Pre-Op talk with surgeon

[HiMyNameIsDale]

So I had my pre-operative testing and appointments this past Thursday and Friday. I talked with my surgeon about my surgery options for my upcoming surgery on the 27th of March. I have posted before in the valve selection section and basically decided that mechanical would be the best choice for me based on the discussions in that section. I also decided that I wanted to give the On-x valve a shot. The surgeon said that he was more in favor of repairing my aortic valve do to my young age and risks of being on coumadin for life. The surgeon is Dr. Roselli at the Cleveland Clinic and I trust his opinion, but I told him that I would only accept a repair if he was confident that it would last 10 to 15 years. My valve does have some calcification on it so it may not be able to be repaired. He said that if he could repair the valve it would last 10 to 15 years. I find this hard to believe that the repair would last that long since I am young. However, I think that Dr. Roselli is a very experienced surgeon and knows what he is talking about. In the end we decided to have an aortic graft put in to replace my aorta and preserve the original aortic root, repair or replace the valve with a On-x valve, and all of this would be done through a mini-sternotomy. My only worry is that the valve will fail early if it is repaired rather than replaced. Is this a reasonable fear? Does anyone have a repaired aortic valve that has lasted a long time? Why does the surgeon think it would be best for me to avoid coumadin for 5 to 10 years? Does it really make a difference? I have been able to handle the idea of surgery for the weeks before this moment with no problem, but now I think I am a little nervous as the surgery date gets closer. I will try to keep posting updates on my condition after the surgery, but I guess that depends on how good I feel during the recovery. Sorry about the long post. Wish me luck.

 

[Sarah_Louise]

Hi Dale,
I was born with a complex CHD (see signature) and as part of my truncus "repair" i had my arotic valve repaired as well as a lot of other things done, at the time i was only 13 weeks old, yet i never needed my aortic valve replaced untill i was 13 years old, so my repair lasted me a good 13 odd years, i've been on anti-coagulants since i was 13, and can't see me coming off it anytime soon,
If i can help in anyway just ask,
Good luck for Tuesday, hope everything goes well for you, i will be thinking of you
Love Sarah xxxx

 

[Greg~]

Dale,
First of all, we'll be praying for you and your surgical team during the surgery on the 27th and then through the post-op recovery process. You're in very good hands in Cleveland as they are nationally recognized as being an elite cardiac facility.

In your previous post you stated you have severe regurgitation and mild stenosis with symptoms associated with regurgitation. So regarding your question about repairing your aortic valve, your surgeon must have a proven repair in mind to be able to state it will last 10-15 years. You may want to ask him what he plans on doing to repair the valve and how many of these types of repairs has he performed that have lasted 10-15 years. I think your concern that the repair won't last that long is legitimate and needs to be addressed.

I can understand your surgeons reluctance for putting you on Coumadin at 23 years old if it can possibly be avoided. Although there's nothing to fear regarding ACT, once you make the mechanical valve decision and you’re on Coumadin, [normally] there's no turning back.
So I'm assuming he's trying to be as risk adverse as possible. In my experience, surgeons may look at doing a surgery now to repair your valve, with the almost certain chance of doing a follow-up surgery in 6 or 10 years as nothing to be concerned about. (after all, surgeons perform surgeries to fix people). Even though the idea of another surgery may scare the snot out of us, surgeons may look at those surgeries as a means to an end - just part of the overall master plan. Of course, I'm not saying that surgeons perform unnecessary surgeries. But I can understand their reasoning for recommending multiple surgeries to get a complete repair - even though we may think it can be done with just one.

Ultimately the decision is yours. And (if I'm reading this correctly) I think you're making the right decision to place the valve repair\replacement decision in the hands of Dr. Roselli. In my case, things looked different once my surgeon was able to get a hands-on look at my heart. At that point, my surgeon changed the mechanical valve model and decided that my AAA was well within normal tolerance and there was no thinning of the aortic artery. So the repair he planned on doing was not necessary.


Please keep us posted as things progress

 

[Bill B]

Why do you doubt the repair will last 10-15 years? A repair is not like receiving a bioprosthesis which has a very limited lifespan in younger people. This is your own valve reconstructed, primarily used to treat regurgitation. I gather he has told you he will not do a repair unless your valve is suitable for that treatment.

 

[ElectLive]

My only worry is that the valve will fail early if it is repaired rather than replaced. Is this a reasonable fear?

You know, Dale, this fear and others like it not only are very reasonable, but expected. Sadly, there are no guarantees in the world of heart valves, no matter what type or procedure. However, in the absence of guarantees, there are well studied and documented probabilities to help guide the decision process. And the Cleveland Clinic is THE place in the country to find this sort of clinical experience and evidence. I would guess your surgeon knows not only how many repairs he's done and how many the Cleveland Clinic as a whole has done, but, how many lasted 10 years, how many lasted 15 years, how many lasted 5 years, etc. He also knows about the risk for reoperation going the repair route. He and they should have all these answers and many more, and it factors into every decision he makes. Unfortunately, the timing what it is, you may not have gotten all of these answers ahead of the game. Even if you did, though, you still may not have gotten the answer that makes the situation crystal clear. But you are definitely in good hands, and I would guess if you did really know everything your surgeon did, it would be a little easier to reach a comfort level with the final decision. Best wishes.

 

[TheGymGuy]

Hey Dale, I agree with everyone else. Trust your surgeon to make the best decision once he is in there checking things out.
My surgeon briefly mentioned a repair, or that he would attempt one, but I would rather not have a re-op and do not object to ACT.

By the way, how are you holding up over there? Do not worry, things will be ok and soon we will be chatting about our post-op/recovery experiences. We all have us a busy week next week. Things are going to be ok.

 

[Bina]

Dale, most surgeons like to see exactly what they have "at hand" after you are opened up. Best wishes !!

 

[Jkm7]

I'm a lot older than you but my surgeon wanted to do a repair on my mitral valve. This was my second surgery (first was also with him but was not valve related). He knew a failed repair was something about which I worried a lot. He was very experienced at the excellent Mass General and we agreed he would try the repair but if he did not think it would be viable for considerable length of time, he would implant tissue valve.

He worked hard to do the repair but he decided it would not be good and proceded with replacement with bovine valve. When I woke and learned what was done, I was relieved. I totally understand what your concerns are but I am considerably older than you.

You are going to a fine hospital with a top surgeon.
You either trust him or not and if you don't, he is the wrong surgeon for you.
Sounds like you had an excellent conversation with him and you have chosen to place your confidence in him. He'll do the right thing..... He has a fine reputation.

All best wishes.
We'll be waiting to hear all good news from you.

 

[RTZdad]

Can't wait to hear that you're surgery went well Dale! Good luck!

Tom

 

[Sarah_Louise]

Hope everything went well for you Dale, been thinking of you!!
Love Sarah xxx

 

[TheGymGuy]

Hey Dale, I hope you are on the other side and recovering well. I am thinking about you mate.