Aortic Valve Replacement and bypasses August 26 - (long)

[RobNDenver]

Good morning everyone;

I am a 56 yo man about to have valve replacement of the aortic valve. I had an echo two years ago when my PCP discovered a heart murmur. I started having symptoms of angina about two months ago on exertion (bike riding and climbing stairs while carrying suitcases in a subway). My PCP saw me and ordered another echo.

When I went back to see the cardiologist (J. McNeil in Boulder) he had reviewed the echo results and said that the opening was much narrower and that I needed an angiogram. During the angiogram he discovered two coronary arteries that were about 50% blocked, and said that the valve was seriously defective. Cardiologist said I need OHS to replace the valve and bypass the blockages.

I got a visit from the surgeon (M. Douthit) after the angio, while I was still a little woozy, and he suggested a St Jude mechanical with the bypasses and no minimally invasive valve replacement for me. He seems like he really knows what he is doing. He and his partner do hundreds of these per year between them so I have to trust his judgement. He was really happy that I dismissed a Ross procedure however, he did not want to do it.

He is having me get a CAT scan the day before the surgery so that he can assess whether he needs to rebuild my aorta. He indicated that it may be dilated, but I forgot to ask what that means.

I am a little apprehensive about the prospect of coumadin for the rest of my life. My PCP does not seem to be put off by that, but says that his experience is that most people manage just fine. I travel a lot in my job, I drink (not usually to excess) and when I am feeling better I like to exercise, hunt and golf.

Between now and next week I intend to talk with both the Cardiologist and the Surgeon. Are there questions that I need to ask that I may not be thinking about??

Thanks!!

 

[Ross]

Hi Rob, don't let ACT scare you. It's nothing like your hearing or even imagining. See the anticoag forum stickies and www.warfarinfo.com for some much needed TRUE information. Too many myths and nonsense is being spread about and were trying to change that for everyone. Perhaps at some point, you can self test and then things really are much easier. Active lifestyle forum has a bunch of coumadin users too. No reason you can't hunt and golf, so just throw that idea out of you mind.

Dilated aorta is the same as saying aneurysm. He wants to be sure you last for a good long time when he's done. He's doing you right.

Welcome to the forums or insane asylum, depends on how you look at it.

p.s. Long? Son, you haven't seen long yet evidently.

 

[Mary]

It sounds like you're ready to go, Rob. I put your date on our calendar so we can track your progress both before, during, and after replacement.
Are you having the surgery in Boulder? We've got a few members from that area that did well with their AVRs.

 

[Ross]

Are there questions that I need to ask that I may not be thinking about??

Thanks!!

See the very first post and sticky in this forum. It has some excellent questions to ask.

 

[dick0236]

Hi Rob, welcome. This is a terrafic site for info.

I have done, and still do most of the things you mentioned, golf, travel, work out, etc. Used to drink. I agree with your cardio that coumadin should not interfere with your lifestyle. It will only require you to develop a routine for INR management. Get yourself a seven day (two if you travel a lot) pillbox. It will remind you, in the beginning, of your dose. Today, it is something that I do almost automaticaly, but every so often, I need the pillbox to remind me if I have, or have not, taken the med.

I wish you a successful surgery and speedy recovery.

 

[Leah]

Hello Rob. There's no "right" answer concerning mechanical valves versus animal valves at our age (I'm 57 and will have valve replacement next month). There are definite trade-offs between lifelong anticoagulation with a mechanical valve versus the serious possibility (or expectation) of a second valve replacement surgery with an animal valve. Either choice is life-saving. The threads in the valve selection forum - including the Tobagotwo "sticky" - summarize many of the issues. The anticoagulation and self-monitoring forums also have good information on people's real-world experiences with coumadin. This is a very personal choice. Good luck!
Leah

 

[skeptic49]

Between now and next week I intend to talk with both the Cardiologist and the Surgeon. Are there questions that I need to ask that I may not be thinking about??

Hi Rob and welcome to this great forum. I'm new here myself but you'll find lots of great info and some very supportive people.

I would suggest that you give some thought to the tradeoffs between mechanical and tissue valves, read up as much as you can, and be prepared to discuss this with your surgeon. ACT (anti coagulation therapy) is not the big problem that some would have us believe, as you will find out here. On the other hand, there have been significant advances made in tissue valves that can be considered when making the choice. Why did your surgeon suggest the mechanical valve over a tisssue valve? It would be interesting to know his reasoning.

Again. welcome, and great to have you aboard.

Cheers,

Jim

 

[Cooker]

Hi Rob ... as others have said ... don't let ACT freak you out ... after 2.5 years I am still stable and never had an issue with it. Wishing you a successful surgery and a smooth recovery??Godspeed.

 

[ALCapshaw2]

The fact that your surgeon wants a CT scan to check for aneurism(s) of your aorta tells me that he is being VERY THOROUGH and wants to know about EVERY possibility before he opens you up. HORRAY for him!

