AVR after a CABG

[BigOwl]

Hi folks; I'm a newbie here, and have enjoyed reading through some of the threads--especially the ones on choices. But I haven't read anything yet from someone in my particular position, and since I'm just in the pre-planning stages (expect replacement surgery in early April) I thought I'd see if anyone had been through anything like this.

I'm a 61 year-old college teacher with familial hypercholesterolemia, who had a 4-vessel CABG in 1995. I was out of the hospital in three days, and back to work three weeks after surgery (mainly because my husband was subbing in my classes and scaring the bejeeziz out of my students). Since I could sit while lecturing and put my feet up on a chair, I had a fairly easy time of it. My insurance didn't pay for rehab, though, and I ended up doing it myself by using a ski machine.

Over the last fourteen years, I've been maxed out on Lipitor (80) and Niaspan (2000), plus (more recently) Zetia and two blood-pressure meds, along with full-dose aspiring. So, obviously, adding another to a post-surgical regimen isn't going to be a problem. The meds have brought my total down from 487 pre-bypass to under 200, with good high HDL and continuously lowering LDL and triglycerides. I've maintained a decent diet over the years, but have a high stress job and have slacked off on exercise, so my weight has exacerbated my diagnosed stenotic aortic valve.

I don't have a lot of symptoms, except for occasional SOB and my particular brand of angina (tightening across my shoulders in response to stress and anxiety), but after the pre-stress test echo in November, the doc wouldn't let me get on the treadmill, and after the resting echo my Cardio guy described the situation in terms of "pumping blood through a pinhole."

I'm being monitored by my internist and will meet with the Cardio March 1, to talk dates for a cath, and then schedule surgery. He's already got a crackerjack surgeon picked out, and I'll be having it at the new Baylor Heart Hospital in Plano (Texas), so I'm not all that concerned about the surgery itself.

But I am nearly 15 years older than last time, not as basically fit, and haven't made up my mind about what valve to get (although, as a science fiction fan, I kind of like the idea of being able to refer to myself as the Bionic Art History Teacher). I suspect that scarring and previous sternum-cracking will be factors, but my internist thinks I will definitely have a choice.

So--sorry for the long post--I was just wondering if any of you had experienced this particular combination of surgeries (or anything like it) and had any thoughts on how I should proceed. So far you've already been helpful in lowering my stress level; it's a great forum. Thanks!

 

[ALCapshaw2]

Been There, Done That (separate CABG and AVR)

In some ways, my AVR went smoother than my CABG.

A good Surgeon (and the surgeons at Baylor should be Very Good) won't have a problem with one-time scar tissue.

You didn't give the "numbers" from your Echo, but "squeezing blood through a pinhole" is NOT good and can lead to Permanent Damage to your heart walls and muscles. You really do need to get 'Fixed' ASAP.

If you don't have copies of all of your Test Reports (Echo, TEE, Cath), I recommend getting and reading them. It would be good to know your Effective Aortic Valve Area. The usual recommendation for replacement is 0.8 cm sq or less. Your Pressure Gradients are also numbers of interest. Chamber size is also important. An enlarged chamber is another trigger for recommending surgery.

For Valve Selection, I suggest you click on the Valve Selection Forum and start witht the "stickys" at the top of the thread list.

First, you will want to decide between Tisse and Mechanical Valves. Once you have made that decision, there are several different models in each category that you may want to familiarize yourself with.

'AL Capshaw'

 

[BigOwl]

Thanks, Al. I'm in the process of teching up on all the choices (I'm leaning toward a mechanical because of my history, but will do more research. My daughter has ordered The Book and we'll probably both read it cover to cover). I haven't looked at the reports yet because I need to bone up on what they mean, but will as soon as I've got the vocabulary. Because of my few and only occasional symptoms and my easy-ish teaching schedule, the docs both seem comfortable with my waiting until the end of the quarter for surgery. I'll take the next quarter off and get going on rehab (I'm covered this time) and try not to go back to work for at least a couple of months. This will be easier because I've got this time to set things up for my temporary (I hope!) replacement. Anyway, thanks for the advice. I've already looked through a number of the Valve selection posts, and they've given me a lot to think about.

 

[briansmom]

My son had valve replacement after a triple CABG. His surgery was only 9 months after the CABG and was to remove the LVAD (artificial heart) and install a mechanical valve and dacron aorta. They also had to redo one of the CABGs because it was in the way for all the other stuff they had to do.

 

[BigOwl]

Wow, Deanne: that puts my issues in a less dramatic perspective! My CABG was an emergency ready-to-pop situation, but except for the valve problem (which may have been with me for some time) I've been healthy for nearly fifteen years. My brother-in-law just had a heart transplant at age 67, so I'm taking heart (as it were) that my difficulties will be easier to overcome. I think it's always tougher when kids have to have stuff like this done, which is why we discovered my hypercholesterolemia when we did--now my very active daughter, on statins and taking care of herself, will probably escape the family "curse." It does help to know that I'm not alone in the multiple surgeries for multiple reasons category. Thanks for the input.