2nd OHS coming in 2015 for me!

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C

camgough

Well-known member
Joined
Jan 1, 2011
Messages
284
Location
Ontario, Canada
Hi everyone,
Like many people I was on this forum several times a day, but as I healed and life moved on, I slowly posted less and read the forum less.

My brief history is in 2010 at age 30 I was diagnosed with BAV, and a 67mm ascending aortic aneurysm. I had valve-sparing aortic root replacement surgery in July 2010. I had some complications and was in hospital for over 3 weeks. The last 4 years have been great, no medications and pretty much my annual echo.

October 2014 echo showed a decrease in the EF(35%) and increase in my left ventricle size (1.1cm bigger). The surgeon who follows me wanted to see me in clinic. At that visit he thought the recent echo numbers may be off, as I have no symptoms and continue a busy/ active lifestyle. He ordered a MUGA test to get a better idea of the true left ventricle efficiency.

Yesterday I learned that left ventricle ejection fraction (EF) is actually 33% and that a re-op would be required. I was kind of expecting this and have taken the news pretty good. I have spent the last 4 years knowing this day was coming, but I was hoping it would be sometime down the road.

My wife and I are expecting our third child, due April 22, but there may be a planned c-section a few weeks prior, so the timing for this news is not the best. We have to try and decide if I should try for the surgery before, or try and hold off until a few months after the birth. It would be awful if we were both on lifting restrictions of 10lb or less.

As for valve, I don't think I am going to go for a repair again, even if it were possible. I am leaning towards a mechanical valve as I am 34 and tissue might be me another 10 years at best. As far as I understand, my surgeon most commonly uses the On-X aortic valve for mechanical replacements. I am fine with this, and am encouraged by the recent study results and new European guidelines for a INR of 1.5 for low-risk patients. I am sure this will follow in the US and Canada if the results in Europe are good.

A few things on my mind are....having a pacemaker and surgery, I'm sure this is common and no issue....since I already have a Dacron aortic graft, will they keep that one in there and insert the new valve, or will they use a new graft with the valve already attached (On-X makes one)....life on coumadin, everyone asks this, but I'm sure I will be able to adjust, and will have to restrict or stop ice hockey, less berrs after hockey and figure out if it will affect my work (police officer).......lot's to think about.

Any thoughts, opinions, experiences are greatly appreciated!

On another note, I can't login with Tapatalk, I thought this forum was supported.............any ideas?

Thanks,
Cam
 
Wow you do have a lot to think about! Best of luck on all of it! I just got my mechanical and have peace knowing the odds are that I shouldn't need another OHS. As far as Warfin goes, I dont see an issue with it. My INS is stable at 2.8 and all is good.
 
You've been thru this once so you know what to expect. In your shoes I might also go for the mechanical to ensure it is the last OHS ... and I may be in your shoes someday myself. I also had a valve sparing aneurysm graft. My BAV was well functioning prior to surgery a little over 1.5 years ago, leaking mildly after. Going to my Cardio on Tuesday for the results of my latest annual echo. Best wishes for you on your surgery.
 
Hi Cam,

Sorry to hear that things changed so soon. However, you sound as well prepared as can be expected and have been followed closely which is a good thing. I wonder if Dr. B will be able to answer your question as to whether you will have the graft replaced.

You have alot on your plate, but your good attitude will serve you well. Thumbs up!

On another note, congratulations on expecting your third child! I think you answered your question as to the timing of surgery "it would be awful to have 2 of us on lifting restrictions at the same time". :)

Out of curiosity, other than the Ejection Fraction, did they mention what kind of shape the aortic valve was in such as the pressure gradients?

Wishing you all the very best and please keep us posted.
 
Last edited:
Cam,
A predicament indeed. If you look at the positives...you have been through this before so you know what to expect, chances are that this will be your last OHS(assuming you go with a mechanical valve), you are young and healthy so your recovery should progress quickly, your surgeon is very good and highly regarded(the chief of surgery here in Calgary offered to send me to see him when my number comes up).

While the timing could be better, this is the time to ask for help. Family, friends, fellow officers, neighbors...enlist them all, you'll have plenty of time to give back.

Things will work out just fine.
 
