Valve Choice- Decisions, Decisions

[iheart]

Hello,

Many questions here--I have an enlarged aorta (5.2) and congenital bicuspid valve which is leaking. I've been told by my cardiologist I will need valve replacement and aortic graft. He strongly suggested a mechanical valve because of my age--50. I did a little research and thought I would go with the dacron graft and On-x valve. I would never need another surgery (if lucky) and have the possibility of reduced blood thinner. It looked like a good design, and the "latest and greatest," although I could be wrong about that.

What a difference a day makes.

In my discussion with my doctor he talked about needing a heart catheterization as a prerequisite to surgery. He said they use a "contrast" or dye, that is hard on the kidneys. But, he said, "your kidneys are normal so that won't be an issue."

Wrong. My kidneys are slightly impaired. This is gross, sorry, but I have a condition where I always have a little blood in my urine, not enough to see, but at times--mostly when I get stressed, the flu or a fever--there is enough to blood to darken it. It's not a big deal, it's a congenital condition I've had all my life. But now I'm off to my Nephrologist to see what precautions to take for when I get the heart cath done, and ALSO to ask about the effects of coumadin on the kidneys. My concerns are: 1. the heart cath will potentially set off a kidney episode right before my surgery, and 2. I'll be taking a chance of having kidney problems down the road if I choose a mechanical valve and have to take coumadin.

So now I'm thinking a bovine or porcine tissue valve is best is the way to go for me. I'm in the early stages yet, but plan to have surgery soon--April or May. I had been in touch with the Cleveland Clinic about possibly getting Dr. Pettersson to install the Graft/On-x as he has a lot of experience with it. I would imagine he could do a graft with a tissue valve just as easily? Anyone know any other great CC docs I may wish to contact? Anyone have this surgery with impaired kidneys? Any other thoughts/advice?

Thanks so much!
Ron

(oops, meant to post this in valve selection forum)

 

[Greg a]

WELCOME to the forum and I hope that what ever you are in, in the "mid Atlantic" is unlike your leaky valve .....sorry I could not resist.....be sure cardio is aware of the renal issues and discuss the pending surgery with your nephrologist.

 

[AgilityDog]

I don't know that the coumadin affects the kidneys. Diuretics, yes, but not the coumadin.

As for the dye - yes check with your nephrologist.

The cardiac cath is so they know whether they also need to do a bypass while they have you cracked open - wrap all that surgery into one package. It's not uncommon, and most cardios insist on a prior cath.

 

[kfay]

Laurie, I'm reading his post not that the coumadin will cause damage to his kidneys, but may cause them to bleed more since he already has a condition that causes him to have blood in his urine without being on coumadin. I think only your Nephrologist is going to be able to answer the question about whether coumadin is going to make this become more of a problem or not, and he may not really know the answer 100% himself, so may recommend you don't take the chance. You have a little bit of a different situation going on that makes the normal choice of mechanical vs. tissue more difficult, so I think you may have to rely more heavily on your doctors and their advise.

 

[Lily]

Welcome to the site. You're asking good questions. Find the best surgeons and ask all of them the same questions. Some here have had success even emailing their questions to surgeons. That may narrow down your consultations. Don't be afraid to consult with more than one highly recommended surgeon. Ask them specific questions. Drill them. Have they performed surgery with someone with your condition? What were the results? Similar questions. BTW, I think most members here with tissue valves take daily aspirin therapy. You will want to ask about that too. And you will probably want to discuss your condition with the anesthesiologist, so they can be sure things they administer won't exacerbate your kidney issue. And you might want to search your subject here too because I'm sure I've read of a couple of members here over the years who have had valve replacement with one kidney.

I'm not sure what caused it but my kidneys didn't want to work for a few days following my last surgery. Possibly my blood pressure was too low. Or a medication could have contributed to the issue. Everything turned out all right but it's definitely something I'll bring up before hand next time. I was on reduced fluid intake for several weeks afterward, because of all of the fluid I'd accumulated those few days.

