Saw Cardiologist today

[dl_mooney]

Been waiting for this.Saw Cardiologist today.Had EKG before Dr. visit. He came in and asked about my breathing, told him it was much more worse,also have it when sitting & also in bed.Hes been following me closely.He said Mitral Valve needed to be replaced/repaired. So he is referring me to a Heart Surgeon. At this time dont know witch Dr. or Hospital yet.

 

[Ross]

Keep us posted. I haven't got to read all your posts. Is it your heart problem causing the breathing issues?

 

[ALCapshaw2]

You have two Big Decisions to make before your Mitral Valve Surgery.

1 - Do you want a Mechanical Valve or Tissue Valve?
See the Sticky's at the Top of the Listing of Threads in the Valve Selection Forum for the 'Basics' in Valve choice.

2 - What Surgeon do you want to use. This decision can depend on what Valve you want as your First Choice (be sure to have a Plan B, "just in case" Plan A is not viable).
Note that Not All Surgeons use / are familiar with ALL of the available Valve Options.

If you are inclined to opt for a Mechanical Valve, I recommend studying the Technological Improvements available in the On-X Valves. See www.heartvalvechoice.com and www.onxvalves.com for details. These valves have been optimized to minimize the 'downsides' found in earlier designs. On-X can advise you which surgeons in California have used their valves.

'AL Capshaw'

 

[dl_mooney]

Ross,Yes my shortness of breath is because of my Heart problem.TEE Mitral Valve,Moderate _ severe. Do want the OnX valve,Been thinking about going directly to replacement,dont want to have my Valve repaired & have it go bad again. Want one surgery. Thanks

 

[Lynlw]

Do you know why your valve needs replaced/repaired? I Think that plays a part in wether the chances of repair is pretty succesful. I'm not an expert but Dengenerative disease, seems to do better with repairs than replacements from most things i've read and have better mortality rates than replacement. Of course having a surgeron that is good in repairs and knows when it is best to repair or replace the mitral valve plays a huge part.
Have you decided/thought about where/who you would pick to do your surgery?

 

[ALCapshaw2]

Do you know why your valve needs replaced/repaired? I Think that plays a part in wether the chances of repair is pretty succesful. I'm not an expert but Dengenerative disease, seems to do better with repairs than replacements from most things i've read and have better mortality rates than replacement. Of course having a surgeron that is good in repairs and knows when it is best to repair or replace the mitral valve plays a huge part.
Have you decided/thought about where/who you would pick to do your surgery?

This seems 'backwards' to me, i.e. the part about a Higher Mortality Rate with Replacement vs. Repair.

Repairs are notorious for Short 'Lifetimes' (of the repair, not the patient).

There are Very Few Deaths following Replacement.

What am I missing here?

 

[Lynlw]

This seems 'backwards' to me, i.e. the part about a Higher Mortality Rate with Replacement vs. Repair.

Repairs are notorious for Short 'Lifetimes' (of the repair, not the patient).

There are Very Few Deaths following Replacement.

What am I missing here?

If you read the more recent PUBmed articles on mitral valve repairs/replace stats, for degenerative valves almost every study shows the same thing here are a couple, the first is based on over 900 hospitals (sometimes my pubmed links do work) and is pretty new (may 09)
http://www.ncbi.nlm.nih.gov/pubmed/...nel.Pubmed_DefaultReportPanel.Pubmed_RVDocSum
BACKGROUND: The purpose of this study is to examine trends in mitral valve (MV) repair and replacement surgery using The Society of Thoracic Surgeons Adult Cardiac Surgery Database (STS ACSD). METHODS: The study population included isolated mitral valve operations performed between January 2000 and December 2007 at 910 hospitals participating in the STS ACSD. Patients with endocarditis, prior cardiac operation, shock, emergency operation, and concomitant coronary artery bypass graft or aortic valve surgery were excluded. RESULTS: During the 8-year study period, 58,370 patients underwent isolated primary MV operations. For patients with isolated mitral regurgitation (n = 47,126), the rate of MV repair (versus replacement) increased from 51% to 69% (p < 0.0001). Among patients having replacement (n = 24,404), there has been a pronounced decline in the use of mechanical valves: 68% to 37% (p < 0.0001). The operative mortality for MV replacement was consistently higher than that for repair (3.8% versus 1.4%), a finding that persisted after risk-adjustment (adjusted odds ratio 0.52, 95% confidence interval: 0.45 to 0.59; p < 0.0001). Among patients having elective isolated MV repair (n = 28,140), the operative mortality was 1.2%. For asymptomatic (class I) patients, operative mortality was 0.6%. CONCLUSIONS: This study documents several important trends in MV surgery, including the progressive adoption of mitral valve repair and increasing use of bioprosthetic replacement valves. Operative risks of MV repair are significantly lower than those for MV replacement. Operative mortality for isolated elective mitral valve repair is 1% in contemporary clinical practice.
(here is one from cleveland in 06)
http://www.ncbi.nlm.nih.gov/pubmed/...nel.Pubmed_DefaultReportPanel.Pubmed_RVDocSum
OBJECTIVE: The study objective was to identify characteristics differentiating patients undergoing valve replacement versus valve repair for degenerative mitral valve disease and to use this information to compare survival and reoperation after each procedure. METHODS: From 1985 to 2005, 3286 patients underwent isolated primary operation for degenerative mitral valve disease. Valve repair was performed in 3051 patients (93%), and valve replacement was performed in 235 patients (7.2%). A propensity model and score developed for fair comparison of outcomes yielded 195 matched pairs. RESULTS: Patients undergoing replacement were older (70 +/- 12 years vs 57 +/- 13 years) and had more complex valvar pathology, symptoms, and left ventricular dysfunction. Thus, the characteristics of the propensity-matched patients undergoing repair more resembled those of the patients undergoing replacement (older, complex valvar pathology) than patients undergoing typical repair. Eight patients died in the hospital (0.26%) after repair and 5 patients (2.1%) died after replacement (P = .001). Unadjusted survival at 5, 10, and 15 years was 95%, 87%, and 68% after repair and 80%, 60%, and 44% after replacement, respectively (P < .0001); however, among propensity-matched patients, survival was similar (P = .8): 86% versus 83% at 5 years, 63% versus 62% at 10 years, and 43% versus 48% at 15 years. Freedom from reoperation among propensity-matched patients was 94% at 5 and 10 years after repair and 95% and 92% at 5 and 10 years after replacement, respectively (P = .6). CONCLUSION: It is reasonable to perform valve repair in elderly patients with complex degenerative mitral valve pathology because it can eliminate the need for anticoagulation and risk of prosthesis-related complications. However, when valve pathology is so complex that repair is infeasible, this study demonstrates that valve replacement does not diminish long-term outcomes.