That is a lot to deal with at once . As others have said it sounds like you have a lot of friends and family to support you. You wrote that you've known for 4 years, basically after your last surgery, that this day was coming. I was wondering why you were so sure of it and if the pacemaker was a result of the surgery. If I was going in for a 2nd OHS I would go mechanical hoping to avoid a 3rd. I'm going in for my first OHS on Feb 6th and I considered a mech. valve but my surgeon says my valve is in really good shape with minimal leakage so he wants to repair it. It was almost like he wouldn't even consider replacing it. I've been trying to look on the bright side, like it's a good thing they found my aneurysm (mine is 48mm) and if yours was 67mm that's pretty big especially if you're physically active and it sounds like you are.
 
It's obviously your decision, but in your shoes I would have surgery absolutely asap, and you should be virtually completely recovered before the new baby arrives. If you hold off till a couple of months after the birth you could find yourself becoming symptomatic and having a harder recovery, or your left ventricle getting worse, which would obviously be bad news. It seems an unnecessary risk which is unlikely to help with the baby, and is likely to prevent you enjoying him or her. Sternal lifting precautions are very variable: the Cleveland clinic is quite generous and says you shouldn't lift more than 20 lbs for 6-8 weeks after surgery- that seems to leave quite a bit of leeway for you! The big problems come from pushing up with your arms from a chair or bed, rather than lifting. You could explain the situation to your surgeon and ask that he wire your sternum really securely.
 
Thanks for the positive encouragement and comments.

I agree Northernlights, I am thinking as soon as I can get this done, the better. 33 EF is pretty low, and I don't know my left ventricle size yet. Don't wany any unnecessary or additional damage.

Bushman, they were going to refer you to Dr.Boodhwani from Alberta? That's crazy! i hear he is still very well respected and the best.

Ottagal, I'm not sure shape of the valve. Last year (2013) I was told after echo that valve was a bit more leaky, but heart function was the same. Not sure what that means, but the last record I recall was that the regurgitation was mild/moderate, maybe 3 years ago. I'm sure it's progressed to moderate or severe if my EF is down and left ventricle size is up.

I have a couple questions I'm hoping people can answer.....
1. Can the heart remodel after AVR for regurgitation? Most of the studies are on aortic stenosis.

2. Is there a difference between the On-x aortic valve, and the On-x 1.5? I;m assuming it is the same valve, maybe now called the 1.5 because of the new European guidelines of 1.5 INR.

3. Is anyone out there with the On-x aortic valve doing same or better than pre-AVR. After my repair I never got back to my pre-repair athletic ability.

4. Is there a max heart rate for the On-x aortic valve. Being somewhat young still (34), I can still get my HR into the 190-200's with hard exercise.

5. Is there home INR testing in Canada yet?

6. Does Tapatalk work for this site anymore? I have a new iphone and can't login on mobile.

Thanks everyone!
 
Hi Cam,

Thanks for the update. I would also want to echo Bushman's comments: " While the timing could be better, this is the time to ask for help. Family, friends, fellow officers, neighbors...enlist them all, you'll have plenty of time to give back."!

I can answer question 5. : Yes there is home INR testing in Canada. I know of other members on this forum who are Canadians and are self testing. One person that comes to mind immediately is Bina (who has contributed a ton to this forum, but I haven't seen her on it in awhile). She is a home tester. You could PM her.

Sorry that I can't be of help with the other questions as I have a tissue valve.

Continuing my most positive thoughts for you!
 
I'll answer the one thing I know about - yes, your heart can remodel after surgery. I don't think it matters what kind of repair/replacement is done, it has an amazing capacity to recover as long as there isn't too much damage.
 
Has your wife had a C-section before? I know it varies how people recover, but I thought it was a piece of cake and within a couple of days barely noticed it (it was just the heart issue that was bad). They usually say "don't lift anything heavier than your baby." I think you're right to go for your surgery now, but if you are not fully recovered, hopefully your wife will still be ok with the baby cares. And yeah call on as much help as you can with your care, the baby care and the older kids.

They're not talking about super early, premature delivery are they? In that case, baby will be in the hospital for a bit and nurses will be lifting the baby, regardless. Plus, it will be a small, light baby in that case . .
Wishing you the best as you work this out.
 
For an update to everyone, we do NOT need a C-Section, which was great relief to my wife and I. I am now scheduled for the morning slot on February 18, 2015 to have my aortic valve replaced. I donot know the condition of my valve specifically as Ottagal asked, however my family doctor said the recent test showed severely dilated left ventricle and moderate global hypokinesis. When I see the Surgeon and do my Pre-Admission tests on February 9, I am sure I will learn more.

