Trifecta Valve Concerns

[pellicle]

Just in the right place at the right time and even got to watch it with a chair, friends, drinks and snacks.

perfect!

 

[Lisa2]

Not for the purpose of second guessing a decision made in the past, as that does no good, but for the benefit of you and others going forward.

Yes, exactly. My attitude has been that he made what he felt was the right decision at the time and he couldn’t run it past me in the moment. So I just got back to the business of living my life and got over it. I would like to understand why he made that choice. I will be asking, for sure. And yes, I will share for the benefit of others. Maybe my experience will help someone else in some way.

 

[Lisa2]

Pellicle I love all of these pictures. The 2nd one is especially breathtaking. I like the view where you live . We live in a rural area and see the stars quite often.

 

[Lisa2]

I feel very lucky to have seen the aurora — around a campfire, in the middle of the summer no less, at my friend’s cabin in northern MN. Serendipity for sure. Just in the right place at the right time and even got to watch it with a chair, friends, drinks and snacks.

That is serendipitous. It makes me happy that you got to experience that, and in such a perfect way. You describe what a perfect night looks like to me; but, it’s usually with a campfire, drinks, s’mores and fireflies! We plan to try again. We have been thinking of Alaska or Churchill, Canada.

 

[pellicle]

An excellent philosophy Lisa

And it's this

And yes, I will share for the benefit of others. Maybe my experience will help someone else in some way.

Which makes this place so valuable to others

 

[Lisa2]

A note about valve sizes - let's take that 21mm valve, the "21" is tissue annulus size - that's, in general, "about" the middle of the sewing cuff. That said, EVERY manufacturer fudges that number - they take whats really a 23mm valve and figure out a way to call it a 21mm. Why do they do this? so they can publish superior hydrodynamic data. Thats also why there is not a universal sizer set as each valve model requires its own specific valve sizer.

Mechanical valves typically have "better" hydrodynamic data over their tissue valve equivalents (size for size) as the orifice is usually made of carbon so it can be very thin whereas for a tissue valve you still need a frame and then all the stitches and mounting points for the tissue leaflets.

So... if they put a 21mm tissue valve in at minimum they could put a 21mm mechanical valve in or more likely a 23mm mechanical valve.

Some history - at one point they sold tissue valves without a stent or frame - this was in an effort to improve the hydrodynamics of the valve, however the time and skill required to implant such limited the market and they simply faded away. Fast forward to today a valve like this (stentless tissue valve) would be ideal for candidates with a potential TAVI in their future.

Then what other reason could they have for putting in a tissue valve? I have to find out. I’m really confused now.

 

[MdaPA]

I obviously have a lot of questions to ask this next time around. Again, I can only state what the team told me at the time. I think UAB ranks #30ish out of the top 50 heart centers in the U.S. and my surgeon is the director of the division of cardiothoracic surgery. He does over 100 open aortic valve replacements per year. I trust him. BUT I do plan seek other other opinions as you’ve suggested, Pellicle. If it’s not cost prohibitive, I would like to seek treatment at Cleveland Clinic.

As this will be your 2nd OHS, you should seek a surgeon that specializes and has experience with "redo" OHS. i.e. ask what percentage of redo's they do per year. Seeking out CC, one of the best, is a good idea.

 

[MdaPA]

Then what other reason could they have for putting in a tissue valve? I have to find out. I’m really confused now.

Call the hospital or surgeons office and ask for the OR (operating room) report and/or surgeon's notes to see if that provides any information.

When my wife had her 2nd OHS to replace her MV, the surgeon 1st implanted a porcine valve but when they did a TEE before taking her off bypass showed it was not functioning sufficiently, the surgeon replaced that valve with a bovine valve. This was in her OR report and we would not have known otherwise.

 

[pellicle]

Hi @Lisa2

I just wanted to add that if you do follow this advice just be aware that it may be the last time that you ever get to access those records. I say may because when I was discussing my issues with a legal person (informally) I was told that if they get a wiff of feeling you may be gathering evidence then those records may "go missing" inexplicably after you've read them.

Call the hospital or surgeons office and ask for the OR (operating room) report and/or surgeon's notes to see if that provides any information.

this question

Then what other reason could they have for putting in a tissue valve? I have to find out. I’m really confused now.

is a very pertinent one one and as you may have "read between the lines" there is either something none of us know about which drove that (IMO rather odd) decision OR there is something which would make me never want to ever trust that surgeon again.

People above have suggested Cleveland Clinic. I would suggest you do that (or some other well known, high profile place). I suggest you go in well informed on your next visit with your next surgical choice.

Best Wishes

 

[Lisa2]

Hi @Lisa2

It is a very pertinent one one and as you may have "read between the lines" there is either something none of us know about which drove that (IMO rather odd) decision

I looked back at my posts from 2017 and found the answer. I don’t know the size of my annulus but at least now I remember what Dr. Davies said. And I actually have the operating notes somewhere. I can’t put my hands on them at the moment because our house was flooded during Hurricane Sally in 2020 and we still have a lot of things packed away in boxes.
Post in thread 'On this side of the mountain for the 2nd time'
On this side of the mountain for the 2nd time

 

[pellicle]

Hi

I looked back at my posts from 2017 and found the answer. I

yes I did the same ... I don't feel qualified to comment but I didn't feel that was a good answer (of his). I'd still take that to question you next consult (with another surgeon).

 

[nobog]

I reviewed that "old" post and a comment about your post:

@Paleowoman, yes, you have it right. The tissue valves are more flexible and can be fitted into a smaller space. He tried a 19 mech, the smallest he was willing to go, and it was too large. He said he could have possibly fit a 17mm but that is more of a child's size and my result would have not been good. He said I would basically have gone through all of that and ended up with the same gradient, heart function, etc. as I had before surgery.

Not all valves are created equally - I have said it before on this forum the Dr's know the anatomy very well but very, very, few know anything about the actual performance of valve A, B, or C. A SJM "baby valve" (mechanical valve) with a Hydrodynamic Plus cuff (15HP) flows better (lower pressure drop and higher EOA) than "others" 19mm valve. As mentioned this is marketed as a 17mm valve.

Yes, your situation is not common as anything smaller than a 19mm is unusual, at least in the USA, On the other hand, Asian woman, being of smaller statue, it is more common for such a small valve size.

 

[user 15848]

That is the compromise, T vs Mech, i spent 6 months thinking 24/7 what to choose, and it was here reading Pellicle's articles that i came to understand the dilemma, Tissue, get ready for next op at any given day, Mech, Warfarin, then my 2 doctor sisters...., told me the same, go mech while people told me stay away from warfarin; At the end, the truth is my native valve is gone, and anything else will never be the same no matter what; and also, all my friends are 60+ and i know lots of them that had suffered AFIB and strokes and also take warfarin or the most expensive contemporary anticoag pill, so, yeah, i wish i did not have to replace my AV, and the Warfarin is not a perfect thing but "for me", get it done once and get it out of the way, and forget about AFIB and strokes, they will no happen; most likely.....