Anyway, best wishes

 

[ramjet]

Hello,

Many questions here--I have an enlarged aorta (5.2) and congenital bicuspid valve which is leaking. I've been told by my cardiologist I will need valve replacement and aortic graft. He strongly suggested a mechanical valve because of my age--50. I did a little research and thought I would go with the dacron graft and On-x valve. I would never need another surgery (if lucky) and have the possibility of reduced blood thinner. It looked like a good design, and the "latest and greatest," although I could be wrong about that.

What a difference a day makes.

In my discussion with my doctor he talked about needing a heart catheterization as a prerequisite to surgery. He said they use a "contrast" or dye, that is hard on the kidneys. But, he said, "your kidneys are normal so that won't be an issue."

Wrong. My kidneys are slightly impaired. This is gross, sorry, but I have a condition where I always have a little blood in my urine, not enough to see, but at times--mostly when I get stressed, the flu or a fever--there is enough to blood to darken it. It's not a big deal, it's a congenital condition I've had all my life. But now I'm off to my Nephrologist to see what precautions to take for when I get the heart cath done, and ALSO to ask about the effects of coumadin on the kidneys. My concerns are: 1. the heart cath will potentially set off a kidney episode right before my surgery, and 2. I'll be taking a chance of having kidney problems down the road if I choose a mechanical valve and have to take coumadin.

So now I'm thinking a bovine or porcine tissue valve is best is the way to go for me. I'm in the early stages yet, but plan to have surgery soon--April or May. I had been in touch with the Cleveland Clinic about possibly getting Dr. Pettersson to install the Graft/On-x as he has a lot of experience with it. I would imagine he could do a graft with a tissue valve just as easily? Anyone know any other great CC docs I may wish to contact? Anyone have this surgery with impaired kidneys? Any other thoughts/advice?

Thanks so much!
Ron

(oops, meant to post this in valve selection forum)

Hey Ron,

A valve and aorta repair at your age is usually best done with a mechanical valve etc, and an angiogram is very important for a few reasons, 1. During open heart surgery you go on bypass, and your coronaary vessel patency needs to be known as your heart will be injected with a solution to stop it beating, but also a solution to keep it alive during surgery, and the coronary vessels need to be pretty good for this solution to travel around the outside of your heart, and if not they may need to be opened up a bit with a stent or a bypass done at the time of your open heart surgery usually. Also, even if your coronary vessels are "borderline" narrowed, your scardiac surgeon may recommened that you have a coronary vessel bypass operation done at the same time as you r heart/aorta operation just to avoid having to open your chest up again in a few years time...but don't worry, thats not uncommon. Now the interventional cardiologist will look at your heart vessels using a contrast dye in your heart vessels, and it sounds like whilst you are passing some blood you don't have whats known as chronic renal failure, so the angiogram miost likely won't be a big deal, honestly, so long as your are still drinking fluids and passing urine and don't need dialysis etc, just be sure they know about your kidneys, and they can take it a bit easy with the contrst dye. The issue of taking warfarin in a patient with haematuria does need to be explored, but to do this you need to have the source of your haematuria (bloody urine) explored, and you may need to be referred to a nephrologist (kidney specialist), just to be sure about what is going on I would suspect.

1. diagnose cause of haematuria, and without knowing the casue no one can really comment much further on the potential effect of warfarin.
2. Determine the potential impact (if any) of warfarin on your particular kidney condition )if indeed you ahev a kidney condition)
3. If its not too bad, I am told by my surgeon that a valve and aorta repair (especially if you also have a cardiac bypass operation as well for a partically blocked coronary vessel) is typically best done with a mechanical valve just to avoid a tricky re-operation, and the aorta repair and bypass operation can make a valve replacement surgery quite a bit more difficult, as explained by my very senior and highly experienced surgeon

...let us kow what your doctors say Ron, but rest assured, if you keep all your medical specialists informed of your condition, they are very used to determing what should be the best course of action for your particulat situation. We can't offer much more on this forum unfortunately Ron, because it "all depends" ...it depends on your kidneys, your possible source of bleeding, and the compelxity of your valve/aorta reapir, and the condition of your coronary vessels...Trust the cardiolosist and cardiac surgeon Ron....and Take care.