http://www.ncbi.nlm.nih.gov/pubmed/16502272?ordinalpos=1&itool=EntrezSystem2.PEntrez.Pubmed.Pubmed_ResultsPanel.Pubmed_DiscoveryPanel.Pubmed_Discovery_RA&linkpos=5&log$=relatedreviews&logdbfrom=pubmed


quite a few say something like "Mitral valve repair (MVR) is the golden standard for the surgical treatment of mitral valve regurgitation and is superior to mitral valve replacement in terms of perioperative and long-term morbidity and mortality. "

 

[ALCapshaw2]

Interesting and enlightening...

I did notice that they *excluded* re-do's
and multiple OHS patients from the study.

For second and third (or more) timers,
I'd stick with Replacement in the hope
that this would the the Last OHS needed.

 

[Lynlw]

sorry to hijack the thread, but here is an interesting 20 year results on repair (it's from 2001, but I haven't senen a more recent one) http://www.ncbi.nlm.nih.gov/pubmed/11568021?ordinalpos=1&itool=EntrezSystem2.PEntrez.Pubmed.Pubmed_ResultsPanel.Pubmed_DiscoveryPanel.Pubmed_Discovery_RA&linkpos=3&log$=relatedarticles&logdbfrom=pubmed
Very long-term results (more than 20 years) of valve repair with carpentier's techniques in nonrheumatic mitral valve insufficiency.Braunberger E, Deloche A, Berrebi A, Abdallah F, Celestin JA, Meimoun P, Chatellier G, Chauvaud S, Fabiani JN, Carpentier A.
Departments of Cardiovascular Surgery, HEGP and Broussai's Hospital, Paris, France. [email protected]

BACKGROUND: Mitral valve repair is considered the gold standard in surgery of degenerative mitral valve insufficiency (MVI), but the long-term results (>20 years) are unknown. METHODS AND RESULTS: We reviewed the first 162 consecutive patients who underwent mitral valve repair between 1970 and 1984 for MVI due to nonrheumatic disease. The cause of MVI was degenerative in 146 patients (90%) and bacterial endocarditis in 16 patients (10%). MVI was isolated or, in 18 cases, associated with tricuspid insufficiency. The mean age of the 162 patients (104 men and 58 women) was 56+/-10 years (age range 22 to 77 years). New York Heart Association functional class was I, II, III, and IV in 2%, 39%, 52%, and 7% of patients, respectively. The mean cardiothoracic ratio was 0.58+/-0.07 (0.4 to 0.8), and 72 (45%) patients had atrial fibrillation. Valve analysis showed that the main mechanism of MVI was type II Carpentier's functional classification in 152 patients. The leaflet prolapse involved the posterior leaflet in 93 patients, the anterior leaflet in 28 patients, and both leaflets in 31 patients. Surgical technique included a Carpentier's ring annuloplasty in all cases, a valve resection in 126 patients, and shortening or transposition of chordae in 49 patients. During the first postoperative month, there were 3 deaths (1.9%) and 3 reoperations (2 valve replacements and 1 repeat repair [1.9%]). Six patients were lost to follow-up. The remaining 151 patients with mitral valve repair were followed during a median of 17 years (range 1 to 29 years; 2273 patient-years). The 20-year Kaplan-Meier survival rate was 48% (95% CI 40% to 57%), which is similar to the survival rate for a normal population with the same age structure. The 20-year rates were 19.3% (95% CI 11% to 27%) for cardiac death and 26% (95% CI 17% to 35%) for cardiac morbidity/mortality (including death from a cardiac cause, stroke, and reoperation). During the 20 years of follow-up, 7 patients were underwent surgery at 3, 7, 7, 8, 8, 10, or 12 years after the initial operation. Valve replacement was carried out in 5 patients, and repeat repair was carried out in 2 patients. At the end of the study, 65 patients remained alive (median follow-up 19 years). Their median age was 76 years (age range 41 to 95 years). All except 1 were in New York Heart Association functional class I/II. CONCLUSIONS: Mitral valve repair using Carpentier's technique in patients with nonrheumatic MVI provides excellent long-term results with a mortality rate similar to that of the general population and a very low incidence of reoperation.