AVR andd Triple Bypass Part 2

[maxximom]

Hi to all of you and thank you to all who have responded to my panic posts. My Husband and I met with Dr. Glower yesterday..he was very nic, informative and very patient..even though he was running 3 hours late..in no way did he rush us. There is no doubt that both surgeries are very neccessary and while there is no emergency..he did addvise me not to put things off to long. He told me that while he wasn't sure..that he felt that there was a possibility that he might also need to do the Mitral valve..he just wanted me to know of the possibity if he found during surgery that there was more calcification that the echo and cath showed. I suggested that unless it was really bad..I would rather take my chances of it progrssing from mild to severe in a few years and wait( it may never advance further) and then if I have to have ot done MI in the future. He was agreeable with that..and so it will not be done unless it is at a more advanced degree than the tests show at present..It will be his call at the time as to what he finds during surgery.I will either have the surgery on the 31st of Aug or the 21st of Sept. I need to check and see whats works best so my childdren can be here to help support Allan ( my husband) and me. Drr.Glower will be away fron Sept 14-20th and I don't want to be in a position to have surgery and have him gone the following week..just in case there are problems. The Mortality rate seems to double when having the combined Bypass/AVR and is in the 8-10% range for ppeople my age (70)..but Dr. Glower didn't seem to be 100% sure of those Stats.
I'm still hoping to find others who have had the combibed surgery..but alas..so far...no-one has contacted me. If anyone knows of someone who has had the ":Full Monty" would you please please have them contact me...orr if you know of another forum , website or chat..please let me know. I continue to be grateful for finding this ffoorum and the wonderful people who share with each other..it is a great comfort.
Joan Seide
[email protected]
PS..I ordered a comfy recliner chair in anticcipation of my recovery..thank you all for that suggestion
Joan

 

[Kevin M]

I don't know if this is of any help to you or if you've seen it already.

It discusses whether or not it is appropriate to do bypass at the same time as AVR. Your situation, like all of us, is unique so remember that this is generic stuff the committee has arrived at for their standard procedures. It cannot take into account any specific case.

Unfortunately you need a post-graduate degree to understand what they heck they are talking about in some parts (I am not that educated, so that's why I found it a bit confusing). The information makes several references to some information which may be of use to you. These references are shown as numbers smattered throughout the article. You can look them up and they may help. I know that AS means aortic stenosis, AVR is aortic valve replacement, CAD is coronary artery disease, LV is probably left ventricle.

I took the liberty of summarizing what I could understand without all the numbers and gobbledeegook. I had to write the summary just so I could understand it because it uses so much medical terminology and poor English (mine's not great either, but you can understand me most of the time):

-Over half of patients age 70+ years have CAD.

-To do both coronary and AVR means longer time on heart lung machine (obvious. there's more to do).

-There is a higher risk of post-operative heart attack when they do the coronary bypass and AVR together vs. just doing an isolated AVR. (It doesn't say if this takes comparison takes patient age, health, etc. into consideration).

-There is a higher risk of death after surgery when they are done together vs. just AVR alone. (no stats, but there might be in the reference they refer to).

-Then, they go on to say that even though the higher heart attack/mortality rates are true in comparison to all isolated AVR patients in their study; the results of doing the combined AVR/Coronary Bypass are far better than those CAD patients who did not have the bypass at the same time as their AVR. Meaning - it sounds like it's best to get the bypass and the AVR done at the same time. If you just get the AVR, you put yourself at higher risk. This of course, does not take your specific situation into account.

-The "multivariate" (?) factors that tend to cause mortality are CAD, severe AS, severe LV dysfunction, age higher than 70 particularly in women and NYHA functional Class IV (as bad as it gets) symptoms.

-The techniques have improved over the past 10 years, resulting in less operative mortality.

-It is now standard practice to do all necessary bypasses at the time of AVR if AVR is required.

Here is the whole section of the article for your perusal. Hope this helps a bit.
Kev


From the American Heart Assoc. Website:

http://www.americanheart.org/Scientific/statements/1998/119803VIII.html#C

C. Treatment of Coronary Artery Disease at the Time of Aortic Valve Replacement

As noted previously, 33% of patients with AS undergoing AVR have concomitant CAD. More than 50% of patients >70 years old have CAD. Several studies have reported the outcomes of patients undergoing combined coronary artery bypass surgery and AVR. Although combined myocardial revascularization and AVR increases cross clamp time (712) and has the potential to increase perioperative myocardial infarction and early postoperative mortality in comparison with patients without CAD undergoing isolated AVR (713-716), in several series combined coronary artery bypass surgery has had little or no adverse effect on operative mortality (717-724). Moreover, combined coronary bypass grafting and AVR reduces the rates of perioperative myocardial infarction, operative mortality, and late mortality and morbidity compared with patients with significant CAD who did not undergo revascularization at the time of AVR (723-726). In addition to severity of CAD, the multivariate factors for late postoperative mortality include severity of AS, severity of LV dysfunction, age >70 (especially in women), and presence of NYHA functional Class IV symptoms (724,727,728). Incomplete revascularization is associated with greater postoperative systolic dysfunction (729,730) and reduced survival rates (731) after surgery compared with patients who receive complete revascularization. For over a decade, improved myocardial preservation techniques have been associated with reduced overall operative mortality (732), and it has become standard practice to bypass all significant coronary artery stenoses when possible in patients undergoing AVR. The committee recommends this approach.

 

[maxximom]

Thank you Kevin

Thank you Kevin

Kevin ..thank you so much for the infomation..I had not seen it and I was looking for something like it. Most of the abstracts that I was able to find were for either surgery and not the combo (except for one or two) I have to sit down and read your infomation and try and digest it..Not that it will make any difference in the long run..both surgeries must be done..and it is only prudent (regardless of the higher risks) way is to do them together. I understand that it is fairly common..that doesen't make a worrywort like me any easier. I guess I'm just into doom and Gloom at the moment..and that I will snap out of iot and be back to my other more optimistic self soon.I really appreciate your help..I wish I were more 'computer litterate" how did you find this info..just wondering where you went and I missed..Joan

 

[hensylee]

Hi Max - Thanks for news about the latest. I had bypass, not valve. I found a site where there is a REAL electrophysiologist cardiologist dr running the site and he has mucho info, tho he is on vacation til 8/14. He could give you his opinions, not medical advice which is illegal to do over internet. He practiced for 20 yrs. If you care to check the site, it is about.com; go there and search for heart disease/cardiology (Dr Richard N Fogoros).

We are here to go along to the hospital with you and your family, so please express your feelings if you need to, ask all the questions you need answered and we will respond kindly and caringly. Please keep us posted on your date and progress at surgery time. God bless.