Repair life

[Geofd]

So I've had my surgical consultation, Dr says there a 95% chance he can repair my mitral valve, my question ,after thinking about it,was great,no more surgeries, but is it a forever surgery, they said basically yes but by chance there were issues down the road there are less evasive
Surgeries that can be done. Why don't they just replace the valve with mechanical if you are a candidate I understand the blood thinner end of it just doesn't make sense if the mechanical valve is forever......I'm ok with the tougher surgery and longer recovery time and am a candidate for both valves and the repair I'm very new to all of this so
Must be missing something

 

[nobog]

You are always better off to keep "OEM" equipment for as long as you can, if your Dr. has sound logic that he can repair your current valve, I would go with that, however there are no guarantee's when it comes to any heart valve replacement/repair.

 

[Geofd]

You are always better off to keep "OEM" equipment for as long as you can, if your Dr. has sound logic that he can repair your current valve, I would go with that, however there are no guarantee's when it comes to any heart valve replacement/repair.

Thanks, thought I had it figured out I guess your right,and Dr seemed very confident also

 

[MdaPA]

Why don't they just replace the valve with mechanical if you are a candidate

"Compared to valve replacement, mitral valve repair provides better long-term survival, better preservation of heart function, lower risk of complications, and usually eliminates the need for long-term use of blood thinners (anticoagulants)."

https://my.clevelandclinic.org/health/treatments/17240-mitral-valve-repair

 

[Geofd]

"Compared to valve replacement, mitral valve repair provides better long-term survival, better preservation of heart function, lower risk of complications, and usually eliminates the need for long-term use of blood thinners (anticoagulants)."

Mitral Valve Repair

Thanks the more info I have the better I will understand, that was a good video,thanks sgain

 

[pellicle]

Geoff

Thanks the more info I have the better I will understand, that was a good video,thanks sgain

I strongly recommend you search not only on the recommendations of clinics about their own performance but about actual peer reviewed data, to be frank its a bit like walking into a Ford dealership and asking if their cars are better than GMC.

ignore any data from clinics about themselves

the next question to ask is "how old are you" and "how long do you want it to last". Say 5 years, 10, 20? How many surgeries are you wanting to have?
Some examples of good informatin
https://www.ncbi.nlm.nih.gov/pmc/articles/PMC4533076/
https://www.ahajournals.org/doi/10.1161/CIRCULATIONAHA.116.023340
When reading that note words like "survival" vs "reoperation". Reading proper source materials may be less "simplified" than clinic self promotion, but you can always ask "what does this mean" of us here.

I see you're a plumber ... to be honest this is a plumbing issue.

Best Wishes

 

[Geofd]

There's alot of info in just those few articals,keep them coming I think by surgery date , I'll be pretty
Educated

 

[Midpack]

For mitral valve, a good repair is allways better than a replacement. Having an estimated repair likelihood of 95% are very good news. You will be fine.

 

[Geofd]

For mitral valve, a good repair is allways better than a replacement. Having an estimated repair likelihood of 95% are very good news. You will be fine.

 

[Geofd]

Dr, and nurse practitioner said I should not need another surgery....... However if I did it would be many years later many years later I could be in my 70s-90s that is what I'm getting hung up on

 

[pellicle]

Hi

There's alot of info in just those few articals,keep them coming I think by surgery date , I'll be pretty
Educated

somehow my edit of my above post isn't there (dunno) however I quoted this from the second article

During a mean follow-up of 9.2 years, 552 deaths were observed, of which 207 were of cardiovascular origin. Twenty-year survival was better after MV repair than after MV replacement in both the entire population (46% versus 23%; P<0.001) and the matched population (41% versus 24%; P<0.001). Similar superiority of MV repair was obtained in patient subsets on the basis of age, ***, or any stratification criteria (all P<0.001). MV repair was also associated with reduced incidence of reoperations and valve-related complications.​

The thing is (to address this)

However if I did it would be many years later many years later I could be in my 70s-90s that is what I'm getting hung up on

not much lasts forever, except a mechanical valve (which brings with it some minor downsides). If you only ever have two surgeries in your cardiac life then that's better than three. One is of course best, but not everyone gets that.
We are fortunate we live in a world where technology has allowed us to get a second bite of the cherry. IF (for instance) you choose a repair (which based on the above is a robust choice) then you'll likely get some decade or two before you need anything else done.

You still haven't mentioned how old your are (or put that in your bio) which is a significant factor in anything anyone wishes to say as advice (because you know, if you're 30 or 60 that makes a difference), but assuming you're in your 50's then if you get a repair that lasts till your 70's then you can be sure in the next 20 years technology will make whatever needs to happen then easier.

I'd use this forum to get a grasp of the basics, and when you next meet your surgeon you'll have a better understanding of things and able to ask better questions and understand the answers better.

