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"The challenge of valvular heart disease: When is it time to operate?"

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  • "The challenge of valvular heart disease: When is it time to operate?"

    Great article I found that was written by doctors at the Cleveland Clinic on the timing of surgery and how the medical community typically evaluates patients. My Cardiologist told me I was a "2a" classification and I did not entirely understand it until I read this.

    AVR on Oct. 1/13 at St. Paul's Hospital in Vancouver, BC to replace a bicuspid aortic valve, at age 47 (25mm On-X valve)

  • #2
    Very informative......Thanks.


    • #3
      Good article...but there are still no hard and fast answers as to timing...wait for symptoms to develop but not too long...and symptoms can be subtle. Hopefully future advances in treatment will make the call easier.
      Bentall Feb 2015 - 29mm St. Jude "Trifecta" aortic root, ascending, and hemiarch replacement, dual CABG by Dr. Grayson Wheatley.


      • #4
        Skeptic 49 - you're right, there are no hard/fast answers, but it does give you an idea for how the doctors think, and the process they generally follow (although every individual's situation may be different). In my situation my cardiologist said "they will operate on you before you see symptoms". I hope he is right, but the reality is that you are never quite sure when symptoms may hit! And it sounds like the post operative complications can increasing once you are symptomatic. I'm going in for my AVR as soon as they will take me! Its definitely not a matter of 'if', but 'when'...
        AVR on Oct. 1/13 at St. Paul's Hospital in Vancouver, BC to replace a bicuspid aortic valve, at age 47 (25mm On-X valve)


        • #5
          I got to know just how my cardio was thinking because over the years, we discussed the timing of my surgery many times, in great detail. I say "discussed" because I am lucky enough to have a cardio who works with me to manage my condition, rather than dictating to me just what to do and when. As we were getting to the place where most of the statistical models would have sent me off to the OR, my cardio said that he could not yet, in clear conscience, recommend surgery. Although some of my statistics were past the usual limits, my quality of life, exercise tolerance and general health were far better than average for my age - with or without the heart condition. Eventually I said "It is time" and we set a date. I'm still seeing the same cardio, as I feel that the easy dialog is of supreme value in management of conditions such as ours.

          The article from Cleveland Clinic, for some reason, will not open. But I have seen that sort of information from one or another of the medical or surgical professional organizations. The charts do a lot to help folks understand where they are, how their cardio's will likely evaluate them and what to expect in treatment. In my case, I am lucky enough to have even more - the open communication with my cardio. If you can have both sources of information, make use of them.
          Go Class of 2011!

          Steve Epstein
          9 Years in The Waiting Room, then on February 28, 2011,
          AVR with 23mm Edwards Bovine Pericardial Tissue Valve, Model 3300TFX, Pacemaker - Boston Scientific Altrua 60 DDDR IS-1 and CABG (LIMA-LAD) at Northwestern Memorial Hospital, Chicago by Dr. Patrick McCarthy and the most wonderful team of professionals I could ask for. New pacemaker (Boston Scientific L101) and ventricular lead, July, 2016.


          • #6
            Didn't open for me either but maybe this is quite old now.
            Aortic Valve Replacement And
            Aortic Root Repair
            Edwards Bovine Pericardial 23mm
            March 7, 2006


            • #7
              I think you have to pay to access the article, here's a link to the abstract of it at the Cleveland Clinic:
              Anne - Congenital bicuspid aortic valve. AVR 6th January 2014 CE Perimount bovine Magna Ease Aortic valve - 19 mm. St Anthony's Hospital London, UK, anaesthetist Dr JP van Besouw, surgeon Prof Jahangiri. Also atypical Type 2 diabetes, osteoporosis, small airways disease.


              • #8
                If you click on the PDF link above the word 'Abstract' it opens the full article.

                Direct link ☞ here

                Bicuspid Aortic Valve discovered February 2015 at St Thomas' Hospital, London. Moderate stenosis. A comfy chair in the Waiting Room.