Which Hospital which Valve

[Monty]

I am a 47 year old male who is a runner. Just 3 weeks ago I was running 8 min. miles. I have been told by my cardiologist that I have severe AI and AS. I am scheduled for surgery Oct. 12 for aortic valve replacement. I have no symptoms except heart palpitations. I am in really good shape. I live in Nashville TN and am having surgery at ST Thomas Hospital. The surgeon that I have chosen is the best in TN for valve jobs. My first Appt. with him he was 3 hours late. When I came back for the 2nd he did not have a lot to talk about as in terms of types of valves. We had decided on the St Jude Toronto Porcine. I am seeing that from your web site that the CE Perimount Magna and the Medtronics Mosaic Porcine are two of the best. He never mentioned these to me. Since coming to your web site I have found that The Cleveland Clinic does minimal invasive surgery. Instead of a complete sternotomy they only cut about 4 inches. I am looking into this Monday morning. Can anyone give me some information concerning this post. Does anyone know of a Good AVR Surgeon at the Cleveland Clinic???

 

[Ross]

Well after reading Dr. Cosgroves report, about half of them are done MIS and the other half conventional, so yes they do do the Aortic valves too.

http://www.clevelandclinic.org/heartcenter/pub/about/surgoutcomes/Outcomes_2003.pdf

 

[Nancy]

Don't let the fact that your surgeon was late for your appt. diminish your feelings about him. They are so extremely busy, plus many times things don't go along according to schedule in the operating room, and they cannot leave a patient on the table without finishing up. They can also be called into emergency situations at the drop of a hat.

Many here have found that surgeons are not ones to do a lot of chatting. Most are short, to the point, but will answer your questions as you bring them up. They are the detail, precise men of your treatment plan.

Make a list of your questions when going into a medical appt. and edit it to one page. We often get nervous when discussing options and forget to ask the right questions. Your list will remind you of what you wanted to discuss.

 

[Monty]

Which Hospital which valve

Which Hospital which valve

Thanks! That will help. Who is a good surgeon at the Cleveland Clinic?

 

[John & Joann]

Pettersson , Gosta , M.D., Ph.D.

He is an outstand physician and a very nice man. He has had extensive experience in high risk procedures. If they are on the staff at Cleveland Clinic they are all good.

Review the link to their staff.

 

[ALCapshaw2]

You may be interested in the 'second opinion' option on the Cleveland Clinic Website.

I 'assume' you are aware of the basic trade off between Tissue Valves and Mechanical Valves...

Tissue Valves last 10 to 20 years before requiring replacement (i.e. another Open Heart Surgery). They do NOT (usually) require anti-coagulation (Coumadin).

Mechanical Valves last 'forever' BUT do require anti-coagulation therapy. Some of the new (third generation) valves have improved hemodynamics with less turbulence and possibly a lower incidence of clot formation than the standard mechanical valves. ON-X is one such valve (do a search for ON-X on this forum and also on the web). There was mention of a study to see if third generation valves could simply use aspirin therapy in place of Coumadin. IF successful, that option will still likely be several years away in the USA.

It might be worthwhile to write the Nashville surgeon with a list of your questions and ask if he would prefer to discuss those issues with you during an appointment, over the phone, or simply send you a letter in response.

Interviewing more than one or two surgeons is probably a good idea if you have the time.

Best wishes,

'AL' in ALABAMA

The BEST Heart Hospital in ALA is the University of Alabama at Birmingham -UAB- They have 3 primary surgeons, Dr. James Kirklin - head of heart transplantation, Dr. McGiffin - a delightful Australian surgeon who I have been told specializes in high risk cases, and Dr. Pacifico who was recruited from Mayo Clinic (along with James Kirklin's father, John Kirklin, now deceased) to begin the heart program at UAB.

 

[tobagotwo]

Monty,

Welcome to the VR site! This is a good place to vent dissatisfaction, frustration, confusion, and even elation regarding valve replacement surgery.

First off, I'm with Nancy on the surgeon's lateness. They do get held up. However, if you're not a match with your surgeon for other reasons, you should consider seeking another. If you're already at CCF, you've hit the mother lode.

I also agree with Al that if you're looking at valves, you should consider all the types, unless you have already ruled out mechanicals because of the required anticoagulation. At 47, you're young enough that it deserves consideration at some level. There are many enthusiastic marathon runners on this site who have mechanical valves, and a famous one or two. A peek at some of the threads in the Active Lifestyles forum should find them quickly.

As far as tissue products, here's my biased take on your issue: The St. Jude Toronto valve was approved by the FDA in 1997, and is an unstented valve. The Toronto valve uses a different implantation technique than other aortic valves, and the surgeon you have may have specialized in that technique, thus making it his preferred valve.

A stent is a fixed ring at the base of the replacement valve, to hold its shape. Unstented valves are shaped by the place into which they are implanted.

Unstented valves can have an advantage in bloodflow over a standard mount valve. The Carpentier-Edwards Perimount Magna overcomes this by its superior placement in implantation, allowing a larger opening as the stent is not in the line of blood flow ("superior" meaning "on top of" in this case). The Mosaic's response is that it uses a stent that is thinner by half than other stented valves, allowing more flow in a traditional placement.

