age related risk for valve replacement

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S

singsong

My husband, aged 90, has been told that valve replacement is going to be the only real answer to his problem. He has diabetes which is well controlled with Lantus insulin, has been in atrial fibrillation on and off for about 10 years, and now has congestive failure. He is in remarkable condition for his age in every other way. Strong mentally, and still tries to be productive. He is surrounded with young people which has made it possible for him to continue doing what he loves best in life. He has an intractable pleurisy right now which seems to have weakened him a lot over the last six months. Does it seem prudent to pursue valve replacement as soon as possible for him with these risk factors present? Given his age, is it important to go to a large cardiac hospital?
 
I can't really answer your questions, but welcome.

At his age, he is probably looking at a tissue valve. These are done in hospitals all over the world - both large and small facilities. My opinion is that you find a surgeon who is an expert at what he does, and the facility isn't as important. However, that's not to say the facility isn't important at all because the nurses & other healthcare providers doing the follow-up care can certainly impact recovery. I wouldn't go to a rural or community hospital, where the nurses aren't as familiar with heart valve patients. They will likely lump him into the category of bypass patients, which is a very different surgery.

Good Luck!
 
My surgeon said his oldest valve replacement patient was 89 years old so I don't think age is a concern as much as overall fitness and health. Sounds like your husband is in very good shape in that respect. My advice given his age would be to go to one of the larger heart hospitals as they will be able to offer the best possible care. And of course I would want a very experienced surgeon, even if the procedure is fairly vanilla, given your husbands age I would think you would want someone with alot of expertise.
 
I certainly understand your concerns and questions. I can only provide some information based on my experience with my mother last year. My mother was two months shy of her 80th birthday last November when she had her mitral valve replaced, her tricuspid valve repaired, and a MAZE procedure performed to address her atrial fib. Although she came through the surgery just fine, her recovery period was difficult, and she had a couple of complications after surgery that were addressed (she needed a pacemaker and she needed to have fluid drained from around her heart). By March 2008, however, she was feeling pretty good.

Recently, she has experienced some additional skipped beats and other symptoms, and she learned that some scar tissue has formed on a portion of the pericardial sac that surrounds her heart. Her cardiologist adjusted her meds, and she seems to be responding pretty well at this time.

I would strongly recommend that you consult with a top surgeon who has a lot of experience performing the type of surgery your husband needs on elderly patients. I would strongly recommend you go to a top facility as well. My mother's surgeon was Dr. Patrick McCarthy at Northwestern Memorial Hospital in Chicago. He had indicated that he had performed many procedures on elderly patients, which was one of the reasons we selected him. I think you need to understand the risks associated with the surgery, the likelihood of success, and whether it will improve your husband's quality of life and/or extend his life.

I wish and your husband the best of luck with your decision.
 
To Singsong....you have raised some very uncomfortable questions.

1. age related risk for valve replacement ? There is significant risk in any major surgery at an older age. The risk in heart surgery is both the surgery itself and the added age risks following the surgery.

2. Is it prudent given other risk factors ? This is a question that everybody involved needs to consider carefully. I would get as much professional (medical and aftercare) input as I could. At some point, the quality of life needs to be weighed against quantity of life.

3. Should a large cardiac center be involved ? I believe so. I would want a very experienced surgical team involved if things don't go as planned.
 
The pleurisy is very concerning for someone contemplating thoracic surgery.

I would be looking at the transcatheter trials going on, to see if I could find a place in one. These are valves that are usually inserted with a cardiac catheter thorugh a leg, arm, or neck vein, then opened up in place.

Did they say that the valve would allieviate the congestive heart failure?

Best wishes,
 
Dr. Debakey, a famous Heart Surgeon who pioneered many heart surgery procedures required surgery in his 90's, using a technique he developed.

Do a Search (see the Blue Line at the top of the page) and type in keyword "Debakey" to find links to posts with more details of his story and surgery.
 
thanks!

thanks!

Thank you all for caring enough to reply. You were all very helpful. I did follow up on your suggestion about the clinical trials for transcatheter placement and will wait to hear back from the University of Washington trial. Great suggestion, as I was having trouble locating information about availability of less invasive procedures. Best to all.




:)
My husband, aged 90, has been told that valve replacement is going to be the only real answer to his problem. He has diabetes which is well controlled with Lantus insulin, has been in atrial fibrillation on and off for about 10 years, and now has congestive failure. He is in remarkable condition for his age in every other way. Strong mentally, and still tries to be productive. He is surrounded with young people which has made it possible for him to continue doing what he loves best in life. He has an intractable pleurisy right now which seems to have weakened him a lot over the last six months. Does it seem prudent to pursue valve replacement as soon as possible for him with these risk factors present? Given his age, is it important to go to a large cardiac hospital?
 
This is certainly a tough one for both your husband and yourself as well.
Both of you will be in our thoughts and prayers.
At my hospital here in Michigan the chief of cardiology did the first successful valve replacement via the catheter in this country.
I have had the pleasure of meeting this patient and he is still doing well.
He was in his very late seventies at that time. He went back to work three days after the replacement!
I hope this gives you some hope for your husband.
Rich
 

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