Post surgery: Cardiologist no longer part of routine?

[carolinemc]

Sorry I meant <70yo. There is no hard and fast age, <60 works too. Biological valves can have a finite life especially if you are younger. That's why routine echos are prescribed by some cardios for patients with a biological valve.

And when we have St. Jude's leaflet valve. So important for those checkups. I get them twice a year. And I will be seeing a Cardio Nurse Tuesday to talk about my echo a week ago. We will nail the irregular heartbeat down soon.

 

[erricojj]

If it wasn't for my cardiologist's monitoring of me annually, and then semi-annually, I wouldn't have known that I had developed severe stenosis of my bicuspid aortic valve. One month ago, it was replaced with a tissue valve, and I expect he will continue the annual echocardiograms. I am 70.

Things are changing in the durability of tissue valves. For example, Georgia Tech did a structural durability study on the Edwards Inspiris Resilia valve, putting it through 1 billion cycles in vitro. Granted, the performance of the actual implanted valve could be different, but it's a strong indication of low probability of SVD. (At 65 BPM, 1 billion cycles would take about 29 years.) Here's the details...

Long-term durability of a new surgical aortic valve: A 1 billion cycle in vitro study - ScienceDirect

Journal of Thoracic and Cardiovascular Surgery (JTCVS)

https://www.sciencedirect.com/science/article/pii/S2666273621004162

Conclusions

In summary, this in vitro study shows that the Inspiris Resilia aortic valve performed well through 1 billion cycles of testing (the equivalent of approximately 25 years of use). All the structural components of the study valves remained intact, and the hemodynamic results were functionally equivalent to those for the zero-cycled control valves. Furthermore, the 1B-cycled valves exhibited similar flow field characteristics as the zero-cycled valves.

Conflict of Interest Statement

The authors reported no conflicts of interest.

 

[KLS39]

Before my valve replacement I saw my cardiologist once a year after first having an echo. I still have an echo once a year, but I see the cardiologist every six months.

 

[dornole]

Once a year post valve repair for an echo and cardiologist consult to review the results. One of my husband’s coworkers stopped going for echos a couple years after surgery …. As the bio valve deteriorated over time, she developed left ventricle enlargement. By the time she had symptoms she had irreversible heart damage and was dead within a year just before she was going to retire at age 62.

Get those echos and have an expert read them., I agree to ask the pcp for a referral and / or a letter to insurance saying in their medical opinion you should be followed by a cardiologist. I had good luck with that kind of White Coat letter when Insurance refused care my twins absolutely needed. Good luck.

 

[carolinemc]

I get my echos done in the Cardiology Department read by the tech and Cardio doctor. I found out recently they looked at the latest Echo and my mitral valve has little calcification, and they will keep an eye on it. Not worried since they are experts.

 

[vitdoc]

Hello All,

Quick history: Aortic valve replacement (biological) June 2021. April 2022 healthcare organization sent me a message stating my cardiologist had retired. Can’t copy/paste the message. In summary, I am to use a Cardiology call center phone number for questions. Otherwise my primary care physician would be handling everything from then on. ”Most chronic, stable heart conditions can be managed by your PCP.” A replacement cardiologist will only be assigned to those with unstable urgent cardiac issues.

I am wondering how common it is to be released from a cardiologist’s care post surgery and how soon?

I had been thinking I would have a cardiologist for the rest of my life, given the significance of the heart and the serious and invasive nature of open heart surgery.

I am a super sub-specialist in my field of ophthalmology. So I often see patients who have seen several other levels of doctors who don't have a clue to what is going on. I often can tell almost immediately since I have seen these things many times.

One phrase I like to use is "you don't know what you don't know". For example most cardiologists should be well aware of the association between bicuspid aortic valves and late aortic aneurysms. They would get the appropriate testing to monitor potential aneurysm development.
Many GPs would not be aware of this issue and would not think of looking for it. Being a GP is hard since you have to have a very broad base of knowledge. It is pretty hard to know everything in medicine. A good GP has to know when to ask for help. The trend seems to be in many things to elevate people to higher levels of responsibility without the concomitant expertise and training simply because they are cheaper. Nurse practitioners for GPs , GPs for subspecialists, optometrists for ophthalmologists etc..

So I think it would be appropriate for someone who has had heart surgery to be followed by a cardiologist.

