2nd AVR Surgery, does the criteria change?

[rcatalano]

Hello,

I had AVR surgery 14 years ago at the age of 31. I had a homograft and have been very happy with the results. At the time, I was told they didn't really know how long it would last, but was estimated between 8-10 years.

I don't know yet that I need another surgery. An EKG last week shows my heart is working significantly harder than past exams. I go for an echo and stress test at the end of the month.

My question, finally, concerns valve selection the second time around. Since I already have a homograft, am I in any way limited in my selection the second time around? I have not had this discussion yet with my doctor and haven't given it much thought the past 14 years.

I've been happy with the homograft since it has let me live a normal life (if you don't count forcing me to retire from the Navy with 30% permanent disability, but thats a story for another time).

Thanks in advance for anyone's experience or insight on the return trip to the operating room.

Rob Catalano

 

[Ross]

Hello Rob and welcome to our humble abode

As far as I know, you should still have all your choices in place. It'll depend largely on how much of a root and such is left to work with. I guess the best answer would be to discuss it with the surgeon.

Are you thinking of going homograft again? I only ask because I can't picture anyone wanting to go through more surgeries 10 or 15 years down the road. I had a rough time with both of mine, so I'm quite gunshy at the thoughts.

 

[Nancy]

Hi Rob-

Welcome to the site. You will find lots of info here, and there are many people who have more than one surgery. I'm sure they will be along soon to give you their thoughts on the situation as well.

My husband has had 3 valve surgeries, and each subsequent surgery has been more and more difficult. As the body ages with additional surgeries, you just don't bounce back as well or as fast. There is a lot of scar tissue and adhesion build-up which makes things harder to do.

It is an important question to ask your surgeon. It might depend a great deal on the conditions that are present at the time you will be faced with surgery. I think that sparing yourself a third surgery will weigh heavily in the decision which is made.

I hope you will take this opportunity to read many of the posts on this vast site. There is a tremendous information here.

 

[rcatalano]

Thank you for your replies. I'm actually considering another homograft, but again, I haven't given it all that much thought. I've been exploring this site, really could have used it 14 years ago!

I was going to ask about minimally invasive surgery and robotic surgery, but it appears those have been addressed in detail previously.

I guess it really is a question that will have to wait until I've been evaluated by a surgeon. Then I will have the options based on my condition. I may not need the surgery just yet, but I know it can't be that far away.

My decision to get a homograft was based on the idea I wanted to continue on active duty in the Navy. My navy cardiologists and surgeons didn't see a problem, only saying that an artificial valve that required coumadin would require me to retire. However, the decision wasn't up to the doctors, it was more an administrative one. I was 30% disabled no matter how successful the surgery, regardless of what the doctors said. I do believe this has changed over time.

I'm sure my recovery from surgery at 31 years old would be much easier than at 45, 60, 75 etc... I get the not so pretty picture.

Thanks for all your help.

Rob

 

[Ross]

Rob some people can go through it time and time again without a whole lot of trouble. I was 33 when I had my first and 40 on this last round. Neither one went well. It all depends I suppose, on how well you tolerate surgery. Definately check with the surgeon on what he'd consider using, but I think if you went with another homograft, it shouldn't be a problem. I might be wrong. Wouldn't be the first time.

Pardon my morning typing. I don't make alot of sense without a few loads of coffee.

 

[Gail in Ca]

Rob,
When my porcine valve failed, my Dr recommended a mechanical as they really want to avoid a third surgery, so that's what I got.
I do miss the tissue valve and no coumadin then.
You just have to discuss this with your doctor, as I'm not sure about redo's with homografts vs. redos from porcine.
I think any redo is more complicated,( scar tissue).
Gail

 

[Kevin M]

I had a homograft for my first replacement and opted for a stentless porcine valve this time.

My doctor sort of pushed me that way and since the homograft only lasted 10 years, I went along with it.

I've been happy with it so far. Same as a homograft, except I had a dialated aorta, so they needed to throw some dacron in there. I've noticed that I didn't spring back as nicely as the first one, but my first procedure was when I was 23 years old and the body recuperates pretty easily when you're that young.

Rob, I cannot tell you whether or not they can put another homograft in, but my doctor advised against it. Like I said before though, I think he was pushing me into the stentless, so your advisors may tell you differently.

The key is that unless there are complications, I can tell you it is definitely possible to get another biological valve.

I think the next time around I will opt for a mechanical. Two is enough, but now that I face a third when I'm in my late 40's-early 50's, I don't think I'll feel up to risking a fourth.

The more ops you have, the more scar tissue they need to mess with and that means spending a lot more time under the knife and a more complex surgery.

Good luck with your decision. It's nice to hear of others that have been happy with homografts. There do not seem to be many of us that have had them for more than a few years. 14 years is a good run.

Keep well,
Kev