Questions for Surgeon

[mainframe]

I'm seeing a Surgeon today and hope to be better prepared than I obviously am. My aparture is down to .65 without many symptons yet. While I will probably cover similar ground as I have with the cardio's I've seen, I also wanted to ask about:

Valve selection. What's the best option for my circumstances. (44 yo otherwise healthy, active guy)

It's a teaching hospital, so among other things I was going to ask what he was going to do during the procedure versus the fellows.

How many of these procedures has he done.

Otherwise, I'm kinda lost as to what else to ask. What questions should I be asking. I'm sure there would many I'll think of after my appointment, but by asking here, I'm hoping to minimize the number of "I shoulda ask that".

Thanks for you help.

 

[JenniferO]

This may be too late if your appointment was today, but take a look at the thread started by "Seabush" called "Evaluating Physicians" on 8/21/01 in the Pre-Surgery Forum. I knew I remembered seeing something along those lines but it took me awhile to find it.

 

[mainframe]

Thanks Jennifer. I'll take a look for the thread you suggest. I did already see the surgeon who was very informative and answered many questions. Naturally, he wants to operate.

He did a great job of explaining valve choices, even had visual aids which help my wife and my understanding. He spent a good deal of time with us and we left feeling pretty good about the appointment.

Hes the only surgeon I've talked with, but comes highly recommended by our daughters cancer doc., who's father had surgery with this doctor. I probably will talk to another surgeon an anesthesiologist friend who works during many heart procedures recommends, but I did like this guy.

thanks. Chris.

 

[JenniferO]

Chris:

Talk to several surgeons, even if you think you've found the one, because the more you talk to the more educated you get and the smarter you get about the questions. Gradually, the right choice for you becomes clear. Even meet with a surgeon under consideration several times. I met with one here in Salt Lake twice, another three times (both of whom I liked very much but who couldn't offer me very good odds of repair), and then chose Dr. Cosgrove in Cleveland whom I've never met (but offered me 95% chance of repair of my mitral valve). Despite the impersonality, I feel really at peace with my choice of Cleveland Clinic at this point. Everyone with whom I have had contact there has really impressed me with their attention and efficiency, much in contrast to the local hospitals and surgeons. As one person told me, "your surgeon doesn't have to be your best friend, he just has to be good at what he does." Granted having both would be the best, but it's not always possible.

Surgeons will offer you what they do best: operate. Cardiologists don't operate and in my experience tend to be a bit lackadaisical about the whole thing because they don't know the difficulties faced in the operating room. Remember with valve problems, you want to operate early before any irreparable or irreversible damage to your heart occurs. If you're hoping for repair instead of replacement, the longer you wait, the thicker the valve tissue becomes, making repair that much more difficult. That may mean operating before your symptoms are really all that troublesome. It's the paradoxical nature of valve problems that you often don't feel all that bad even though you need surgery. There are definite measurements in your echo results that indicate whether or not "now is the time." Your surgeon will explain those; heed them! In the course of facing my own problem, I had to battle my basic premise that "doctors are alarmists." I now somewhat regret that I didn't heed them sooner.

Jennifer

 

[mainframe]

Hi Jennifer.

I'll definetly talk to another (or two) surgeons before making my decision. In my case (bicuspid aortic valve), don't think repair is in the cards. One of things I like about this guy was he explained the pluses and minuses of each valve/procedure without interjecting alot of bias. The other thing I like is that he's done more Ross Procedures (100+, what I leaning toward) than just about anyone in town.

The first cardio I saw flat out told me "I needed a mechanical St. Jude valve". I thought that was like a car salesman telling me I need the cargo van, when I'm looking for the super duper SUV. Didn't qualify the customer.

He said I'm ready for surgery. I'm guessing another surgeon(s) will say the same thing. They want to operate. Its what they do. By the same token, I want to get it done before I have any complications from not having it done. Looks like April for me.

 

[Bill Hall]

Chris - I agree with what you say, that the surgeon will almost always say you need the surgery when you get that far. I think my cardiologist was far too conservative about recommending surgery. I think he thought I would not go ahead since I had no symptoms. Anyway, when I had my surgery last year, Cleveland asked why we waited so long. I had my surgery last year at age 47, a homograft Aortic and mitral valve repair. Hope all goes well with you.

 

[Mara]

Hi Chris-

If you are leaning toward the Ross, make sure the surgeon is doing the operation himself. My surgeon did 100% of my Ross.
You know doctors have to learn, but do you want a fellow doing his first Ross on you?

Also check out if the hospital you are going to is totally prepared for the Ross. If it is a teaching hospital, it should be.

Getting thru the Ross is a sinch, but it is a long and technically demanding surgery. You want a very competent and skilled surgeon. My surgeon had done less than 100 but all had great outcomes, andhe had done over 500 AVRs. I liked him because he had the right mix of cockiness and confidence.

 

[Mara]

OOps

Chris, what valve are you getting for your new pulmonic if you go with the Ross? I got the Cryovalve SG.

 

[mainframe]

Hi Mara.

I would love to have the same situation you do, to have the synergraft has my pulmonic valve, but when I mentioned the synergraft to the surgeon, he mentioned something about Cryolife as a source of homografts. I've mentioned the synergraft to 2 cardiologists and now the surgeon, but drawn a blank. Well, I do live way out here in Seattle. So at this point I would say a homograft but I?ll sure bring up the synergraft again. I?ll trust the surgeon.

I really feel comfortable with this surgeon, Edward Verrier. He has done over 100 Ross procedures, and did a great job of explaining everything to us. The hospital is the top rated in our state (he's also the chief) and was recommened by our daughter?s oncologist. Her dad had a positive outcome. Although he?s the only surgeon I?ve talked to, I feel comfortable with him doing the surgery.

Thanks Mara. I keep reading your progress with much interest. Wish you all the best.

Chris.

 

[Mara]

Chris...
Thanks for your good wishes.
Feeling comnfortable with your surgeon is, I think, half the battle in getting mentally prepared for the surgery.

 

[sylviayasgur]

hi chris!
joey had a ross. when i asked about the cryolife for the pulmonic, they didn't have any available (they only got one or 2 at this hospital, and they needed to be reserved ahead of time). joey has a homograft. his surgeon said that his "buddy" elkins at cleveland, who also does tons of rosses, uses only cryolife valvas for the pulmonic. joey's surgeon, however, felt more comfortable with the old "tried and true" homograft, so.....
i think you have to be comfortable with your surgeon and his methods/choices.
please keep us up to date on your decisions. i'm sure all will be well. good luck!
-sylvia