 

[pellicle]

One phrase I like to use is "you don't know what you don't know". For example most cardiologists should be well aware of the association between bicuspid aortic valves and late aortic aneurysms.

this may seem unkind of me, but I suspect this is a bit related to what was uncovered in this paper
https://pubmed.ncbi.nlm.nih.gov/10626367/
I suspect I'm in some sort of mood this morning

PS: I've noted that arrogance and hubris play a major part this issue. When I was in China I observed that among petty officials (drunk on their own power but sober enough to note the presence of their superiors) were often the most guilty of this sort of thing.

I've reflected a lot on that situation and I feel that it comes down to a lack of actual humility in people today. This is something I've noted is accelerating in society not slowing down. To my mind not saying "well heck I don't know anything about that" leads us to over-estimate our ability, fail to research a topic (instead favouring what supports our argument) and promote fluff and misinformation. Leading to what some call conspiracy theory, but I call just plain nutbag because there is no conspiracy.

just to coin a stereotype above

 

[Carnelian]

So the concensus is to visit the cardiologist every 6 months? My valve replacement bipass was exactly 5 years ago and went fine. I saw my Dr. every 6 months for a cursory brief visit and took a few tests. I skipped the last visit...figured it is unnecessary, and the secretaries are so annoying, if they answer the phone! (They care more about my ID than anything.) Healthcare is so impersonal in large offices.
Why return? and save the co-pay.

 

[carolinemc]

So the concensus is to visit the cardiologist every 6 months? My valve replacement bipass was exactly 5 years ago and went fine. I saw my Dr. every 6 months for a cursory brief visit and took a few tests. I skipped the last visit...figured it is unnecessary, and the secretaries are so annoying, if they answer the phone! (They care more about my ID than anything.) Healthcare is so impersonal in large offices.
Why return? and save the co-pay.

It is to monitor your heart and how the valve replacement is doing. Never stop going to the cardio, for you never know when an issue will come up. Many have gone and found another valve in trouble mode. So, make another appointment and go. Not a waste, I found I have calcification of my mitral valve, and they will keep an eye on it. In my case the cause of irregular heartbeat. So, things can happen in a blink of an eye.

 

[tom in MO]

So the concensus is to visit the cardiologist every 6 months? My valve replacement bipass was exactly 5 years ago and went fine. I saw my Dr. every 6 months for a cursory brief visit and took a few tests. I skipped the last visit...figured it is unnecessary, and the secretaries are so annoying, if they answer the phone! (They care more about my ID than anything.) Healthcare is so impersonal in large offices.
Why return? and save the co-pay.

My cardiologist needs to see me once a year due to his requirements and my insurance company to continue to write my prescriptions for warfarin and BP medication. For warfarin he likes to see my INR history and for BP medication he likes to see my home BP results.

 

[dornole]

I would say go once a year and if they have concerns they will schedule you for more frequent. You could be talking life and death here, irreparable damage to your heart from a failing valve could be asymptomatic so an echo is the only way to catch it before it is too late. Save the co pay and an annoying phone call? Are you serious? Snap out of it! (Cher slap here) You’re not talking sense. Please tell us you will act rationally and follow thru with regular echos, not skip on a whim due to minor discomfort.

 

[Carnelian]

I got an appointment in December, the soonest date for cardiologist. It's been a year, I didn't realize.

 

[dornole]

Yay!

 

[JaneF]

I never had an in person exam or consultation with the cardiologist. They were all online video. My impression of those consultations were that he was overqualified to be basically scheduling and describing processes in a very general way and he made mistakes even with those menial tasks. However there were other doctors doing echocardio with the radioactive solution from the heart dept. Not "Cardiologists." The surgeon and anesthesiologist I had confidence in and these doing the tests as well. I just learned my PCP also is leaving the area so I have been assigned someone new starting Sept 1 2022.

Your story is frustrating and scary, in my opinion. I had mechanical MVR in May 2017 at age 48, less than 6 months after finding out I had Mitral Regurgitation. After 2 follow up appointments with the surgeon I have seen my cardiologist every 6 months. My favorite cardiologist retired after 3 years, however I was transferred to another cardio within the same group. I can do a few telehealth visits, but after typically 2-3 I have to go for an in-office visit and have an Echo every 1-2 years. I am have been on Coumadin since surgery and home-test my INR levels under the guidance of my PCP. I have Anthem insurance and my plan does not require a referral to a specialist. I suggest you check the limits of your own insurance plan to see if a referral is required. If not required then absolutely find another cardio! If they do require a referral then reach out to a PCP and explain that you would feel much more comfortable with a cardio monitoring your progress. Just my 2 cents after my experiences. Best of luck to you!