Which Hospital

[dave1939]

Hello all.
Just discovered this forum and am happy to see all the valuable information it has. My first echo cardiogram was 16 years ago and revealed mild aortic stenosis. A few months ago, I noted a severe decrease in my exercise tolerance. Although I don't do marathons any more, I still compete at shorter distances,up to half marathons (13.1 miles). In 2011 and 2012 I finished in just over two hours and enjoyed it, finished strong and felt great. This year, it took about two and a half hours and I felt awful. On some days i can barley do one mile at a 15 minute pace.
Obviously, there was a problem, and this was confirmed by a recent echo which showed severe stenosis. I have decided to proceed with valve replacement.
My first question is where to have it done. I live in Asheville NC, the home of Mission Hospital, which has an excellent reputation, but does not seem to enjoy the same rating as the Cleveland Clinic. I am meeting with surgeons form both Mission and Cleveland soon. It would certainly be more convenient to have the operation in Asheville. I would appreciate any comments anybody has about deciding which facility to choose.
Also, I am hoping to resume my running activities at a reasonable pace. Does anyone have any experience in this regard?
I am 74 and normally finish in about the middle of the pack in races and at or near the top in my age group.
Thank you.

 

[Duffey]

Hi Dave and welcome!
I think most members would recommend you find your surgeon first and then see what hospital he operates from. I personally feel that the you should go with the best surgeon you can find. After you meet with the two surgeons, you will probably know which one you feel most comfortable with for your replacement. If you feel that there is relatively little difference between the two, then I'd let hospital choice influence my decision.
Regarding your running, if you'll check out the Active Lifestyles forum you'll find all kinds of threads and posts from people who've resumed post-op running and how they've fared.
Good luck!
Mary

 

[Eva]

Welcome aboard Dave!

In my opinion, it is the surgeon's rating that is more important than the facility rating.

You are making a wise decision by interviewing two surgeons from two different hospitals. When you interview those surgeons, you need to ask each one about:

- his years of experience in performing such surgeries,
- the rate of success
- who will assist him during the surgery (especially who will handle your heart/valve...him or a surgeon assistant, or PN?!)
- which procedure/vale will he use? and what is his reasoning behind his choice (is it based on his experience or based on what is best for you?)

Then follow your instinct!

Good luck with your decision. keep us informed

 

[epstns]

Hi, Dave, and welcome!

I applaud your continued intensity of training. I am a bit younger than you (now 65) and have been a recreational runner/jogger for over 30 years. I, too, noticed my aortic stenosis initially as a reduction in exercise tolerance. I went through two internists and a cardio before I found a competent care team, then was able to continue my life for nearly 10 years before I ws "ready" for surgery. When I felt the time was right, I discussed it with my cardio. We narrowed the field down to 3 surgeons at 2 hospitals. I ended up opting for the top-rated of the surgeons, and got the top-rated hospital in the region along with him. I agree that as long as the hospital is good enough, it is good enough. When it comes to surgeons, though, you want the best you can get for the procedure you are having.

As to the likelihood that you will be able to regain your strength and stamina after surgery, it depends. Most patients are able to get back to where they were a couple of years before the decline in valve function led them to surgery. In my case, though, I had complications and came out of it with a pacemaker. I still do interval training, but have not yet gotten back to being able to run any distance. Part of it has to do with how the pacemaker is adjusted, and part of it has to do with my knees, which really want no part of the impact of running. I'm still training hard, and feel good and am maintaining my weight and muscle tone, so life is good.

 

[scott.eitman]

Not to plug the CCF, I am a little biased. I do recommend a hospital with a good track record in whatever specialty is needed. In doing so, you will find that the entire staff is well versed in the care needed for that area of expertise, not just the surgeon. At the CCF, pretty much your entire stay (pre and post op) will be with heart patients. When, and hopefully you won't, you have a complication (small or large) you will find they have experience with that and are ready to handle it.

My example is that I had extreme back pain after my 1st. The nurse did not bat an eye, she knew exactly what it was and how to handle it. I understand that this is not uncommon after minimally invasive OHS.

