sets the costs of the various procedures. So not having insurance aside from not having the costs covered also allows the medical care system to charge anything that they want. So the "bill" of nearly $200,000 might be actually be reimbursed at significantly less than 50% given the contractual agreements. If on the other hand there is no insurance and the individual is not destitute they can be reamed and forced into bankruptcy. This is one of the most unfortunate issues with the US healthcare system.
An other issue with costs is the possibility of things not going perfectly which might require an extended stay in the hospital and more procedures and even more surgery. This can markedly affect the costs and again having insurance is critical. If one can negotiate a fee that would include the possibility of unexpected extra issues that would be very helpful.

 

[Dunwanted]

Hello everyone, thanks tommyboy for the website, will try to join (my German is not the best since i have around 95% of my live outside germany).

Yeah i will definitely start looking for an international insurance for any complications i may have after surgery.(hopefully there are none).

Currently boarding the plane, got some medical tests tomorrow at Cleveland clinic we will see how it goes, im a very positive person and usually never feel bad or depressed but the uncertainty of whats gonna happen os starting to weigh in my emotional state and i just wanna get this over with.