Consult with 2nd surgeon

[Phyllis]

I was considering this subject last night.
I decided that when the time comes that the cardiologist feels I'm going to need my valve replaced, I'm going to ask alot of questions about who handles their anticoagulation monitoring. I'm also going to find out how easily I can, or can't, acquire my own home monitoring unit. If I'm satisfied that anticoagulation wouldn't be a hassle, (and that would be the exception in all the myriad considerations surrounding valve replacement ) I might consider a mechanical valve.
But last night, after spending a portion of the day at my own doctor's appointment and then the evening with a son who underwent an appendectomy at 11pm, I'm darned glad I've got a tissue valve.
I really don't want to deal with hospitals, either as a patient or with a loved one, more than is absolutely necessary. And I'm sure they feel the same!

Which son, Mary? Neither is good, but I hope it wasn't John who just got home from Iraq and if so, thankful it happened here and not there!

 

[Mary]

Which son, Mary? Neither is good, but I hope it wasn't John who just got home from Iraq and if so, thankful it happened here and not there!

Phyllis, it was Haley's dad. He's our child that when he says he's hurting, he's probably hurting worse than 95% of the population. Due to lack of good health insurance, he waited as long as possible before he went to the doctor.
Voilla! Six hours later, appendix out!

 

[catwoman]

Betty:

John's never had any orthopedic problems, other than the time he jammed his toe against a door frame. No back problems. He shouldn't have to worry about osteoporosis (my dad has it & so do I).
John's dad died @ 78 from cancer (he was an ostrich when it came to going to doctors). His (my FIL's) sister was 90 when she died; one brother (a paraplegic) was 92; one brother is still living and is at least 85. John's mom died @ 64 from Alzheimer's. Her only sibling, a brother, died last month at 97, I think.
Other than John's dad, no one has had cardiac issues.
So, I see his family as being long-lived, excepting the Alzheimer's and ostrich syndrome.

Mary:
Sorry about the appendicitis. That's something most people never face, and those who do are typically young, although there are exceptions. When I went for a 2nd consult for my hysterectomy, I asked the OB/GYN if he would do an appendectomy (the first surgeon wanted to do one). He declined, saying that (1) OB/GYNs don't do general surgery and (2) I was 34, over the age range for appendicitis. I thought about it, and opted to have him do the surgery.

 

[Karlynn]

Mary, I hope your son has a quick recovery! Given his pain threshhold, I hope it didn't burst!

 

[dick0236]

Untill I joined this form about two months ago, I never gave ACT too much of a thought. It was something that went with having a mechanical heart valve. For me it has never been a big deal. I am careful (but not paranoid) about taking the proper Warfarin dosage and I have it checked routinely. If I was diabetic I would have to take insulin, etc, etc. I am concerned that some in the "waiting room" get the wrong message and become very fearful regarding ACT. I live in a Patio Home Community and have three friends (golfing buddies) here who are on Warfarin. I have been on warfarin 40 years, one friend had a tissue valve in 1976 that was replaced with a mechanical valve in 1992(?) and the other friend has A-Fib and a Pacemaker. ACT is a non-issue with all of us. We also have another homeowner who had a tissue valve implanted in Feb., 2007. He is 77 and may or may not continue Warfarin indefinately. Letting ACT dictate valve choice is "letting the tail wag the dog".

There were no valve choices when I got mine so my continued use of warfarin is a necessary treatment and a mute point BUT I have been able to forego two or three re-operations to replace a worn out valve. For me, the sometimes "hassle" with warfarin has been a much better choice that multiple OHS

 

[Ross]

Untill I joined this form about two months ago, I never gave ACT too much of a thought. It was something that went with having a mechanical heart valve. For me it has never been a big deal. I am careful (but not paranoid) about taking the proper Warfarin dosage and I have it checked routinely. If I was diabetic I would have to take insulin, etc, etc. I am concerned that some in the "waiting room" get the wrong message and become very fearful regarding ACT. I live in a Patio Home Community and have three friends (golfing buddies) here who are on Warfarin. I have been on warfarin 40 years, one friend had a tissue valve in 1976 that was replaced with a mechanical valve in 1992(?) and the other friend has A-Fib and a Pacemaker. ACT is a non-issue with all of us. We also have another homeowner who had a tissue valve implanted in Feb., 2007. He is 77 and may or may not continue Warfarin indefinately. Letting ACT dictate valve choice is "letting the tail wag the dog".

