Open Heart Surgery and mortality rates

[Der Biermeister]

I keep reading (articles on AI) that the AVR surgery has a mortality rate of between 2% and 8%.

Is it the AVR part that is high risk? or the basic open heart surgery?

I am also wondering if it were broken down further, the higher risks might be attributed to:

older patients?
those whose AI disease is much more advanced?
specific surgeons?

or, does it just fall under "act of God" category?

DB

 

[KristiinSD]

Mortality rates

Mortality rates

My understandning is that mortality rates are strongly influenced by health, age, and gender. Healthy, younger, and women tend to do best...

Good luck,

Kristi
mr

 

[ALCapshaw2]

The numbers I've seen quoted here on VR.com indicate 1 to 2% Morbidity and Mortality for FIRST TIME Heart Surgery in otherwise healthy patients under age 60 when performed by experienced surgeons at hospitals that do high volume (1000/year) heart surgery. EXPERIENCE COUNTS !

I'm not sure where those numbers come from but several people had cited similar numbers from their surgeons.

'AL Capshaw'

 

[OldManEmu]

Der Biermeister
Obviously mortality rates are strongly influenced by age and any secondary health issues.
Statistics for heart surgery tend to be broken down into patients that are <60 years and over.
The risk factor for >60 years then tends to rise with increasing age.
For a straight AVR in <60 years with no other health issues the general quoted risk is 2%. This is then broken down to 1% risk of death and a further 1% risk of stoke. I am not aware of any difference that is related to gender.
Obviously not all surgeons/hospitals have the same mortality rate.
Page 39 of the attached like has statistics on survival rates.
The presentation is mainly related to the Ross Procedure but does have some other interesting AVR statistics.
www.atbf.org.au/Docs/Skillington.ppt
The presenter is one of the few surgeons to have done >200 Ross procedures.

 

[RCB]

Gender differences

Gender differences

Females are at a slightly higher risk than males for HS, except in the case of
of neonatals where females just seem to have more fight in them than males.
In the case of neonatals, this is generally the case for all conditions.

 

[Emma]

We were given a 5% risk of death when Chloe (age 18 months then) had her mitral repair and 2 days later, her replacement - but I don't know whether that was due to her condition at the time - she had just had 5lbs of fluid drained off her due to severe CHF. Perhaps, a relatively 'healthy' person going to surgery to avoid CHF developing would have a much lower risk factor.

Emma
xxx

 

[barbwil]

Cleveland Clinic mortality rates

Cleveland Clinic mortality rates

http://www.clevelandclinic.org/hear...e1.asp?firstCat=59&secondCat=440&thirdCat=443

There are three pages of data here for the CCF surgical (valve) rates for the year 2004.

Being a 74 yr old female I was very hesitant about undergoing mitral valve and the Maze procedure, especially after reading on the American College of Cardiologists' site that people over 75 did not do well with this surgery.
However my cardiologist and the surgeon to whom I was referred at the Cleveland Clinic assured me that I should do well and indeed I did. I am 22 days post-op and doing very well.

I think the thing is to chose the best surgeon and hospital and thereby increasing your chances for a successful outcome.

Barb

 

[Marty]

Age no contraindication

Age no contraindication

I had concern about age. I was 72 when I was told I needed the surgery. My surgeon told me it wasn't the age that mattered as much as the shape the patient is in. He said he had recently replaced a valve in an 85 year old man who did well. Now almost 7 years later I feel very good and am sure I would be dead if I hadn't had the surgery.

 

[McCln]

I have to say that 2 to 8% is very low. Most of the real rates is what agree with the others. You have to take into account health and other possibles to account for any rate.

 

[jayaresq]

Low AVR Mortality Rates

Low AVR Mortality Rates

I went into surgeryconfident that I wouldn't end up a statistic. Every cardiologist and surgeon with whom I consulted this summer downplayed any real risk of someone like me dying during or soon after my AVR surgery. All of them quoted mortality numbers for a 1st OHS that were almost exactly what Al Capshaw and OldManEmu wrote earlier: 1-2%, evenly weighted between OHS and later stroke, and even less for younger candidates. I also assumed that the numbers these doctors quoted to me pertained to those lucky enough to receive care from top-tier providers (i.e., Cleveland Clinic, Mayo, Duke, Cedars, UCLA, etc.).