Here's a link to some info on the Toronto valve:
http://www.sjm.com/devices/device.a...#174;+Valve&location=us&type=19#designhistory

The Toronto valve does not indicate that it has the newer anticalcification features found on the Mosaic or CEPM. Its history in the US is relatively short, and the studies it refers to are very short-term and mostly over five years old. Also, the numbers from their "patient recovery" graphs stretch reasonable limits. As examples:

• Average ICU time for unstented valves - 26.4 hours, stented valve - 110.4 hours. Most people are expected to leave the ICU the next day with any valve type. I was home in 75 hours (with my stented valve).
• Average hospital stay for unstented valves - 9.7 days; stented valve - 14.2 days. Most people are expected to stay 5-7 days for all valve types in the US. Three days for the lucky.
• Average ventilation time with unstented valve 16 hours; unstented 55 hours. Most people are now off the ventilator later the same day with all valve types, usually in less than 12 hours.

Of course Ross, Harpoon, and a few others had to go and mess up all those quick ICU, ventilation, and hospital stay times for everybody...

So, the graphs in the St. Jude description/marketing site don't cut it with me, as the numbers (to me) clearly do not reflect current practices. I am not aware of any difference in ventilator, ICU, or hospital stay time accorded to patients at this time, based only on the brand of the valve or whether the valve is stented. You could ask the surgeon's people whether that practice exists at CCF.

This doesn't mean the Toronto is not a good valve, or even a great valve. It has been in the US for seven years, and its competition has been there much longer. And the track records of the Magna and CEPM predecessors are excellent. Although St. Jude is a very large name in heart valves, and is by far the largest supplier of mechanical heart valves, use of the Toronto valve still lags behind the use of Medtronics and Edwards Lifesciences tissue valves.

The Mosaic and CEPM also have extra anti-calcification features which could reasonably be beneficial to a young tissue recipient like yourself, as younger valvers seem to calcify their valves more rapidly.

This is not a vote against the Toronto, but it is one for looking at the other offerings as well.

This here is a link to a post that has links to tissue valve sites (sounds convoluted, but really isn't): http://www.valvereplacement.com/forums/showthread.php?t=8653

I know you're in kind of a hurry. Hope this helps you find more to chew on.

Best wishes,

 

[joy]

I have to say that when I had my open heart surgery, my surgeon decided on the CE bovine pericardial heart valve. he did no think that a mecheanical valve would last forever in me...in fact, did you guys know that they only last 30 years? That's an average. I am on coumadin due to TIA's and chronic afib. Just thought I would let you know what I was told.

 

[Guest]

I live in Nashville TN

*sighs*

Dangumit, someone else who lives in my favorite city .

*pauses*

That is all.... You have received some great information/advice thus far, and I'm afraid I can't add much more to it, except...

GOOD LUCK!

Cort, "Mr MC" / "Mr Road Trip", 31swm/pig valve/pacemaker
'72/'6/'9/'81/'7, train/models = http://www.chevyasylum.com/cort/
MC Guide = http://www.chevyasylum.com/mcspotter/main.html

 

[tobagotwo]

My assessment of surgeon's choices of valve brands is somewhat different. We know that at CCF, there are a number of surgeons who heavily back and use Carpentier-Edwards valves. However, we also know that several key cardiac surgeons at CCF have participated in cardiac device research and development with Edwards Lifesciences, and have professional (reputational) stakes in valves and other devices that are produced by them. That's okay, insofar as they are fine valves anyway. Certainly, no one is being cheated by this. However, it does not speak to the pristine nature of their choices.

My own surgeon was willing to be talked into a CEPM valve, but was more bent toward Medtronics Mosaic. He had installed as many of the Mosaics in patients as any other surgeon at the time. So, his personal tally was at stake. That didn't mean that he pushed the valve. But it meant that if you were receiving a tissue valve and made no other request, that is what you got. Again, it's okay, as it is also a very fine valve. Certainly, no one is getting second best here, either. But again, it is more an affect of whimsy than individual selection.

Surgeons may specialize in a type of valve that they were trained on (perhaps the case with the Toronto valve above), or which their group has developed a philosophical affinity to. In other situations, surgeons choose the valve that comes from the sales person who they choose to work with, or from the company that ships the fastest when they need it. They may be predominantly using a particluar valve because they are involved in a study of its effectiveness. Or even from the company that the Purchasing department chooses to engage. The top valves are good enough that they could be considered largely interchangeable at the surgical level.

That is why I believe it remains in your interest to investigate the valve choices yourself as well. It doesn't preclude you from taking the surgeon's recommendation. And there is always the possibility that the surgeon will have to take another tack, based on the tissue quality that he finds. But most of the time, you can get what you bargained for.

I feel that if you present a "simple" valve replacement, and the surgeon will only consider one brand or model, because that is what he likes to work with or is used to, you might want to take the reins back. If it is a model you don't agree with, and he produces no convincing reasoning why it would work better for you, you should consider whether that is the person who should be doing your surgery.

You need to trust your surgeon's ability to choose. If not, you need the ability to choose a surgeon you can trust.

Best wishes,

 

[Granbonny]

Did we miss Monty's surgery

Did we miss Monty's surgery

It has been 4 weeks since he last posted he was having surgery Oct. 12th He never replied back on this thread?Did he post back on another thread? Bonnie

 

[Harpoon]

Of course Ross, Harpoon, and a few others had to go and mess up all those quick ICU, ventilation, and hospital stay times for everybody...

Somebody has to keep the surgeons on their toes...