Aortic Valve Stenosis for my healthy 88 yr old Mom

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B

bfukuba

Wanted to get some feedback on this procedure Dr. Bob Hu at the Palo Alto Medical Foundation (any feedback on this physician?) thinks should be done on my Mom. She is extremely healthy for her age, but has had episodes of dizziness recently (about three months). She's diabetic, but controls it completely through her diet. Up until three months ago, she has been extremely energetic, healthy, lived on her own, and acts years younger than her actual age. These past three months, she has started to pace herself because of the dizziness.
Since all of this is new to me, I'm wondering what questions I should ask both the doctor and my Mom. Her thoughts are that she'll probably have 5-10 yrs, and if she could last without the surgery and have a comfortable life, that would be preferred. If the Aortic Valve replacement will give back her energy levels, she might consider the procedure. I realize that this is very sketchy information, but I'm wondering about the pros and cons of an Aortic Valve replacement for an otherwise healthy 88 year old woman.

Thanks for any feedback.

Brian
 
Hi Brian and welcome. To really give you an answer, we'd need to know more. Has she had any heart testing done and if so, can you post some of the results?
 
Welcome Brian,

Valve Replacement Surgery has been done successfully on elderly patients. One of the pioneers in Heart Surgery had his own procedure performed on him in his 90's and lived several more years after. (I've forgotten his name ...)

The 'usual tests' include an Echocardiogram of the heart along with an angiogram (heart catheterization to assess the coronary arteries and valves). A TransEsophageal Echocardiogram (TEE) may also be requested if greater detail is needed in viewing the valves. Be sure to get copies of ALL of her Test Results, including Lab Work. We can help you interpret the numbers and significance if needed.

One of our members, Marty (an MD/Radiologist) had Aortic Valve Replacement in his 70's and is still working half-time when he isn't playing golf.

You will probably want to go to a High Risk Surgeon who has experience dealing with more elderly patients. Dr. Craig Miller at Stanford and Dr. Laks at UCLA in Los Angeles come to mind as some of the better West Coast surgeons.

Minimally invasive techniques (and even robotic surgery) may be interesting options to minimize the trauma of cutting the sternum and subsequent rehabilitation.

At your mother's advanced age, using a Tissue Valve would seem to be the ideal replacement and avoids the requirement for anticoagulation therapy with mechanical valves with it's increased risk of bleeding events in the elderly. The Bovine Pericardial Tissue Valves have the greatest longevity, especially in patients over age 65.

'AL Capshaw'
 
Brian,
I have no direct knowledge, only an anecdote. A radiologist I saw just before my AVR told me her 84-yr-old aunt had recently had the surgery and was doing very well.
You might ask the doctors about the implications of diabetes added to age for recovery. As to quality of life, consider that the course of stenosis once symptoms appear is continued decline, so it's not even that she would continue at the current level without treatment. These are only opinions, I have no medical standing.
Best wishes in reaching a solution you are both at peace with.
 
One of the men on my ward in hospital when I had my AVR a few weeks ago was 84, he had surgery the same day as me and was up and about and helping me and the others with simple tasks the following day ! He was amazing ! He had a bovine aortic valve implanted very cleverly from his groin, up his femeral artery ! Apart from being a little sore down there he was right as rain and even went home smiling a day earlier than me ! He didn't seem too bothered about having it done again at 100 either !?
 
Hello!

Hello!

Hi Brian,

I go to Palo Alto Medical Foundation. My cardiologist is Dr. Lissin,
in the same office and Dr. Hu. Dr. Hu did my TEE, and Dr. Lissin and him
work together. He looked at all my ECHO results as well. I liked him. He
seems to be very well respected, and I would not have any reason to
doubt his recommendation of surgery. However, when it comes to
surgery, I would advise always to go for a second opinion. I am not very
knowledgeable about the aortic valve, an options without involving
surgery, some other folks can comment on that. I can only say that a
TEE (trans espphaegal echo cardiogram, through a tube in your throat)
gives you a more accurate picture of the state of the valve and maybe
you should request that, if it hasn't been done already.

I would be interested in knowing which surgeon they are refering her to.
You can ask them about surgeons who can do a minimally invasive
procedure. As far as I know, the surgeons at Stanford (well, I only
know of Dr. Craig Miller) are not doing it. Since I haven't done any
surgeon consults yet, I don't know.

I think a lot of elderly patients go through OHS. Here is an inspiring story

ttp://www.heart-valve-surgery.com/heart-surgery-blog/2008/09/16/mitral-valve-repair-video/

All the best, keep us posted, and glad to see another bay area VR
member.

Nupur
 
Everyone,
Thanks so much for your replies!! It is greatly appreciated, as this diagnosis was a surprise to the family, and we weren't quite sure how to gather information on the process.

My mom did call her primary at the PAMF, and they are in the process of mailing her all the test results. Once I get that, I'll post the details with any questions we may have.

Again, thanks for the warm welcome and replies!

Brian
 
IF she is interested MAYBE she would be a candidate for aortic valve replacement by a cath instead of open heart. (or PERCUTANEOUS Aortic Valve Replacement). I believe Stanford and Cedars are both doing the trials. I had the trial contact info somewhere, if you are interested I'll look for it. I'm not sure if she would be a candidate, but it might be worth looking into.
 
Sorry don't have any answers but just wanted to wish you all the best for your mum.
 
Valvuloplasty

Valvuloplasty

Hi Brian, I wanted to mention that another bay area VR member had a procedure called valvuloplasty at Stanford, which is via a catheter I believe and tries to open up the valve. If you search the forum for "valvuloplasty", you should be able to find it. That's something you should consider, and ask Dr Hu.

If you need more details, please let me know and I can contact the other member for name of the surgeon and so on. Or you can PM her.

Good luck,
 
Ross, and all who have posted, thanks so much for your replies. You have given us a lot to digest and consider. We have gotten the test results which I will try to attach to this reply.
 
Brian,

Your mom's Aortic Gradient of 30 mmHg is a bit higher than normal. Her Aortic Valve Area of 0.8 sq. cm equals the 'trigger' number used by many Cardiologists and Surgeons for recommending Aortic Valve Replacement.

It's probably time to start interviewing Surgeons.

My *guess* is that they will not recommend Mitral Valve Replacement because none of the indicators are severe. Some of the Mitral Valve issues may even lessen after the defective aortic valve is replaced. The surgeon will be able to determine this while she is still 'open' and can make a final determination 'on the spot'.

As I mentioned previously, a Bovine Pericardial Tissue Valve would seem to be the ideal replacement valve for her. Those valves typically last around 20 years when placed in patients over age 65 and it avoids the automatic requirement for anticoagulation therapy with Coumadin / generic Warfarin.

'AL Capshaw'
 
Al,

Thanks for your reply. My mom is going to get a second opinion from her previous Cardiologist, but based on your post as well as other investigations I've done, we will start the process of finding our options with Surgeons as it does appear that surgery would be prudent at this time. We will also take your advice and query about High risk surgeons who deal with elderly patients. I believe my Mom mentioned that Dr. Hu did suggest a Bovine valve would be best in her case.

Thanks again!

Brian
 
Last edited:
An Update.
Thanks much everyone for all the great information. After much thought, and discussion with her primary care physician, my Mom has opted out of surgery at this time. Her symptoms have not been debilitating, she is able to get out on her own, she gardens goes shopping, etc. So we will continue to monitor her, but at this point, she has decided against surgery. This was a quality of life decision that she made.
I feel so fortunate to have found this site and received so much information so quickly. Thanks everyone for your contributions.
 

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