Renal failure: do AVR or not ?

[plsflgood]

My 74yo mom had CKD stage 3 for several years. 4 months ago she was told she needs AVR due to stenosis and regurgitation. She was procrastinating, though, afraid of the procedure. All of a sudden, her GFR went down to 25, over the course of about 1 month. So the question is: should she now be in a hurry with the surgery, or AVR is not indicated for her now ?

 

[Mentu]

I am afraid that this is not a question many of us can help answer because there are too many variables. It seems likely that your Mother's Nephrologist, Cardiologist, and Cardiac Surgeon working together are the only ones who can balance whether the demands of surgery and recovery are likely to improve your Mother's health or exacerbate her kidney condition.

Your position is similar to my own in this past year when my Mother's health took a dramatic decline and she turned to me to help her understand her options. I found it helpful to understand, as fully as I could, my Mother desires and let them be my guide. Her choices were not always the ones I would have made but once selected, I did my best to support her as her doctors pursued her treatment. It is at such times that medicine can become more art than science and it is most important that physicians keep in mind the person for whom they are caring.

Larry

 

[Bill B]

Second what Larry said. Renal failure complicates things and only the doctors involved can make the assessment of risk/benefit from AVR.

 

[sarahsunshine]

I think that the main issue you will have to figure out is what is the cause of her kidney failure?

My step son went into kidney failure various times as an infant needing valve replacement surgery due to the lack of circulation and huge amounts of drugs he was on. As soon as he received a new valve and his heart was working properly, his kidneys started working better because of increased blood flow.

I don’t know about the specifics of your mother, and I don’t know about kidneys in general, so I’m not very helpful. You will need to talk to your mom about her wishes, talk to her doctors, and do your own research.

I wish you and your mom the best. It’s really tough being someone’s advocate!

 

[plsflgood]

Yes, basically my question boils down to: is there a way to figure out whether the renal failure is caused by the bad valve, or not ? That would decide whether the surgery is needed.

 

[Bill B]

Certainly if the valve disease is severe enough to cause heart failure, that can affect kidney function. So, it may be contributing, but, honestly, the doctors should answer this for you. There's no way anyone here, not knowing your mother's medical history or having the proper medical training, can make that assessment or tell you how to figure that out on your own. You need to ask the doctors these very questions you are posing here, and if for some reason they won't tell you anything useful, you need to get another opinion from other doctors.