The Surgeon Choice...

[LouLou]

Hi to all of my Heart Valve Family -
I need your advice and this may be a long post so I apologize ahead of time. I have my 2nd OHS scheduled for October 10th with Dr. Gillinov at Cleveland Clinic. I do not like that I can not speak with the surgeon before I make the long and expensive trip to Cleveland for surgery. I have questions and the nurse is out of town until Thursday. Ughhh. Meanwhile, I met with Dr. Edward Chen at Emory Hospital in Atlanta which is my home base. He is an extraordinary person and instantly gained my trust. He took a lot of time explaining every detail and giving me his insights and opinions. I believe is very capable of performing the surgery with success.
Since I already have a Mitral mechanical valve, valve choice for the Aortic (I thought) was a non-issue - I want a mechanical valve. Dr. Chen concurs. The paperwork I received from Cleveland Clinic stated a homograft valve....WHAT??? Last time I spoke to Cleveland they said we will discuss when I arrive prior to surgery.
I am not going to Cleveland unless I know that I will get a mechanical valve. Now I am second guessing my decision. Oh this is quite stressful.

Pros for Dr. Gillinov: #1 Heart Hospital, a top surgeon in the U.S.
Cons for Dr. Gillinov: Away from home, busy, busy, busy - don't feel like he has time for me, don't know what valve I will get.

Pros for Dr. Chen: At home, a top surgeon in the Southeast, lots of personal attention, for sure Mechanical Valve.
Cons for Dr. Chen: Not at a top hospital.

All feedback is welcome and appreciated.

Tammy B

 

[Jayhawk]

Does the hospital ranking really mean that much? I would place more value on getting the valve you want, personal attention and location than just the hospital ranking. I am gearing up to have AVR and will be going to my hospital that is about an hour away. I really like that I can go and meet the surgeon beforehand, my cardiologist is right there in case I need him and my family can be close by too. I just don't feel the need to travel all that way just to get a top rated hospital. Now... if my local hospital wasn't too good then I would be thinking otherwise too. Emory is ranked #44 for US News and World report, which isn't bad really. As long as you have a good surgeon then thats all the matters, at least to me. Just my thoughts.

 

[LouLou]

Jayhawk - You make some good points. I have been focusing on success rates and/or mortality rates and was not taking in to consideration other important factors. Having family close by is important.
Thank you for your reply.
I had my 1st OHS at Emory 24 years ago and at that time it was ranked in the top 10. One of my concerns is that Dr. Chen is branching off to a new division - Emory/Saint Joseph and will begin doing his surgeries at St. Josephs Hospital in October. Not a huge deal but another consideration. I will not consider Cleveland if I find out I can not get a mechanical valve there.

Tammy

 

[VegasBAV]

If you explain your concerns and insist on speaking with Dr. Gillinov for 5-10 minutes before going through with the surgery, I imagine they will accommodate you.

I had a workup and consultation with Dr. Gillinov 3 months before my surgery. The surgery was then performed by another surgeon because Dr. Gillinov was off work due to a sports injury on my surgery date.

 

[ski girl]

I'm with Jayhawk on this - the hospital ranking shouldn't be your deciding factor. I know that OHS is a scary prospect for all of us but in terms of surgical difficulty, it's not that complicated for the surgeons. There are people on this forum who had the exact same op you'll be getting 40+ years ago . . . it's not new, either. Basically we all just get a bit of plumbing work!

You need to go into whatever hospital in the calmest, happiest state possible, and it sounds like Cleveland Clinic is not that place for you!

 

[big_L]

I find the 'unavailability' of the doctors to be EXTREMELY disturbing. We really struggled with this prior to my recent surgery. You can always get the 'gate-keeper' to call you , but getting the surgeon - good luck. You want your answers NOW, not after a long trip and right before surgery. The problem is, you can't think of everything in advance. Add to that the general issue with most surgeons - they're don't always have the best people skills and tend to rush through the consult - and it's very frustrating.

I'd agree with the others and look more at the closer options. I would ask the surgeons how many valve replacements they've done. At a more regional/local facility, you may find that they're doing many more bypasses than valve surgeries. You need to know so you can make a good decision.

 

[dwhist]

I live outside Chicago and so had the choice of local hospital or going down to Northwestern which is well know for heart surgeries. I met with local surgeon and felt very comfortable with him and had the surgery done at Elmhurst Hospital, only 2 miles from my house. Was a lot less stressful for me and my family.

Go with what you feel comfortable with and reduce the stress level.

 

[dg_moore]

My local hospital, while very good, does not do valve replacements. I was sent to Washington Hospital Center, which is one of the best and only 20 miles from home.But my wife was terrified - not because of the surgery, but because she had to drive alone in D.C. traffic :eek2:. But the GPS and a big turn-by-turn list taped to the dashboard saved her: I survived the surgery and she survived the drive.