Stay well
Scott

 

[Guyswell]

Dave,

I was very satisfied with CCF and Dr. Lytle. Some might refer to it as a "heart surgery factory" (they do more AVRs each year than anyone else). I was comforted by the thought that my surgeon and the rest of the team had seen it all and done it all many times before. I figured they would be able to handle anything that came up.

 

[dg_moore]

Dave,

I was very satisfied with CCF and Dr. Lytle. Some might refer to it as a "heart surgery factory" (they do more AVRs each year than anyone else). I was comforted by the thought that my surgeon and the rest of the team had seen it all and done it all many times before. I figured they would be able to handle anything that came up.

+1. I had the choice of Johns Hopkins, U of MD Med Center Baltimore, or Washington Hospital Center. I chose the latter, largely because they do so many of these (and most of their docs trained at Cleveland). It is a factory, which is not a bad thing - as Guyswell noted, they have seen it all and done it all many times over. I feel fortunate to live in an area where so many qualified providers operate.

 

[Jkm7]

While I fully agree the surgeon's skill and experience is critical, it is also very important the support staff be top notch. It is the nurses who look after us and get us 'well'. The techs are the ones who draw our blood, do our x-rays, PA's who care for us beside along with the surgeons (some of whom never see their patients post op). I think it very important to pick a high ranked, well reputed hospital/heart program for the whole experience to be the best possible. I liked knowing I was at Mass General both of my surgeries where they had seen it all, nothing would surpirse or catch them off guard and it was all in a day's work to them.

 

[Heather Anne]

I have to agree with this. Obviously, you want an experienced surgeon with whom you feel comfortable, but the surgery is, really, not that difficult for these guys (my surgeon compared it to "plumbing"), and we are asleep during it. What matters at least as much is the hospital's reputation for dealing with heart patients post-surgery. I've read some pretty chilling stories on these pages of nurses and other hospital caregivers not really getting it in terms of post-surgical cardiac care, and either ignoring potentially life-threatening issues or simply being too inattentive with respect to pain management or other common post-thoracic surgical issues.

The hospital I went with (UCSF in California) is renowned for its cardiac care, and I was on a cardiac-only floor both in ICU and afterwards. Those nurses knew what they were about, and I felt extremely confident with the care I received, as did my husband. The one time I went into AFib, I was sitting in my chair, and my heart went a little nuts for about ten seconds. Before I even had time to wonder what that was all about, the head nurse on the floor was in my room -- they'd seen it on the monitor at the nursing station. They knew exactly what to do, and I never worried for a moment.

I know it must be a pain to travel for surgery, and I'm fortunate I didn't have to do that. Maybe your local Asheville hospital has a well-regarded cardiac program, which case you can just go there. But if they don't, I'd probably -- having been through it -- go to Cleveland. Just my opinon, of course.

 

[Bryan B]

Dave,

Don't forget Duke either. Duke is one of the top 10 heart hospitals in the country (#6). I don't know enough about Mission in Asheville, but you can't go wrong with either CCF or Duke. I would say the two biggest concerns I would look at between the two are 1) finding the surgeon you are most comfortable with, and 2) which one would be easiest for you and your family to travel to and from. I used to live in Nashville for a few years but have lived in Cary/Raleigh for most of my life. I've driven through Asheville many times making the trek on 40 between Nashville and Cary. It's about a 4 hour drive on the button, maybe a little shorter to Durham. I had both of my surgeries at Duke. With them being one of the best heart hospitals in the country and a 30ish minute drive from my house it was a no brainer. I was very pleased with the care I received there. Of course CCF is the top rated hospital in the country so I wouldn't hesitate to choose them for your surgery. It's a win-win to have those kind of choices.

 

[clawie1]

Dave,

Don't forget Duke either. Duke is one of the top 10 heart hospitals in the country (#6). I don't know enough about Mission in Asheville, but you can't go wrong with either CCF or Duke. I would say the two biggest concerns I would look at between the two are 1) finding the surgeon you are most comfortable with, and 2) which one would be easiest for you and your family to travel to and from.

