What happens if they can't complete the surgery?

[ChicagoMammy]

Hi

I've read the report from my surgery of 5 years ago. Judging from what I was told afterwards and reading the report it sounds like they had great difficulty placing the new valve due to extensive calcification. What happens if they can't place the new valve? Is there some kind of machine to keep things going while you'd wait for a transplant or something. Obviously I'll ask the surgeon when it comes to re-operation time, but just wondering if anyone knows. It's the thing that scares me most.

 

[Julian]

Hi

I've read the report from my surgery of 5 years ago. Judging from what I was told afterwards and reading the report it sounds like they had great difficulty placing the new valve due to extensive calcification. What happens if they can't place the new valve? Is there some kind of machine to keep things going while you'd wait for a transplant or something. Obviously I'll ask the surgeon when it comes to re-operation time, but just wondering if anyone knows. It's the thing that scares me most.

Good question, I don't know what they would do for sure but I think in worst case scenario they could install an LVAD system http://en.wikipedia.org/wiki/Ventricular_assist_device You could live on that for the rest of your life in theory if not several years until a transplant is ready. But I don't know what they would really do in a situation if a valve could not be placed, I'm just guessing the LVAD would be the final option. From what I read people live pretty full lives with an LVAD, Dick Cheney has one.

 

[markp66]

If they had trouble putting a valve in I'm very surprised why they didn't put a mechanical valve in. They normally have options ready just incase. Some people have had 4 valve replacements in the same position so I'm sure it will be ok. Hopefully it's something you won't have to worry about forma good few years. I know with the aortic valve they can attached it onto the aortic root which works very well although the mitral structure Is very different.

 

[Bina]

This is where you need to have confidence in the skills of your surgeon, and I'm sure that he had a "Plan B".
My aortic valve was very calcified and I still got the valve that I wanted.

 

[Eva]

Both of my valves were extremely calcified and my aortic valve was deformed...my surgeon was surprised I was living with that valve. It was very tough to decalcify, yet he was able to do it and replace it with a mechanical valve, which was what I asked for.

 

[markp66]

However, I think if the surgeon thought that there was no chance of replacing the valve in the future he would have put a mech valve in. Therefore there is no reason why this won't be possible in the future.

 

[Protimenow]

Imaging may be improving, so they may be able to determine degree of calcification before going in (I realize that this may not help you, because you've already had your surgery). In the not so distant future, they may be able to fix or replace the leaflets in your tissue valve without cracking your chest (or dealing with existing calcifications).

I'm not sure what the protocol is for extremely calcified valves and adjacent structures but, as some have already noted, mechanical valves seem to be an option.

 

[Lynlw]

One good thing is you go to one of the best surgeons, who does all kinds of surgeries so knew what to do with out having to stop and think about it.
without knowing more details, my guess is they cut out all of the bad calcified tissue and used patches if they needed to, so replacing this valve will be much easier than the first one was. especially since they are monitorring everything and it hopefully wont get as bad as the first time.

I can't imagine them not being able to replace the valve or at least making it that it is a functioning heart, since some surgeons (mainly Congenital Heart) can basically rebuild a heart/reroute blood flow with various parts and patches.
but in the worst case, there are quite a few options of machines depending what isn't working wel, from the different types of VADs as julian mentioned to ECMO which is pretty much like the heart/lung machine they use during surgery.

Since your surgery was a few years ago, if REDO would be a big concern,or higher risk than normal REDOs, I'm pretty sure (would hope) one of your docotrs would have mentioned it by now. At least that has been our experience when we knew there were some concerns about Justin's heart beteen his 3rd and 4th surgery. We were told why it would be higher risk, so had good questions to ask various surgeons about their plans to lessen the risks. Mainly we were told, because it would affect the Benefit/risk of having/not having surgery, we knew years before his 4th surgery that they would put off surgery a little longer as long as he was doing. He did fine with the 4th, even tho the surgeon had to work harder and also had a 5th.

 

[ChicagoMammy]

Thank you all so much for the responses. Yes I mentioned it more recently with my cardiologist (not surgeon) in passing and she agreed it would be a big surgery and that the surgery would have to be planned out and the surgeon would be able to go over all the options. Thankfully he's one of the best and I'm hoping surgery won't be for a while. I am thankful he gave me a bio valve (what I requested) because otherwise I wouldn't have my three year old!

When it comes time for surgery again they'll do the mitral (replaced last time) and the aortic (never been touched) at the same time. There is calcification throughout my heart which screws things up a tad - stupid heart

 

[Rocky]

One of the reasons for the angiogram is so they can visualize what is inside. Because they where not able to go inside the heart when I had my angiogram (valve was way to small and they did not want to risk damage) I also had a CT scan. And I was told that if it was not good enough for the surgeon, I would also have had an MRI.

It had the appearance to me that they where going to cover every base before they started the surgery. I also have to think that they have a plan b, c, d, e.... just in case something goes sideways. I had complete confidence in my surgical team.

 

[Jkm7]

Tees and angiograms give them lots of information but still surgeons see things they did not expect when they actually open us. It is always such a comfort to know you have the very best surgeon you could possible get and trust he/she is calm and unphased by whatever they find and have the skill to manage it. When in question, I think we all agree the better the heart center and the better reputation of the surgeon, the best for us.

 

[ChicagoMammy]

Tees and angiograms give them lots of information but still surgeons see things they did not expect when they actually open us.

That's the main thing I suppose. They didn't realize how bad it was and I had had all the tests in the world. I'm confident I have an excellent surgeon, but scared senseless all the same.

 

[Lynlw]

That's the main thing I suppose. They didn't realize how bad it was and I had had all the tests in the world. I'm confident I have an excellent surgeon, but scared senseless all the same.

Is your valve starting to look bad and surgery will be in a few years, or are things pretty stable right now and hopefully you'll have quite a bit of time before it needs replaced?
If you have time, chances are things will continiue to improve, both surgery techniques and testing etc.

 

[ChicagoMammy]

Is your valve starting to look bad and surgery will be in a few years, or are things pretty stable right now and hopefully you'll have quite a bit of time before it needs replaced?
If you have time, chances are things will continiue to improve, both surgery techniques and testing etc.

It's so-so. Maybe a couple of years maybe 10+. My aortic is also heavily calcified so they effect each other negatively. If either needs to be done - they'll do both and the descending aorta at the same time. I'm hoping I can wait long enough until they can grow me my own heart from stem cells - haha. That would be lovely.