Repeat Surgeries

[tigerlily]

I was wondering how many times a heart valve can be replaced whether tissue or mechanical. I know the answer would depend on a lot of factors but I'd like to hear feedback on this. Thanks!

 

[Agian]

I was wondering how many times a heart valve can be replaced whether tissue or mechanical. I know the answer would depend on a lot of factors but I'd like to hear feedback on this. Thanks!

I asked my surgeon the same question. He's one of the best in Australia. He answered 'multiple'. When I asked him to clarify, he told me he's had patients who've had 'four or five' (or was that 'five or six'); usually in relation to congential heart disease in kids, not valve replacement.
Multiple heart surgeries is a very specialised field. When I told him people say you can't have more than four (I was testing him), he looked at me and said 'those people aren't heart surgeons.' The risks theoretically increase with each OHS and some surgeons don't want their stats to look bad. Yes, it seems possible to have multiple surgeries, but most of us want to keep the number to a minimum.
The number one killer in people who survived middle age used to be heart disease (coronary). With all the new treatments and technology, cancer has overtaken in the developed world.

 

[pellicle]

I asked my surgeon a similar question when in 2011 I was facing my 3rd operation. He said that my 3rd would already be a tricky operation and that I should think very carefully about valve choice because if I chose a tissue valve that when it needed replacement (his words) "you won't have surgeons lining up to do your 4th". He also said that anyone who tells you redo surgery is not increasingly dangerous is actually dangerous.

basically each time (as Agian says above) the risks of injury (oh, **** I've cut a nerve) due to everything being massively obscured by scar tissue goes up. Each time those risks compound.

From what I understand you may survive your 4th and 5th surgery, but you won't be a well person anymore.

You can find people on this forum who've had more than 4 surgeries. It hasn't always been to the same valve, and they aren't to my knowledge out doing their 100th hike.

 

[Agian]

You can find people on this forum who've had more than 4 surgeries. It hasn't always been to the same valve, and they aren't to my knowledge out doing their 100th hike.

Is that because of the number of surgeries, or the reason they needed them in the first place?

 

[pellicle]

Is that because of the number of surgeries, or the reason they needed them in the first place?

I understood that it was directly related to the points I mentioned ... scar tissue, cut nerves, sternums that don't heal ... Break your leg multiple times in the same place over years and it gets weaker right?

I guess that the gradual reduction of health each time the valve goes south also creates a "saw tooth" graph in drop of health that (as you age) will be harder to recover from. Which augments the losses above.

 

[neil]

not to sure myself, but I asked my surgeon about my re op which I know I will need and he was laid back about it all saying he had done numourous ones no problem, hes the expert so that's good enough for me, saying that its not something I look forward to lol, be interesting to know the most anybody has had replaced though

 

[tigerlily]

I'd be interested too in learning if anyone has had a particular valve replaced 3 or more times. I'm also curious about damage done to the heart when a valve starts to go south. I've only had one replacement so far but I remember that I did have some enlargement (don't remember exactly what) but it went back to normal after the valve was replaced. I just wish they could come up with something less troublesome than warfarin for mechanical valves. It would be a no brainer for me if that were the case but since I seem to have to have a surgery or procedure almost every year unrelated to heart issues, warfarin really seems tricky.

 

[pellicle]

Hi

not to sure myself, but I asked my surgeon about my re op which I know I will need and he was laid back about it all saying he had done numourous ones no problem,

It would be important to clarify if he meant :
Done a single reoperation on many people.

Or

Done many multiple reoperations on individuals, say three or four redo ops on a given person.

I'm expecting that he was speaking in context of you.

Given your age at your first operation I think it's quite possible you will need one reoperation, but very unlikely you will need three and I'd put money down that you won't need a fourth.

So rest easy there.

In my case if I'd chosen a tissue prosthetic at my 3rd operation in 2011 as a 48 year old that it would be almost a certainty that I would be needing a 4th by my mid 60's

There is a big difference for those of us who start down this path young and those who start older.

 

[zee112]

Carbomedics carboseal ftw! (27mm of goodness might I add)

 

[neil]

hi pellicle, no he meant in general, I was 51 when I had my first op and the little piggy shows not sign of slowing down, it will be 10 years next year, my cardio has told me the way things are 1 more re op will be suffice, unless things go tits up which can happen to anyone, I agree 4 or 5 re ops would not be good at all, pellicle also think he meant re ops just the once or twice,

 

[neil]

so anybody know what the most valve re ops there has been?

 

[zee112]

I've seen someone post about having their fourth surgery on this forum. Didn't hear back from them since.

 

[Mellyouttaphase]

31 with tissue vave (pulmonary) placed in July. Watching this thread with keen eyes!

 

[pellicle]

31 with tissue vave (pulmonary) placed in July. Watching this thread with keen eyes!

probably not worth your while as research outcomes go

and what will it matter?

Do not do buyers remorse on your valve. EVERY choice has pros and cons, so focus on the pros of your choice now that its made!

 

[pellicle]

so anybody know what the most valve re ops there has been?

http://www.valvereplacement.org/foru...rt-surgeries-e

http://www.valvereplacement.org/for...-complications-in-surgery?p=573411#post573411

 

[pellicle]

I found this article:

http://www.ncbi.nlm.nih.gov/pubmed/1...ubmed_RVDocSum

however I'd be very cautious about its conclusions given:

Median age was 3.6 years (range, 0.1 to 45.1); weight, 14.2 kg (2.0 to 112.2).

yes, you read that right surgeries beteen months old and 45yo

then:

Incidence of second sternotomy was 67% (406), third 28% (166), fourth 4% (24), fifth 0.8% (5), and sixth 0.2% (1).

so they had their bulk data on second, some on third and almost no data on 4th and 5th

Hospital survival was 98%.

nothing about 10 years later or quality of life for the fourth, fifth and sixth redo patients (or who was the 2% or who was the infections).

Myself I would not feel comfortable with making any conclusion on such minimal data.

 

[Nocturne]

http://www.sciencedirect.com/science/article/pii/S000349751100004X

Main points are that if you are roughly 60 years old when your second AVR is done, you have a roughly 60% chance of living another decade, 80% if you don't need the surgery due to endocarditis.

 

[Mellyouttaphase]

probably not worth your while as research outcomes go

and what will it matter?

Do not do buyers remorse on your valve. EVERY choice has pros and cons, so focus on the pros of your choice now that its made!

No buyers remorse, just curious. You are right that it doesn't matter in the scheme of things, still interests me anyway. Buyers remorse on this kind of thing would be a pretty nasty psychological situation! I may have had a shortlived bout when I was in ICU but fortunately that passed over relatively quickly. Phew!

 

[Nocturne]

Actually, the interview I posted recently WRT TAVR got me to thinking. Does TAVR "count" as surgery? If you undergo TAVR, then valve within valve, and then eventually need OHS to replace the TAVR valve(s), is it in a way your first surgery? It is your first OHS, technically. How does this translate to overall outcomes?

I'm sure that the data isn't fully in on that, but it's worth considering.

 

[cldlhd]

Well there's surgery and then there's surgery. I had arthroscopic knee surgery a few years back to clean up a torn meniscus. I was in and out in a few hours and wasn't nearly as big a deal as my ohs. I would consider TAVI to be surgery just not one.