I was also advised that mortality rates for a second OHS varied substantially even among the most experienced providers and turned on factors such as age, general health, residual OHS scar tissue, history of embolic events and others.

While I didn't obsess over the possibility that I could suffer an unhappy surgical result in my (first) AVR, it did occur to me that the odds were a lot like rolling craps twice in a row. -- Jim

 

[danielgilboa]

mortality rates have clear statisitics. But, there are other results that should be looked at as well.

Recovery - I get the feeling most people on this forum believe (I know of no evidence) that the healthier and shapier you are before surgery, the better your recovery will be. I strongly believe in this, and built myself, under tight limitations of a pre-MVR patient to be as strong, low weight and healthy as possible.

Other compications - going on by pass machine may cause neurological complications. I believe we all do, but for most, they go away. This could be anything from numb limbs to loss of congnitive capabilities. This is also a result of the time on by pass or as refered to as cross clamp time. over 120 minutes might be wobely...

And here are my personal statistics-
My grandmother went through quad bypass surgery at the age of 81. She had a good life for 12 years after.
I had my MVR 16 months ago at age 45. I was quite fit and healthy before. My recovery went well but I suffered pain ,weakness, sleeplessness and all of that for a long time.
My Father had his by pass surgery 3.5 weeks ago at 68. He was basically a pottato before (and after) surgery. His recovery is going absolutely unbelievable.
So for you as an individual, do all you can, but luck /God are taking the largest part in your results. Statistics mean very little.

 

[Nancy]

On the far end of the spectrum, for my husband who has multiple serious medical co-morbidities, he was quoted a mortality/morbidity rate recently of as high as 80 percent to the bad for a fourth heart surgery. So I think he'll opt out of any further surgery. He's doing OK just using medical symptom treatments. It's not only the scar tissue, but other things as well.

So, of course, the stats vary according to what type of condition your health is in.

I watched an operation on the heart of a much operated on young person on the Learning Channel, done by a very, very experienced surgeon.

He had a difficult time both with scar tissue and adhesions which took a long time to free up, but also due to that person's arteries which were what he termed friable. One, in fact, just about fell apart as he was working on it. In the end he was able to get things working, but it was a very difficult and tense surgery.

 

[geebee]

I did not ask for percentages before my 3rd OHS because I really didn't want to know. When I asked after, my surgeon said he would have given me 60/40 odds (in my favor) due to scar tissue and prior problems. Who knows what decision I might have made had I heard that figure?

Like Joe, I would be very hesitant to agree to a 4th unless there was absolutely no alternative but dying.

I think statistics can be useless because they take into consideration all the crummy surgeons out there (and they do exist) as well as the excellent ones. If you have an excellent one, your chances go up (even when they might be conservative with their survival "guesses").

 

[Der Biermeister]

great replies and puts it all into proper perspective -- thanks

 

[hiker]

http://www.clevelandclinic.org/hear...e1.asp?firstCat=59&secondCat=440&thirdCat=443

There are three pages of data here for the CCF surgical (valve) rates for the year 2004.

Being a 74 yr old female I was very hesitant about undergoing mitral valve and the Maze procedure, especially after reading on the American College of Cardiologists' site that people over 75 did not do well with this surgery.
However my cardiologist and the surgeon to whom I was referred at the Cleveland Clinic assured me that I should do well and indeed I did. I am 22 days post-op and doing very well.

I think the thing is to chose the best surgeon and hospital and thereby increasing your chances for a successful outcome.

Barb

I was very interested in your comments. I am 63 and had a valve repair in 95. I was debating which type of valve for my upcoming replacement. I was wondering how it would be if I chose a non mechanical valve and might face surgery again far into the future. Your comments are very encouraging.

 

[gijanet]

Haha! I can vouch for that one!

Haha! I can vouch for that one!

Females are at a slightly higher risk than males for HS, except in the case of
of neonatals where females just seem to have more fight in them than males.
(

I have one hell of a little fighter on my hands.............5 OHS's in 4&1/2 years??? NO sweat at all............well, for Katie, maybe. Mom, on the other hand, did lots of sweating. And mortality rates?? Unh, unh! Wasn't even going to go there, seeing as Katie was only the third kiddo to go through that particular combination of surgeries with the fontan and valve replacement and the FIRST kid to go through the EC fontan and common AV valve replacement at UofM..........and probably one of very few in the world.

