AVR #2 Update (Hockey Heart)

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I had posted previously about my husband needing a second AVR surgery and Dr. McCarthy at Northwestern recommending a TAVR. After, testing and having the surgery scheduled, the team at Northwestern decided he is not a candidate for TAVR due to his anatomy, specifically the height of his left ventricle. Currently his velocity is 4.5, and Northwestern is pushing to have the mechanical valve surgery on April 8. As I stated previously, Dr. McCarthy did my husband’s first surgery and the recovery was uneventful. My husband played professional hockey in the minor leagues and the first time around McCarthy suggested a bio valve with the hopes of his continued hockey play and other lifestyle reasons.

This time around we have been less than impressed with the team and the suggestions we have received. We also met with Dr. Jonathon Somers from North Shore Hospitals. His opinion is my husband can put his work affairs in order and have the surgery the week after Easter. He is recommending a mechanical valve as well. We liked Dr. Somers and if he did the surgery he would be doing it from start to finish. At Northwestern, there is a good chance residents/fellows would be involved. Dr. Somers uses titanium plates as well as wiring to close. Dr. McCarthy uses wire. However, Northwestern is a top rated hospital for cardiology and obviously has a wealth of experience. So my question now is would you select McCarthy again just on Northwestern name and fact he did the first surgery or would you go with Dr. Somers who has provided us much more information and is more accessible. Any insight would be great. Thank you.
 

ottagal

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Thanks for the update on your husband and I wish you both all the very best going forward. In my humble opinion, I would want to know who has the best track record and experience on a REDO AVR. Also, listen to your gut as to what makes the most sense to you and your husband and what will give you the best peace of mind. Take care,
 

pellicle

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Hi

firstly I'd agree with Ottagal above, I think picking heart surgeon based on their "vibe" is fraught with problems. Surgeon personality or bed side manner is not relevant, his or her performance as a surgeon (results) and experience with redo surgery is primarily what you are interested (I doubt he'll be over for dinner much or having beers in the back yard ... so you're not picking a friend, your picking a professional.

Being an Australian I don't know your system well, but tom in MO has previously published links to hospitals and evaluations of surgeons which would be a good place to start.


Guest;n886949 said:
...My husband played professional hockey in the minor leagues and the first time around McCarthy suggested a bio valve with the hopes of his continued hockey play and other lifestyle reasons.
which I'm sure was a sensible call at that time in the situation you were in. I've never faced those choices but my second OHS was my AVR which was when I was 28 and I got a homograft (I simply followed the surgeons advice as he'd been my surgeon since I was 10 and did my first repair).

However I'm encouraged to read that others who are professional in the area are now on this occasion recommending a mechanical for the redo ...

e also met with Dr. Jonathon Somers from North Shore Hospitals. His opinion is my husband can put his work affairs in order and have the surgery the week after Easter. He is recommending a mechanical valve as well. We liked Dr. Somers and if he did the surgery he would be doing it from start to finish. At Northwestern, there is a good chance residents/fellows would be involved. Dr. Somers uses titanium plates as well as wiring to close. Dr. McCarthy uses wire. However, Northwestern is a top rated hospital for cardiology and obviously has a wealth of experience. So my question now is would you select McCarthy again just on Northwestern name and fact he did the first surgery or would you go with Dr. Somers who has provided us much more information and is more accessible. Any insight would be great. Thank you.
I have no idea (and really what is your basis) of knowing if one hospital is better than another, I strongly suggest you pick based on results not (puffs chess and polishes fingernails) prestige.

As to wires vs plates I'm not sure there is much in it, although my surgeon on my 3rd OHS is renoun for using an extra blanket stitch at the high pressure point because he is concerned with dehisence (look that up) and sternal mobility after surgery (also a very bad thing). Plates are new so have less history but I believe that its likely with his build and activity that wire removal in the first or second year post surgery will be desired by him. I had my top two taken out in my late 20's (due to martial arts causing sternal flexing and it is a flexible bone by nature) and again in my last OHS due to infection.

The top two are gone now, but you can see what I mean about the blanket stitch



the valve is visible (just) in the left side as only the slim area where stitching is ...

Best Wishes
 

DDT77

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Being in Chicago, I would look into Cleveland (or Mayo). 5-6 hour drive is not trivial, neither is a redo. It is not just the surgeon, but the entire crew inside and after the OP. PreOP is different than main stage and after, but similar culture likely exists among these three regimes.

