Urgent Need of Advice- 83yr old facing AVR surgery

[Amelia]

Hello everyone, I’m in urgent need of advice and would greatly appreciate your thoughts.

My beautiful grandmother is 83 years old, very active and sharp, mentally sound as a rock. She drives, she cooks, she gets around great and loves doing everything herself.

I’m not great at technical terms, but to my understanding, she was born with a bicupsid valve and has severe aortic stenosis. Heart cath confirmed severe AS with a 60mmHg peak gradient (that’s from the doc’s report). She’s known she had a heart murmur for years, but her general care doctor always assured her she was fine. I don’t think he prepared her for the possibility that she might one day need aortic valve replacement due to this problem.

I would love to hear your thoughts and advice.

Thank you,
Amelia

 

[Allisoninoz]

Hi Amelia, I'm sure somebody with more knowledge about surgery for the elderly will answer you soon. You sound like a very caring granddaughter - you're lucky to have each other. When I had my surgery nearly 18 months ago I was in hospital with an 80yo lady who had just had her third aortic valve replacement - and she was doing better than me on the walks around the ward! So, you never know. The cardiologist is the one who can sort this out for you - if he's not being clear, see another one until you find somebody you are both comfortable with and who is willing to listen and talk. Good luck.

 

[dick0236]

My beautiful grandmother is 83 years old, very active and sharp, mentally sound as a rock. She drives, she cooks, she gets around great and loves doing everything herself..........
Amelia

Given what you posted above, her thoughts concerning this should be a major factor in any decision. Heart surgery, although very successful in most people, IS major surgery and the medical consequences, especially in seriors, can be devastating. I am in your grandmothers generation.....I had a very successful valve implant when I was much younger and probably about your age. Hopefully, I will not have to make a decision regardin surgery again. If I do, it will be much harder since "quality of life", not "quantity of life", will be the overriding factor.

No one, other than your grandmother and her physicians can know the better approach to her overall problems. I might suggest that you also get input from a doc who has a "geriatric medicine" speciality.

 

[Lynlw]

Hi Amelia, You've gotten some good responses so far the only other thought I had was, I dont know if your GrandMom is a candidate, and dont know where you live, but I would probably look into seeing IF she is a candidate for having a percutaneous valve replacement, which is a valve replacd by cath and not opn heart surgery,right now the 2 valves being used either trial or just approved, for aortic valves are Edwards sapien or medtronis Corevalve, as far as i know the Corevalve is just doing trials, and I believe having a biscuspid valve would rule her out , BUt it MAY be possible to qualify for the Sapein valve with a bicuspid valve, since it has been approved for highest risk patients so some of the restrictions arent the same as trials, and already severl patients with bicuspid valves have succesfully had the valves.
it might not be an option for her right now, but I would cetainly look into it, since the recovery is pretty much the same as other heart caths, instead of recovering from major open heart surgery, so It couldnt hurt to ask about it.

Since I dont know where you live or if travelling is an option, here is the link to the sapein trials and at the bottom is a list of all the locations taking part, which would be a good place to see who is doing them in your area http://www.clinicaltrials.gov/ct2/show/study/NCT01314313?term=sapien&rank=9&show_locs=Y#locn if your Grandmother is interested in finding out if it is an option for her

good luck with everything

 

[kfay]

Hi Amelia, what a great caregiver you are! Your grandma is very lucky to have to looking out for her. We've had other members here in the past who have had an elderly family member needing this surgery. If my memory serves me correctly, some have done quiet well and gotten back to a fully functioning life, while others haven't been so lucky. The risk of this surgery is usually very, very low (around 2% or so), but I don't know how much that changes when you have someone her age (although I think both Barbara Bush and Barbara Walters were near her age when they had this surgery, successfully). That would definitely be a question worth asking her Dr's. Has she actually consulted with a surgeon yet or are you just dealing with her cardio? If she hasn't, it might now be time to go talk to one and really understand what he feels her risks might be. She sounds very competent, so obviously she should have the most input in this decision, as long as she understands all the associated risks and consequences.

I feel for you having to be in these shoes. Quite honestly, if I were her age and faced with this choice, I'm not sure what I would do.


Kim

 

[Amelia]

Thank you everyone for your responses, it helps knowing there are others out there who have faced similar issues.

 

[kfay]

I can only imagine how hard this decision is for you. I wouldn't want to be in your shoes. From your description, she obviously is already having symptoms, and as you've already discovered, it can be fatal. Many on here have said that when it starts going bad, it can get bad rapidly. Have you been able to review her echo's for a couple of years in a row to see how quickly it is progressing? It's also worth considering that the healthier you are going in can have a big impact on how you recover. If she waits until she becomes really ill and her heart sustains more permanent damage, she could really have a much harder time in the long run. It wouldn't hurt to search out another surgeon for a second opinion and to find one who has experience with valve jobs, not just bypass surgery. If you are going to go for surgery, I would start moving in that direction sooner rather than later.

 

[Gail in Ca]

My Mom's neighbor had her valve replaced in her early 80's with a pig valve. This has been a few yrs ago. She continued to play cards with "the ladies" and has led a very active life since then. She recovered well, and would drive my Mom to the grocery store, as my Mom doesn't drive, at age 94!