There were no valve choices when I got mine so my continued use of warfarin is a necessary treatment and a mute point BUT I have been able to forego two or three re-operations to replace a worn out valve. For me, the sometimes "hassle" with warfarin has been a much better choice that multiple OHS

Dick we keep telling this, but some have preconceived notions and most are relying on downright misinformation. Mary, I'm not citing you here, so please don't think I'm attacking your views. I'm speaking for just about every single new member here that shows up in valve selection.

I don't care what anyone says. Heart surgery is serious business and should only be done one time if it can be helped. I'm really dismayed that people are lead to believe that just because it can be done again, doesn't mean that it should.

 

[Karlynn]

I think because surgery is done a lot in this country, we don't give it as much weight when compared to the possible issues with Coumadin.

Have you ever watched Dr. 90210 or any of the other plastic surgery shows? It amazes me how people will put their bodies through the ravages of those kinds of surgeries for personal appearance. At least heart surgery is to save your life! Some of those surgeries take twice as long as an OHS.

However, I have said that if I ever have to have OHS again, I'm lining up a plastic surgeon too. Just joking!!!!

 

[MaryC]

Just wondering, since with valve repairs there is a chance of another future surgery, has anyone had the surgeon do a valve replacement with a mechanical valve and didn't have the surgeon attempt a repair?

 

[Karlynn]

Mary, it's my understanding that most surgeons who do repairs will only do so if they feel the repair will last a long time, hopefully indefinitely. As with any valve surgery it's a given that they don't really know for sure what will occur. Mitral valve repairs are more common repairs although we are seeing some more attempts at aortic repair.

Since the surgeon doesn't know exactly what they'll find until they get in there, they can't say 100% if a repair will be possible. We do have members who went in for repairs and came out with replacements. But I think this is happening less and less as repair techniques are perfected.

This is one of the reasons we always tell people to have Plan A and Plan B.

 

[leecrowley]

I had my Ross Procedure performed by Dr. Ryan in August '06. During our preliminary discussions about the Ross and having a back-up plan, his first suggestion to me was a mechanical valve. I chose tissue as a back-up for several reasons, but my point is........I definitely didn't receive a tissue valve bias. After I told him my reasons for tissue, he agreed with my reasoning. Gladly, I was able to get the Ross, so the back-up wasn't needed.

This was just my experience. I have nothing but great things to say about Dr. Ryan and Presby Hospital. They did me well.

Good luck.

Lee

 

[WayneGM]

Originally Posted by MaryC
Just wondering, since with valve repairs there is a chance of another future surgery, has anyone had the surgeon do a valve replacement with a mechanical valve and didn't have the surgeon attempt a repair?

I had a mitral valve repair and was told it should last indefinitely, so a repair does not necessarily mean a greater likelihood of another surgery. Obviously, each case is different, but from what I've heard/read repairs are usually considered good for the long-term.

 

[catwoman]

My uneducated guess:

Longevity of repairs (I'm talking MV here) depends on

1. Nature of the valve problem (i.e., ruptured chordae? myxamotous tissue? Both?)
2. Skill and repair experience of the surgeon
3. Whether the surgeon was able to fix the valve with 0 regurg post-op on the OR table, or perhaps only a grade 1 regurg.

If all that's needed is to reattach or replace the chordae, it's safe to assume that no reop will be needed.

Surgeons expect valve repairs to last indefinitely & tissue valves to last as long as the valve companies say. That's being optimistic.
A patient whose repair or valve fails may not return to the same surgeon for the reop, patients move, patients become noncompliant about rechecks, patients die, etc., so it might be difficult to determine the % of patients whose repairs have held over X or XX years.

 

[tommy]

I said I'd rather deal with warfarin than going through surgery again, going through several months of total recovery and paying co-pays and deductibles again, when I could have most likely avoided it with a mechanical.

That is my reasoning. It's a deeply personal decision.

I have absolutely no criticism at all for those that prefer second surgery over ACT. But it's a shame if anyone ever makes a decision based on bad information.

All we need to do is read through the problems posted on the anti-coagulation forum and see that well over half of the problems are either due to the fact that the warfarin manager didn't have a clue what do to, or turned a problem into a big problem because of mismanagement. It truly is a more valid reason, in my opinion, to consider tissue,

A very valid point, but geeze, what a shame! ...... That a wonderful therapy should be avoided due poor understanding and spotty management by the medical community that make it available.

 

[catwoman]

I had my annual physical this morning and explained our dilemma to my PCP -- that we have seen 2 surgeons whom I feel are equally skilled & rated very equally among their peers. Dr. Murphy said to go with the surgeon we believe will do the best repair to avoid a replacement. However, he said that he knows John will be in good hands if a repair doesn't work: He's seen me take warfarin, do my own testing, everything's been fine & he would let me run John's INR tests if it comes to that.