 

[Stopper]

I stayed close to home, and am so happy I did. I have a great relationship with my surgeon and his staff, and they will take my calls when ever I call. My deciding factor on location was the ability to stay close to my family, and the 100% trust I had in my surgeon. Just my 2 cents. Best of luck with your decision.

 

[Heather Anne]

I'm going to chime in and say being close to home is really a great thing for your family. I went to a hospital 30 minutes from my house, and the night I was in the ICU my husband slept at a friend's apartment five minutes away -- not in a hotel, and not in an uncomfortable chair in a hospital waiting room. He was able to go back and forth to our home and deal with our kids, dogs, etc. the rest of the time. It made everything so much more relaxed for all of us.

For me the location of the surgical facility didn't make any difference once I was discharged. My regular cardiologist is my contact for any questions I might have and he's the one I go to for followup exams. (I did see the surgeon once two weeks later, but that was very cursory and short -- yeah, they're not the chattiest people around!) But the convenience for my loved ones mattered a great deal to me.

As a counterpoint, the quality of a hospital's post-op nursing care is very important. The surgeon does the plumbing while you're sleeping, but the nurses take care of you the rest of the time while you're awake. If a hospital is understaffed or doesn't see a lot of heart patients that could affect your care and, certainly, your stress level. I imagine Emory is very good in that regard. But if there's a ranking for that you might check.

 

[AZ Don]

While there is something to be said for a top Dr and hospital, I can't imagine going into OHS surgery without talking to the Dr in advance, and not after making the trip to Cleveland. I think being comfortable with your surgeon is probably the most important factor. I would have reservations about a surgeon that is too busy to spend a few minutes on the phone. Being close to home is also nice. My surgery was only 30 minutes from home which made everything much easier for my family.

 

[dg_moore]

When I called my surgeon's office about a pre-surgery visit the nurse said if I wanted an appointment they would set one up, but that it's optional because I'd see the surgeon immediately before surgery, and while some patients have a pre-surgery appointment, most don't bother. Since the surgeon came very highly recommended by both my cardiologist and my PCP, I decided that I would forgo the appointment. Before surgery my surgeon met me in pre-op and answered all of my questions. I don't think I would have gained anything by a separate appointment (other than an additional bill for services). My docs' recommendations were on the mark - Ammar Bafi is the best.

 

[scott.eitman]

Dr Gillinov is a really nice man. I am sure when you get to talk with him, you will concur. I expect that he will listen to you desire to have a mechanical valve. However, if he doesn't, there are many great surgeons that will do it. I do recommend also conferring with a Cardio about all this as well. I believe they are as important to the team as the surgeon, if not more important.

On thing to keep in mind, yours is sort of a redo. Make sure that whoever you see is comfortable AND experienced with redos.

 

[LouLou]

I am feeling better since I spoke with Dr. Gillinov's office and was assured I would get a mechanical valve.
While staying near home has real advantages, I feel comfortable going out of state. I have a good team at home for when I return.
I have a big issue with AFIB and this is one of Dr. Gillnov's specialties so that was kind of the determining factor along with other things.
So the decision has been made for now....lol
I am a woman after all so I could change my mind again.
Tammy

 

[Guyswell]

LouLou,

I've been a patient there twice and was very happy with the care I received. It is a very busy place but I never felt like I wasn't receiving enough personal attention. Your situation is a little more complicated than some (existing mechanical valve, afib and redo OHS). You may benefit from being a patient at a hospital that sees plenty of cases more complicated than yours.

 

[TomG]

Hi there,

I had my mitral valve repaired last year on todays date, but at any rate, always remember "YOU" are the boss and you have the final say. When you get there you tell them want as per past conversations with your doctors, end of story. Do not let them boss you around it is "YOUR" body so it is "YOUR" decision.

TomG

 

[kimcdougc]

Hi, I interviewed three doctors before I picked one for my avr surgery. I feel like you should go with your gut. That doesn't necessarily mean going to Cleveland Clinic. Emory is a great hospital and if you liked the dr you spoke with there go with that. I don't think I would be having a dr operate on me if I didn't have a chance to talk with them at length before my surgery. Just my 2 cents. Good luck with your decision.

 

[Haoming Li]

Hi
I have two valve problem need replacement,I hope you can help me those Dr and hospitals surgery have more experience in LA
Best fo luck

 

[clay_from_nj]

Wow. Some folks put a lot of time and effort into this choice. I was lucky. My cardio suggested Dr. Mark Ammons at Exempla St. Joseph and I was impressed at the initial consultation and went ahead with him as my surgeon. He did a wonderful job, surgery was quick, recovery fast and easy, and the whole thing was virtually painless. He is really great to talk to and welcomes questions, calls, etc., any time. Later on, of course, I found that St. Joe's has received several awards and honors, not surprisingly.

 

[ejc61]

Emory/St. Joseph's not a top hospital? Really? A lot of experts on this board.