I live in So. Calif. and after doing due diligence in researching surgeons and hospitals, I was convinced CC was the only place to have my minimally invasive AVR. I came to this conclusion even before knowing whether or not I was even a candidate for the procedure. I was in the "waiting room" for 13 years, no symptoms, so I was confident I had time to plan my journey - wrong. Landed in ER after running errands to Costco and I knew this was my "moment." I proceeded to tell my cardiologist about wanting the minimally invasive AVR and he promptly replied "we'll see" - I had to pass the cardiac cath to make sure I had no other problems. Now I started to worry because I knew the odds of having clean arteries at my age (73) were not good. To my surprise, I qualified but my local hospital did not perform this type of surgery, it was a Friday, and I was in an extremely high risk position. My luck ran out for CC, I had to depend on my cardiologist for help. I was referred to Keck Hospital at USC, Los Angeles (this wasn't on my list of favorites) and on the following Mon. morning, I had my surgery.

What I learned from being 4 weeks post op, is that there are probably very fine hospitals and surgeons within your region. I was in a hospital where the whole wing was filled with people like me needing valve repairs, replacements, etc. The surgeon, Dr. Cunningham, and the entire staff at this hospital are top notch. I also realized how important it is to have the family support around you - something I really did not think was important. The day I was released, I had an anxiety attack because I had been in a hospital for 13 days and being in the fresh air was more than I could take. I honestly don't know how well I would have done if I had to take a plane home. Good luck to you, Nita

July 21, 2013, Minimally invasive Aortic Valve Replacement, 21 mm St. Jude porcine valve, septal myomectomy, Keck Hospital at USC, Los Angeles, Ca. Dr. Cunningham, Surgeon

 

[dave1939]

Thanks to all for their valuable advice. I met with the Asheville surgeon and have decided to have the operation done here, in Asheville. My surgery date is September 11.

 

[Duffey]

Thanks to all for their valuable advice. I met with the Asheville surgeon and have decided to have the operation done here, in Asheville. My surgery date is September 11.

Best wishes going forward!

 

[Heather Anne]

Good luck to you!!

 

[clawie1]

Best of luck to you Dave and we will see you on the other side. Nita

 

[Stopper]

Dave,

I wish you the very best. I am no expert, just had AVR 3 weeks ago, but I stayed close to home. The surgeons 5 miles from my house did a good amount of cases each year, and I really wanted to be close to my family. For me, it worked out well, I had pericardial effusion after my surgery and it was such a blessing to be able to go back to my hospital, with the people I knew, and have it taken care of. One of my fears of going to a larger teaching hospital, was who would actually be working on me. I feared a surgical fellow could be doing a lot of the work. That just scared me. I looked at number of cases and outcomes when deciding on where I would have the surgery. My local hospital and surgeons compared very well to the well known hospitals throughout our great country. God Bless!

 

[clay_from_nj]

Wow, all the work involved. I was lazy about it. My cardio pretty much told me what surgeon and what hospital, and I went along, though I did some quick checking up online. I haven't regretted it for a moment.

 

[mike dab]

Good luck with your surgery and please keep us posted.

 

[enkaynj]

Dave,
You may note that I did not have my surgery in any of the well-known hospitals such as Cleveland or Mayo but in Baylor Heart Hospital in Plano, Texas upon the recommendation of my cardiologist brother in law. The surgeon was very experienced and fantastic, the hospital was brand spanking new and the staff was just amazing. Every one of them was very professional and caring.
Of course, there may be several hospitals nearby where you live; it is best to see what folks on this forum say and go with one that you feel comfortable with. Good luck in making the right choice.

 

[dave1939]

Had my pre-op tests and meeting yesterday. Today I did my last, for a while, bike ride: 26 hilly Asheville miles. All set for tomorrow. I'll get back to you on the post surgery page. Thanks everyone for your good wishes and encouragement.