Valve Selection 1

[Bob Bates]

Landon;

Those are the words I want to hear: that the OHS was MUCH LESS traumatic than you thought it would be! Obviously, that is a major concern as my surgery date is a few days away (11/3/03).

I admit I am still second quessing a little bit about my valve choice ,since I don't know just how bad the first OHS is going to be. So your words of encouragement are very , very welcome.

A question for you since you in fact had the CE bovione valve, which is my first choice in a valve. Were you told before the surgery that you would be able to engage in very active pursuits with the CE bovine valve? Have you felt restricted in any way with this valve, other than what you mentioned in your post to me?

Again, thanks for taking the time to pass on your thoughts.

Regards,

Bob

 

[LKC]

Bob,

I don't recall any restrictions after the 6 weeks recuperation period. I think there may be an issue about lifting heavy weights, but since I don't do that and have no plans to take it up, I didn't ask. My understanding was, and is, that there are no restrictions, but you probably should go over that with your doctors. In addition, unless you are a high-level competitive athlete, I don't believe that the valve will significantly affect athletic performance. To the degree that the valve does affect performance, I can't believe there would be much difference between valves.

I certainly have not encountered any restrictions or differences. After the surgery, I took up handball again after 20 years, to stretch and strengthen the upper body, and felt just fine. I believe that if I wanted to train for it, I could easily start doing 5 and 10K footraces like I used to do 10-15 years ago.

The second guessing is natural; we all do it. The best advice for post-op I received: when you feel a sneeze coming on, push firmly immedately below and between your nostrils and the sneeze usually goes away. Good luck next week.

Landon

AVR - January 2002

 

[Bob Bates]

Landon;

Thanks for you reply about the CE bovine valve performance. I am no athlete by any means, but up until a few years ago , I jogged a couple of miles a day, and went backpacking on a regular basis. I want to resume those activities, perhaps even start a weight trainning program.

The CE valve is a stented valve, which all else being equal provides a smaller orifice than an unstented valve. But I was told by my surgeon that unless I had an very small arotic root, this valve would allow me to do the above activities. Your experience seems to confirm that possibility.

Thanks again for the information and your words of encouragement.

Regards,

Bob Bates

 

[Birky]

choice

choice

I was hoping for a repair but have a St. Jude mechanical. I ordered my operative report from the hosptial and found that when they opened me up, they thought that the valve had another infection on by the way it looked so they opted for the mechanical. Turned out to be vegetation. They took pictures of the valve to give to me. Pretty gross. If it wasn't for that , I guess they could have done the repair. My cardiologist had no way of seeing this prior to surgery or did the surgeon. Coumadin isn't really an issue. I took it for 7 years prior to the surgery as a precaution. I now have the readings sent to a Coumadin clinic versus the family Doc. Having the family Doc regulate was a nightmare. At this point I am so glad to be fixed. I am going to look into the home testing but not for a while. We have bcbs so maybe they will pay for this since they pay for my husbands needles, strips etc. for diabetes. I was 55 when they replaced my valve on 02/27/03. Good luck in your choice.

 

[bvdr]

Hi Bob,

I just found this note and thought you might be interested.

ABSTRACT 102

PORT-ACCESS AORTIC VALVE REPLACEMENT

Donald Glower
Duke Univ, Durham, NC

Purpose: To apply port-access techniques to aortic valve operation (AVR} via right thoracotomy.

Methods: A 60yo lady presented with severe aortic stenosis after pervious median sternotomy. An 8 cm incision was made in the right 3rd interspace. The right 3rd and 4th costal cartilages were detached from the sternum. A standard pursestring was placed in the ascending aorta, and the aortic was cannulated through the incision. A percutaneous 25Fr venous catheter was passed from the femoral artery into the right atrium. Once on pump, AVR was conducted in the standard fashion using a flexible external aortic clamp. Laparoscopic instruments can be used but are not necessary. The groin stab was repaired with 2 absorbable subcutaneous sutures. The rib cartilages were reattached to the sternum using two #4 figure-of-eight sternal wires.

Results: The postoperative course was unremarkable and the patient was discharged on the 5th postoperative day.

Conclusions: In patients desiring minimally invasive AVR, a small right thoracotomy with modified port-access techniques is an excellent option. Advantages relative to other sternal splitting incisions include avoidance of sternotomy, excellent cosmesis, and few wound complications.

 

[maxximom]

Hi Bob.. Sorry I didn't see your post before this.. I have been off the computer for the last few weeks..the heart's fine..the darn back has been causing me problems..but that's another long story I had a triple bypass and a AVR 2 years ago at Duke with Dr. Glower as my surgeon. I have a St Judes Toronto Stentless Porcine Valve. Dr Glower is very open to whatever valve that you may want..but in the end HE must make the decision of what will be the best for you when he actually gets in there and takes a good look.I was older 70 at the time of my surgery and told Dr. Glower that I wanted a tissue valve and not a mechanical valve if possible..we discussed my choice for quite awile and he understood my point of view. If I can help you in any way please feel free to email me and I will give you my phone number. I live in Wake Forest not to far from Duke..so if I can help you or your family in any way..I would be very happy to do so.Much good luck with your surgery..you are in good hands with Dr Glower
Joan
AVR, triple bypass,Sept25.2000, St Judes Toronto stentless Porcine Valve, Duke Medical Center, Dr Donald Glower

 

[mike anthony]

Bob, everyone is different and I think you made the right choice. I had 2 open heart surgeries within 9 months and went with a tissue valve(Bovine). My first surgery was due to an AA. It has been 9 months since my last surgery and I'm back playing basketball, golf, ect;. My second surgery was much easier than my first and I know at sometime in the next 15-20 years I will need another one. What helped me more than anything was I asked my surgeon, what would you do? He indicated to me without a doubt he would go with a tissue valve. I hope everything goes well for you and you will be in my prayers.