Since he is recommending a mechanical valve, you may also want to look over the advancements offered by the relatively new (1996) On-X Valves. See www.heartvalvechoice.com and www.onxvalves.com On-X is approaching 70,000 valves implanted in 60? countries with a good track record.

Also see the thread "On-X valve question" or something close to that title in the Valve Selection Forum.

Finally, as Ross suggested, read the "stickys" at the top of the Anti-Coagulation Forum, browse around that forum to see how those of us on Coumadin live with / on anticoagulation. Al Lodwick's website www.warfarinfo.com is an EXCELLENT source of current and accurate information on anticoagulation. He is a Registered Pharmacist and Certified AntiCoagulation Care Provider who lectures and has written a book on the subject.

It sounds like you will be well prepared for your surgery.

Feel free to ask any questions as the come to your mind.

'AL Capshaw'

FWIW, when/if I go in for another VR surgery, my first choice is On-X with the St. Jude Masters Series as my 'backup plan' in case there is a problem with using the On-X. It is ALWAYS a good idea to have a Plan B "just in case".

 

[Phyllis]

All great advice so far, Rob. I just want to add my welcome and let you know that we are all here for any questions that may come up between now and surgery.

 

[Ana]

Hi Rob and welcome.

My husband (who is 58) had the same team of cardiologist and surgeon for his heart surgery this past Spring. I am head over heals enamored of them, the staff at Rocky Mtn. Cardiology and the Boulder Community Hospital CICU and CCU nurses. We were blindsided when my husband's condition was diagnosed and from that first day until his surgery was a very short (and oh so long) 10 days. He had little time to make decisions and have tests done, choose a valve, yada yada yada and I believe we could not have had any better care or compassion from all involved.

I don't know what else to say except that McNeil and Douthit were so damn skilled (Douthit trained under Debakey) and conscientious that I would never hesitate to recommend them to anyone.

As others have said, there are some wonderful threads in here regarding questions one should ask. Write them down and bring the paper with you and mark down the answers next to the question - you will forget a lot during this time, as it's rather stressful.

Good luck, if you need someone to discuss this with, please feel free to send me a private msg and I will give you his email address.

Take care and again, welcome.

 

[WayneGM]

Welcome to VR. You've come to the right place. Best wishes for a successful surgery and smooth recovery.

 

[Lauren's_Dad]

Guess we have something in common...

Guess we have something in common...

Welcome Rob. I am also having valve replacement surgery on August 26, and like you, won't be able to have a minimally invasive procedure due to a dilated aorta.

As others have suggested, make sure to have a list of questions ready for both the surgeon and the cardiologist, and don't let them leave until you have every answer you need.

And keep asking questions to these great people as they come up. They have been instrumental in helping me come to terms with this difficult time.

Best of luck to you Rob.

Jason

 

[hall]

Welcome Rob. Sounds like you have a lot of faith in you doctor and that helps a lot. Good luck and keep us posted.

 

[Alistair]

Just wanted to send you a welcome. I am 10 years younger than you at age 46. I opted for the mechanical (St. Jude) valve on the advice of my Surgeon. I believe it was the right choice for me with very little chance of needed re-op. My surgery was 8.8.08 and today I feel great. I had much the same symptoms as you of angina. And while I am hardly athletic, I am far from sedentary.

I don't foresee any drastic changes in my lifestyle nor were any suggested by my Doctors. Having my blood tested frequently to coincide with coumadin usage is a small trade off for a continued quality of life.

Best of luck to you,
-Alistair

 

[Dawn-Marie]

Hi Rob and welcome to VR. Like the others said, there are pros and cons to both types of valves. Just do all the research you can and get your doctor's input about what he thinks is best for you based on your tests. Wishing you a successful surgery and a smooth recovery.

 

[RobNDenver]

Thanks everyone for your support and great information!!

I have done a fair amount of research after finding this site and think that I am ready to go next week. I am getting a colonoscopy done today, just so I won't have to do that after I have been on ACT. I have not done much research on the valve choices, after I asked my surgeon why he selected the St. Jude Mechanical and he told me that he was most comfortable with its functionality and longevity, given my physiology (size, activity level, interests, etc). So I am going to accept his professional judgement and this forum's assurances that I will be able to manage the Coumadin after I have the valve replacement. . .

The beat goes on!!

 

[Ross]

ACT is always fun at first. If you have problems with range or anything, come see us in the anticoag forum.

Big thing is to remember: Dose the diet that you NORMALLY eat, don't diet the dose of Coumadin your on. This includes green veggies, salads, etc. Your bound to hear a lot of boloney. All new persons do! Please come see us.

 

[DebbyA]

Welcome Rob!

I bet Ana's post made you feel good. The only thing I have to add about the surgeon consultation is to take someone else if you can. My husband took notes, and even though I had my own notebook, I can't believe how many times I've asked him for items from his notes. This is actually true for all medical appointments until at least a month after your surgery--even if you start driving early.
Even though I didn't get a mechanical valve, I used the same decision path as you: ask the surgeon and go with it, and haven't had second thoughts.

Best wishes,
Debby