Best Wishes

 

[Geofd]

Hi



somehow my edit of my above post isn't there (dunno) however I quoted this from the second article

During a mean follow-up of 9.2 years, 552 deaths were observed, of which 207 were of cardiovascular origin. Twenty-year survival was better after MV repair than after MV replacement in both the entire population (46% versus 23%; P<0.001) and the matched population (41% versus 24%; P<0.001). Similar superiority of MV repair was obtained in patient subsets on the basis of age, ***, or any stratification criteria (all P<0.001). MV repair was also associated with reduced incidence of reoperations and valve-related complications.​

The thing is (to address this)

not much lasts forever, except a mechanical valve (which brings with it some minor downsides). If you only ever have two surgeries in your cardiac life then that's better than three. One is of course best, but not everyone gets that.
We are fortunate we live in a world where technology has allowed us to get a second bite of the cherry. IF (for instance) you choose a repair (which based on the above is a robust choice) then you'll likely get some decade or two before you need anything else done
You still haven't mentioned how old your are (or put that in your bio) which is a significant factor in anything anyone wishes to say as advice (because you know, if you're 30 or 60 that makes a difference), but assuming you're in your 50's then if you get a repair that lasts till your 70's then you can be sure in the next 20 years technology will make whatever needs to happen then easier.

I'd use this forum to get a grasp of the basics, and when you next meet your surgeon you'll have a better understanding of things and able to ask better questions and understand the answers better.

Best Wishes

Thanks for mentioning the bio I just filled it out
I'll be 61 September 21, surgery is September 27

 

[pellicle]

Thanks for mentioning the bio I just filled it out
I'll be 61 September 21, surgery is September 27

repair if surgeon deems it viable would seem a good option, but I'm sure no expert on that matter.

Myself at your age I'd have a good "look in the eye" discussion as to why a mechanical valve replacement is not the best idea to avoid a 2nd surgery (as you mention).
I'd ask why he holds whatever views he has and if its that "warfarin management-my-diction" answer, ask him why (given all the evidence supporting better outcomes with good INR management and only being inferior outcomes with poor INR management) he he thinks you'd not be able to manage your warfarin properly? Is it just that he thinks you can't be relied on, or is it the other drugs?

Best wishes

 

[Midpack]

Pellicle, keep in mind that Mitral and Aortic valves are completely different beasts.

The most usual problem regarding mitral valve is mitral insufficiency as a consequence of degenerative mitral valve disease. In this specific case, no cardiac surgeon will perform a mitral valve replacement if a good repair can be achieved. Of course, even when a repair is intended, a new valve (mechanical or biological) will be ready in the operating room to be implanted just in case a good repair cannot be achieved. So, after all, a valve choice has to be made before surgery.

This is the condition I have myself (no surgery yet).

Regards.

 

[Geofd]

Pellicle, keep in mind that Mitral and Aortic valves are completely different beasts.

The most usual problem regarding mitral valve is mitral insufficiency as a consequence of degenerative mitral valve disease. In this specific case, no cardiac surgeon will perform a mitral valve replacement if a good repair can be achieved. Of course, even when a repair is intended, a new valve (mechanical or biological) will be ready in the operating room to be implanted just in case a good repair cannot be achieved. So, after all, a valve choice has to be made before surgery.

This is the condition I have myself (no surgery yet).

Regards.

The Dr will do what ever I want,he does think he can repair it,and like yourself I have a choice of valves if after he's in there and thinks repair is not an option,he did mention it maybe more difficult to regulate but he will do what ever I ask, from what posters on the forum have said taking warfarin with my other meds shouldnt be a big deal,Otherwise I think he would have advised against it

 

[pellicle]

Hi

Pellicle, keep in mind that Mitral and Aortic valves are completely different beasts.

agreed ... precisely why I wrote

repair if surgeon deems it viable would seem a good option, but I'm sure no expert on that matter.

so I'm sure not going to say anything on a surgeons choice there

 

[pellicle]

from what posters on the forum have said taking warfarin with my other meds shouldnt be a big deal,

well I certainly didn't say that, what I said after I found it was phenobarbital was (bolding only in this):

...
so that's pretty clear and significant. So it then goes on to say

These drugs can substantially increase the rate at which warfarin is metabolized and thus reduce the effect of a previously adjusted dose. Likewise, sudden withdrawal of any of these drugs may decrease the rate at which warfarin is metabolized​

this should not be understated, next

so what this is saying is that if you are consistent with your doses of phenobarbital (meaning you take the same dose and don't miss them) that INR management is possible.

Are your doses consistent (within a 24 hour time)? If you always take the same dose (in a 24 hour period) of phenobarbital then it is simply a matter of determining dose of warfarin by measuring INR and dosing according to the desired INR. The dose of warfarin is irrelevant, the intention to administer warfarin is only the INR.

this pre-supposes you are self managing (as I do) and depending on the lab who manages you it might indeed be a big deal.

 

[Midpack]

Needless to say that I am just a patient and not an expert at all on any medical subject. I just share my opinions from what I have been told by my own cardiologists (I see regularly 2 of them, both very well considered) and from what I have read myself on the web (I am the kind of patient that googles about their medical conditions. Probably not a wise thing to do, but I really can’t help it. And I only take into account what I believe are serious and respected sources, and eventually ask my cardiologists about my readings).

 

[pellicle]

Needless to say that I am just a patient and not an expert at all on any medical subject.

Confused, you called me out on the differences; I explained why I didn't make any comparison of aortic vs mitral, and clarified that I was not contradicting anyone.

So what are you trying to say here please?

 

[Midpack]

Confused, you called me out on the differences; I explained why I didn't make any comparison of aortic vs mitral, and clarified that I was not contradicting anyone.

So what are you trying to say here please?

Pellicle, my third post was not directed to you at all.

It was just some kind of disclaimer to remind members that my opinions are just from my own experience as a patient and that I am not a doctor. Yes, i know it is probably unnecessary to state it, because it is a forum for patients, but anyway…