 

[Bob Bates]

To Betty, Joan, and Mike Anthony;

Thanks to you all for your information, advice, words of encouragement, and offers of support.

Betty- your comments were especially timely, as I must make the decision of port- access vs. sternal splitting soon. I am thinking sternal splitting for reasons I may have mentioed before: less time on the pump, and less risk if there is a problem, so Dr. Glower will have full and immediate access to my heart.

Mike: I have read many of your posts, since you had the bovine valve I was very interested in what you had to say. Although there are no "right or wrong" answers on valve choice, it is nice to hear someone say I made the right decision.

Regards,

Bob

 

[peter zug]

My Valve experience

My Valve experience

I had an aortic valve replaced 4 years ago when I was 49years old . I was sure I wanted a tissue valve (until my surgeons reccomended a mechanical valve) due to the coumadin life therapy.
The reality of a second open heart operation forced me to rethink the options. The valve I got was a Carbomedics valve supposedly "Bench tested for the equivalent of 200 years"
Hopefully your surgeon is up on the latest model of whatever valve they reccomend.
I returned to my job as a Ski Patroller after a few days past 2 months.
The following summer I returned to work roadbuilding as a construction laborer.
You can do everything you want to do for the rest of your life.
Coumadin hasn't proven to be that much of a big deal either. Blood is a little thinner but after you get used to it, and are able to keep blood in acceptaable ranges reccomended by the cardiolgists,it is no real problem.
I also self test INRS so with the advise of the doctor's office, I make all the dosage decisions for coumadin.
I was worried about getting out somewhere without the drug, but like most other things , it becomes part of your life.

Good luck, ask alot of questions, do alot of research.Hang in there and work hard to get through the first week or two and things get better fast.

 

[Bob Bates]

Peter;

Thanks for your comments. I have to admit a second AVR is a big scary unknown, due to advanced age and potential poor medical condition at the time it takes place. Plus, like you, many folks have indicated that coumadin is no big deal. However, it can be a big deal, and there are definite risks associated with its use as well. I am sure I could deal with it if I had to.

But, I've expressed the thought before, for me , the trade off is no real restrictions/ risks associated with coumadin for hopefully 15 years or so, in exchange for the second reop and its risks.

To me, assuming you do in fact have a choice, the coumadin route is the "safe" path, taken to avoid that 2nd OHS. But you pay a price for that the rest of your life in having to deal with coumadin.

All of this is very subjective. You belive the "price" you are paying to take coumadin is not that high. Others have expressed a different opinion. There really is no right or wrong.

I appreciate you relating your experiences to me. This has been one big learning curve for me, made possible by hearing from many good people.

regards,

Bob

 

[bvdr]

Bob,

You are right. The choices are varied but there is no real right or wrong choice. I wish you the very best with your surgery and you will be in my prayers.

About my heartport....I hadn't ever really discussed it with Dr. Glower until the night before surgery. He suggested it as he thought I might have a faster recovery time. (Maybe he had a resident or another Doc. that needed to do a heartport to complete their training)

 

[Bob Bates]

Betty;

Thank you for your kind words. I hope I don't need God's intervention, or good luck, but I'll take as much of it as I can, just in case.

Dr. Glower just emailed me and said we would be discussing the port access decision at my pre-op screening this Sunday, 11/2/03.
I know he is known for this procedure, and probably does need to instruct his residents. And I would like a shorter recovery time. But like I said before; I want this to be as quick as possible, with the least amount of risk to me as possible. The trade off may be a big scar, and a longer recovery time.

Regards,

Bob

 

[mike anthony]

Bob, like my doctor told me," they can cut my head off as long has they put it back together right. If something goes wrong I would rather they can get to it right away". You are going to be fine and I really think you will be amazed on how fast you recover.
I was out playing golf today and as I was walking, I thought jeez just 9 months ago I was under the knife for the second time. Today I hardly know that I've had surgery, accept for some pain do to the nerves. Again. good luck and you will be on your way to recovery before you know it.

 

[mike anthony]

Bob, like my doctor told me," they can cut my head off as long has they put it back together right. If something goes wrong I would rather they can get to it right away". You are going to be fine and I really think you will be amazed on how fast you recover.
I was out playing golf today and as I was walking, I thought jeez just 9 months ago I was under the knife for the second time. Today I hardly know that I've had surgery, accept for some pain do to the nerves. Again. good luck and you will be on your way to recovery before you know it.