But she's kicking butt and taking names now. Hugs. J.

 

[marge77]

aortic valve replacement & smoking & mortality

aortic valve replacement & smoking & mortality

hi -
I just signed up here so that i could ask whoever is listening about valve surgery, mortality, and smoking.
specifically, my partner underwent aortic valve surgery as a 2 year old, and stands to have another operation soon. he is 26 now and has echocardiograms every year. the last one showed leakage and some uneven muscle development, but the doctor said to keep waiting. his heartbeat is very strong, and shakes him in his sleep. (i can´t feel my own when i am in bed with him)
now he is smoking again, and i am terrified.
how bad is it for him to smoke?
is there anything i can say or do to help, or stop him?
i don´t know anything about mortality rates in cases such as his, nor about the effects of smoking on an already damaged heart.
thanks in advance.

 

[RCB]

Slam dunk!

Slam dunk!

hi -
I just signed up here so that i could ask whoever is listening about valve surgery, mortality, and smoking.
specifically, my partner underwent aortic valve surgery as a 2 year old, and stands to have another operation soon. he is 26 now and has echocardiograms every year. the last one showed leakage and some uneven muscle development, but the doctor said to keep waiting. his heartbeat is very strong, and shakes him in his sleep. (i can´t feel my own when i am in bed with him)
now he is smoking again, and i am terrified.
how bad is it for him to smoke?
is there anything i can say or do to help, or stop him?
i don´t know anything about mortality rates in cases such as his, nor about the effects of smoking on an already damaged heart.
thanks in advance.

Marge,
Sorry to add to your worrys, but every study(do a Google search) that
does a risk assessment, show smoking to be heads and shoulders above anything that contibutes to surgical death, because of the effects on the whole body and particulary the lungs. There is no dispute in the medical community about this.
There are many programs out there to help. Ask his doctor(A cardiologist
wouldn't be doing his job unless he advised him AND told him where to get help quiting!), your local health dept., the American Cancer Soc., The American Lung Assc., and online. Good luck!

 

[maiae]

Re:

Re:

hi -
I just signed up here so that i could ask whoever is listening about valve surgery, mortality, and smoking.
specifically, my partner underwent aortic valve surgery as a 2 year old, and stands to have another operation soon. he is 26 now and has echocardiograms every year. the last one showed leakage and some uneven muscle development, but the doctor said to keep waiting. his heartbeat is very strong, and shakes him in his sleep. (i can´t feel my own when i am in bed with him)
now he is smoking again, and i am terrified.
how bad is it for him to smoke?
is there anything i can say or do to help, or stop him?
i don´t know anything about mortality rates in cases such as his, nor about the effects of smoking on an already damaged heart.
thanks in advance.

Hello Marge77

I'm sorry to hear that your partner is facing another surgery. In reference to smoking--I can't tell you exactly how bad smoking is for a heart patient, but I can tell you that I've been a smoker for 32 years and I had a very rough recovery from mitral valve repair surgery; how much of that pain and the longevity of the aforementioned was due to smoking, I don't know ... but, it couldn't have been good. I can tell you that, in my opinion, nicotine addiction is very individual--some of my friends just threw theirs out without much trouble, yet I continue to smoke after trying everything but voodoo to quit. Unfortunately, nicotine addiction (like many other addictions) can make a rational, educated person look like a complete fool as they continue with their bad habit even though they completely understand the often deadly ramifications of smoking. If you haven't already done so, I'd suggest you educate yourself about the dangers of smoking and then approach your partner in a "it's your life and the choice is yours , but I want you to know that..." and then share your knowledge about the dangers--leave printed information somewhere for your partner to read when you're not around. As tough as it is to watch a loved one slowly kill themselves with cigarette smoke, the decision to quit smoking is, and must be, their own.

Best wishes,
Maia

 

[Georgia]

Ditto Maiae - no one ever nagged anyone out of smoking (or eating or drinking).

It's entirely possible that a surgeon will refuse to do surgery on a heavy smoker irrespective of the amount heart damage. That might be enough to get your partner off the cigs. I've heard scuttlebutt around here that surgeons are refusing some folks.

Good luck.