Valve Replacement vs. Bypass Surgery

[Jed]

Hi All,
I was just wondering (for no real reason) which surgery is harder, valve replacement or bypass surgery? I realize that the incision part is pretty much the same and the fact that sometimes they need to use a vein from the patients leg might make it harder. But as for the heart portion of the surgery which do you think is harder? Seems like since my VR surgery everyone i know knows someone who has had OHS. Thanks, Jed

 

[Gemma]

Hi Jed,
I know what you mean - Jim met a guy 2 weeks after his AVR who'd also had a valve replaced, then a friend's dad had bypass surgery (triple - should've been quadruple but they couldn't get round the back of his heart) on New Year's Eve last year!
I think recovery from valve surgery is supposed to take longer than bypass, but I don't know if this necessarily means the surgery itself is harder for the surgeon. I suppose the longer recovery time may be to do with the fact your heart is damaged during valve surgery and takes a while to recover, whereas in bypass the blocked arteries are bypassed and the nice clear ones mean the patient feels better quicker. (Before anybody says anything, I know this is a very simplified explanation!)
Gemma.

 

[hensylee]

Mornin Jed - Like Gemma, I don't know. I had quad bypass and not valve replacement. There used to be discussions about the differences but it's only something the oldies might recall. We never got to any real conclusions.

In reading the past years about valve replacement and comparing to my own surgery, seems the opening and closing is the same, recovery about the same, time in hospital about the same. Valvers say the surgery deals directly WITH the heart where bypassers' hearts aren't touched, just arteries passed over with the new piece of the saphenous vein from the leg. (or another vein from somewhere). Cardio told me complete recovery would be a year and I think that's about the same as vr. VR is probably more dangerous than bypass because of the direct involvement of the heart itself. Bypass is done with a quick decision from the cardio, where it seems more careful decisions with longer examinations are made by vr doctors. There are a heap more bypassers than valvers. More bypasses than actually needed, some say.

All in all, it's something none of us ever wanted to do, isn't it. But then we are grateful for the life saver, after all.

 

[Mb]

Good morning:

I just thought I might add a comment on this one.

Mys husband had his aortic and mitral valves replaced with St. Jude's three years ago. His surgeon, on our last visit to him, made the following comments. - "Do not let anyone confuse the surgery you have had with by-pass surgery. Even people in the medical profession will attempt to deal with you in the same way, when in fact, the surgery is more difficult to recover from." - Ninety percent of all OHS are by-pass. Ten percent are valve jobs, and other repairs. Ten percent of those are double valves. In by-pass surgery, the heart is not "opened". Therefor, open heart surgery is a misnomer. Of aortic and mitral valve replacements, the mitral valve is the more difficult to recover from. Perhaps because they actually have to enter the heart for the replacement, where the aortic valve is close to the outer surface of the heart.

All that said, I personally think the "difficulty" comes with the patient. Some folks to into surgery much "sicker" than others. Some have depressed immune systems. Some have additional health isssues. Therefor, how a patient endures the surgery, recovers, etc. really has a lot to do with their individual situation. - Marybeth

 

[Harpoon]

From a technical standpoint, valve replacement is MUCH more difficult and SERIOUS than any form of by-pass surgery.

For one, a lot of by-pass these days is done while the heart is still in motion. You may be on heart/lung by-pass, but they never actually stop the heart and start it again. Valve replacement almost always involves stopping the big ticker with the hopes it will restart when the docs want it to.

I've seen by-pass operations on TV. Generally they'll punch little holes where they want to attach the new blood vessels then sew them in. That's another BIG difference. Most valve replacements involve dicing the heart up and sewing it all back together, another major techinical difference.

The skill level is a LOT higher, the stakes are higher too. I'm pretty sure by-pass has a fair amount of leeway for minor mistakes or "Murphy's Law" situations. Valve replacement either gets done right or the patient dies.


Most hospitals can do by-pass procedure. I can get one down the street here in a 300 bed hospital that does mostly sports injuries, rehab, birthing, and some limited cancer treatment. Not a valve though.


And then if you take into account doing a valve job on an infant.....


Apples and oranges.

 

[Jed]

One more question

One more question

Thanks guys,
Your answers opend my eyes alot. Kinda scary thinking that my heart was discected and put back together. I know how Humpty Dumpty felt, only mine was successful, lol. Ok now that i know the answer to my last question i have one more. How long should it take for the heart to completly heal? I had my Aortic and Mitral valves replaced with mechanicals and my Tri-cuspid repaired. Next week will be my 3 month anniversary and i feel pretty good. Still not back to normal yet but all things considered its pretty amazing where i have come from. My surgeon has released me to go back to work next week but i am still a bit apprehensive. I have a very physical job and i feel my incision will be ok just not sure how my heart will do. If anyone has thoughts on this subject please share them with me. I would greatly appreciate it. Thanks alot, Jed

 

[MarkU]

I would be still be real careful about any heavy lifting or strenuous exercise after only three months. Even though I started working out again three months after my AVR, it took me about nine months to feel completely healed - my sternum was sore and tender for a long time.

 

[tobagotwo]

Jed,

Considering what MarkU has accomplished since his surgery (triathelete), I bow to him as a good source for information. The only addition I can think of would be to also ask your cardiologist to set it up so that you only work half days for at least two weeks at the beginning.

After being able to have down time during the day, it's shocking how long an eight hour day is to get through, as we normally don't take real rest breaks. When I worked as farm labor, we just didn't get breaks, and when I worked construction, we just took breathers.

It's great that you're recovering well and feeling good. You must have been in good shape to begin with to be recovering so well. Please consider starting slow and working up to it, so you don't get set back.

Best wishes,