I am hoping this will be a quick and simple re-do, with good prognosis! I know healing is a long process, and I want to get on with it!
 
Good luck with your surgery. Looks like I will have a 2nd surgery in my future as well. As mentioned, after my valve sparing aneurysm graft, my BAV started leaking. In a year it's gone from mild to moderate with a significant change to my EF and left ventricle size as well. I had also hoped to avoid or at least have much more time before needing a 2nd surgery. I wonder what it is about the aneurysm graft that makes valves suddenly start leaking so much. Have to go back to the Cardio for a follow-up MUGA test as well. Haven't yet discussed timeframe for surgery but at this rate I may only have another year or two.
 
camgough;n852288 said:
For an update to everyone, we do NOT need a C-Section, which was great relief to my wife and I. I am now scheduled for the morning slot on February 18, 2015 to have my aortic valve replaced. I donot know the condition of my valve specifically as Ottagal asked, however my family doctor said the recent test showed severely dilated left ventricle and moderate global hypokinesis. When I see the Surgeon and do my Pre-Admission tests on February 9, I am sure I will learn more.

I am hoping this will be a quick and simple re-do, with good prognosis! I know healing is a long process, and I want to get on with it!
Click to expand...


Well now you have a date and can focus on 'getting er done' so that you can move on to healing and look forward to the arrival of your third child!

Wishing you all the very best, Cam and will be interested to hear what Dr. B. has to say on Feb 9th.

Fingers and toes crossed for you. :)
 
I had my pre-surgery meeting today with Dr.Boodhwani and the pre-admission unit. I`m told that the main risk of a re-operation is the scar tissue that may be at the incision site. The plan is to go in through the same incision, but it may take a bit longer, and if there is concern then the bypass machine can be started sooner through an incision in my leg. I am a pretty thin guy, so I am hoping there is not much scar tissue.

The day before I am going to have a heart cath to check my arteries. They want to see the shape of them, and address any issues during the surgery. This will hopefully reduce the chances down the road of needing a CABG if it can be done now. They will try to cath through my wrist first, and if that does not work, my groin. Are you on aspirin or Plavix for this test? Dr. Boodhwani will discuss these results before the valve replacement.

I learned that my pacemaker will just be turned off during the AVR, and that temporary pacing wires will still be used. This is incase a lead from my permanent pacemaker becomes loose or faulty during the surgery. Nobody seems concerned that I have a pacemaker.

I was told that I have a 32 mm Dacron graft, and that the plan is the cut it, remove my BAV, size the opening and insert the new valve. I have chosen to go with the On-X Mechanical valve, and this is the valve of choice for my surgeon and hospital. His idea is that the bigger the valve the better , which reduces blood damage. He thought the 25mm would likely fit, and said that it is actually the same size as the On-X 27/29 mm, but only the sewing cuff is bigger on it.

Apparently my left ventricle has been in the severely enlarged category for a couple years, and is now 7.3 cm, which I guess is quite big. It was 6.3cm last year. He expects that overtime my heart will reverse remodel and likely (Hopefully) go back to a more normal size/ shape. This should also help increase my ejection fraction.

Overall it was a stressful day, but I think positive for the most part! I just need to keep myself healthy for the next week and hope for the best!
 
Cam - While all these things may be unsettling, at least nobody has said anything like "Ooooh, THAT's interesting!" You seem to have a very good team of specialists to take care of you, and they should be ready for anything that may happen. Just like last time -- develop your plan, then just work the plan. Do what needs to be done, when it needs to be done, and try to live your life until the next step is called for. I know it isn't easy - we've done it before. But. . . it can be done. You've proven your mettle, this one won't get you down either.

Keep us posted along the way. We're here for you.
 
Cam
A big Ditto to Steve's comments.

You are in the best of hands and although no one relishes undergoing a second surgery, it sounds like Dr. B. and the team have an excellent plan in place for you. Hope you manage to do something good for yourself leading up to your surgery day.

My wish for you is that on the day of your surgery, you walk through the hospital doors at peace and having full confidence knowing that Dr. B. and the team have your best interest at heart (pardon the pun!).

We will all be waiting to hear the good news and your progress after your surgery.
Keeping my most positive thoughts for you! :) thumbs up.
 
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