Plates are great for the first few months. Had plates for my redo, and never felt any discomfort from coughing, sneezing, etc. Nice difference from 1st AVR with standard wires. Sternum often cracked (like knuckles) after first AVR, but for more than a year after second- no cracking, which would be uncomfortable. Started cracking again a few weeks ago, so all is well again... can feel plates distinctly, which can be odd.
 

pellicle

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DDT77;n886955 said:
Being in Chicago, I would look into Cleveland (or Mayo). 5-6 hour drive is not trivial, neither is a redo. It is not just the surgeon, but the entire crew inside and after the OP. PreOP is different than main stage and after, but similar culture likely exists among these three regimes.
I want to vote that I totally agree with this, and since we are now discussing this post surgical (meaning in the hospital itself) infection rates are also something to examine too (I can speak a little to that myself).

Plates are great for the first few months..... can feel plates distinctly, which can be odd.
very interesting and informative feedback ... as I mentioned above the top wires were difficult for me in the first year (one of them started to pronate) and were eventually removed (talking about my 2nd OHS here). Now that you're at this stage do you feel the plates are more obtrusive (with the rest of your life) than the wires (given you've had both)?

This is only an abstract question as I'm pretty sure I don't want to be considering a 4th (a nice quick death might be preferable given all the factors in my case)
 

Hockey Heart

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Thank you all for the great feedback! For those of you with titanium plates, does it bother you at all or have any long term I’ll effects?

i also sent a PM to Tom in MO asking about those links to evaluations of surgeons and hospitals. Does anyone know of any other resources for making comparisons of surgeons and hospitals related to AVR?
 

tom in MO

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I don't know anything about ratings for doctors or hospitals other than the what is readily found on line. It's hard to find out statistics about a hospital that you can believe and is pertinent to your operation. I asked my surgeon how many operations he did a year and he didn't know, but estimated it was >100. I researched my surgeon and found out he was involved in clinical trials (TAVI) which was good but not a deal sealer/breaker.

Where I live there are two heart hospitals, and I chose number two based upon my past operations there, the fact they had a Quality System (Malcolm Baldridge Award), they are not-for-profit-religious, and past scandal in the heart group at the other hospital. The one I didn't chose advertises they are the best hospital in the area and are top rated hospital by USNews and World Report survey. Top rated though turns out to be a score of 67 vs. my hospital's 64. The hospital with the "better" ranking founded their current "state-of-the-art" program by attracting doctors from the other hospital. I also like hospitals that are not-for-profit over corporate or state facilities. Too much focus on money is not good for medicine. All hospitals advertise, but I like a hospital that advertises less.

I also searched my state medical records for the surgeon to see if there were any problems. I do that with any surgeon that will work on me.

I think Cleveland Clinic must be a "Mecca" but I know you can get state-of-the-art care at many other places. I wouldn't want to be 5-hours away for any operation, unless it wasn't possible where I live. I believe in the "non-tangibles" in health care and having friends and family near is helpful post-surgery in many ways. It keeps you motivated if things go south.
 

DDT77

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pellicle;n886956 said:
very interesting and informative feedback ... as I mentioned above the top wires were difficult for me in the first year (one of them started to pronate) and were eventually removed (talking about my 2nd OHS here). Now that you're at this stage do you feel the plates are more obtrusive (with the rest of your life) than the wires (given you've had both)?

This is only an abstract question as I'm pretty sure I don't want to be considering a 4th (a nice quick death might be preferable given all the factors in my case)
Hockey Heart said:
For those of you with titanium plates, does it bother you at all or have any long term I’ll effects?

From my understanding there are wires in both cases (wires used to stabilize while plates are screwed in). Never had any issue or discomfort with wires 1st time around, even during sandlot tackle football. I think I have three plates, but can only notice one of them ('X' shaped), usually when one of nieces / nephews sit on me. There are other times where there is a tight feeling in this area. Only time plates bothered me is when trying to be a bit physical blocking out during basketball, did have a few bruises after one particularly rough episode in a few spots along sternum. It was not hockey...

Compared to sternum discomfort with wires alone, quality of life is much better with plates compared to wires. I think i could even sleep on side a few short weeks after 2nd OHS, couldn't consider same for months after 1st.
 


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