AVR with Replacement of Ascending Aorta and Triple CABG

[Jase_101]

Hi

I am new to the site and have been advised by my surgeon and cardiologist that I need to have extensive OHS with a list that reads like a shopping list!

I am still rather shell shocked and due to have surgery by end of Feb/Mid March 2024 and as I have never had any heart surgery prior to this I am a little apprehensive as I have a leaky, calcified bicuspid aortic valve, with an aortic aneurysm measuring 5.1cm.

After a recent angiogram it was found that my LAD and 2 other arteries were calcified and required fixing by way of CABG. I have read some of the threads on the site and noticed some members having a valve replacement with possibly and aorta replacement, but has anyone had a procedure where valve, aorta and a multi- CABG have been done all at the same time.

I am 58 and do need to lose at least 10-12 kg I feel before my surgery and wanted to gain some advice on what to expect.

Thanks

 

[jimbob123]

Keep positive. It's really good that all these things have been identified, and they can fix them all during the same surgery. It's quite a list you have, but from your perspective it's one operation and one recovery, and to get all those things fixed at the same time will be fantastic.

When I was in Edinburgh for my valve replacement (6 weeks ago today), someone there had just had valve and CABG done at the same time, so he of course had the long cut in his leg which you will also have, but he was recovering well and ready to go home.

Yes it's big stuff, especially to us mortals, but the surgeons do this every day and they are good at their jobs.

Hang in there. Think of all the things you'll do when you get back home to rest.


Jim

 

[Jase_101]

Thanks Jim

That's very helpful and I agree whilst its huge in terms of what needs to be done, these surgeons are highly skilled so I guess I just need to keep the faith, but obviously with the longer and more complex the surgery is the risks go up exponentially so its just trying to come to terms with that and keeping me head together.

By the way what type of valve did you have? mechanical or tissue?

My surgeon is recommending mechanical.

Thanks again

 

[jimbob123]

Thanks Jim

That's very helpful and I agree whilst its huge in terms of what needs to be done, these surgeons are highly skilled so I guess I just need to keep the faith, but obviously with the longer and more complex the surgery is the risks go up exponentially so its just trying to come to terms with that and keeping me head together.

By the way what type of valve did you have? mechanical or tissue?

My surgeon is recommending mechanical.

Thanks again

I've watched lots of videos of surgery now, and a lot of the surgical time is opening and closing your chest, so I suspect having a CABG won't add a huge amount of time. It'll just give you a longer snooze. In terms of time, once you're on the ECMO machine (heart/lung bypass) it's estimated to give ~3 hours working time for the specialists to earn their money.

My surgeon was very very careful not to recommend one or the other, he presented the pros and cons but left it to me. I'm only 51 so the logical choice was mechanical, but I opted for tissue for two reasons. I didn't want to hear it clicking (very light sleeper) and I did't fancy warfarin. There are enough posts on this forum to suggest that neither would actually be a problem, but I made up my mind and stuck to it. Only time will tell if I made the right call.

So I'm now part-human, part-cow.

Jim

PS If you want to read my full story, it's the first post I made here, a couple of weeks ago.

 

[Jase_101]

Thanks Jim

Thats great and I will read your first post.

Take care
Jase

 

[jimbob123]

https://www.valvereplacement.org/threads/endocarditis-leading-to-avr-my-story.889366/

 

[Chuck C]

Welcome to the forum Jase.

Sorry to hear that you have so many issues which need to be taken care of surgically. On the bright side, it is fortunate that they discovered them before you had an event and that there are successful procedures to deal with all three issues that you mention. It is a positive that they will be able to take care of everything with one OHS.

My surgeon is recommending mechanical.

In my view, your surgeon is giving you sound advice. At age 58, for most people the scales tilt towards mechanical, which is why the EU guidelines call for mechanical for those under age 60. If you go tissue, you will almost certainly face future procedures. Something else to consider, as you have some issues with plaque buildup in your coronaries, there is some possibility that you will need another OHS should they get clogged up down the road. I believe it is best to plan for as few procedures as possible. Life happens and sometimes we get what we plan for and a bit more. For example, I went mechanical at age 52, hoping to be one and done, as is the case for most mechanical valvers. But, perhaps at age 70 I get endocarditis and need another OHS. So, one planned procedure then becomes two. Being realistic about your plaque burden would be something to consider. You might get mechanical and then need a future intervention for coronary, so planning for one could become two. If you go tissue, you are planning for 2-3, which could easily end up being 3-4 if there is another coronary intervention needed.

On another note, you are a little on the young side to have so much coronary plaque. Have you had your Lp(a) tested? Having elevated Lp(a) can cause early plaque deposits in your arteries. Unfortunately, most cardiologists still miss this, but that is slowly changing. In EU it is now recommended in the guidelines that all are tested at least once in their lifetime for Lp(a).

Also, have you had a test to measure whether you are diabetic or pre-diabetic? You have probably had a fasting blood glucose test and possibly also an A1c. I would suggest that you have an oral glucose tolerance test done- OGTT. Fasting and A1c will often both miss pre-diabetes and even sometimes miss diabetes. It is pretty well known that diabetes can cause accelerated plaque deposits, but this is also true when a person is in the pre-diabetic range, something which is often overlooked.

Good luck with the choice before you and with your procedure.

 

[pellicle]

My surgeon is recommending mechanical.

I'd suggest that too ... aside from Chucks great reply I'd take a pen and paper and a cup of coffee (or tea) and listen and take notes)



While there may have been some changes in tissue valves and procedures for the very frail (like TAVI) I think that for your age (and the risk of Lp(a) which I'd sort out) mech is your best bet.

 

[Jase_101]

Hi Chuck & Pellicle

Thank you very much for the advice and I will get the Lp(a) checked and at present I am now focusing on getting as fit as I can for the surgery as the surgeon has calculated a Euro II score for me at 3.7.

Whilst I appreciate that all surgery comes with risks the level and scope of this one which lies before me is rather concerning, as its 3 main areas that the surgical team will need to attend to and thats if nothing goes wrong.

Thank you once again.

All the best
Jase

 

[pellicle]

Whilst I appreciate that all surgery comes with risks the level and scope of this one which lies before me is rather concerning, as its 3 main areas that the surgical team will need to attend to and thats if nothing goes wrong.

to say its a well oiled, iteratively introspective and recursively self improving system is an understatement.

You'll do well ... and that you're taking the steps to do (don't over do) the fitness pre-surgery bodes really well for your success in recovery.

If you choose mech, hit me up when you're out and I'll give you a good start on INR management.

 

[ChuckM]

Hi

I am new to the site and have been advised by my surgeon and cardiologist that I need to have extensive OHS with a list that reads like a shopping list!

I am still rather shell shocked and due to have surgery by end of Feb/Mid March 2024 and as I have never had any heart surgery prior to this I am a little apprehensive as I have a leaky, calcified bicuspid aortic valve, with an aortic aneurysm measuring 5.1cm.

After a recent angiogram it was found that my LAD and 2 other arteries were calcified and required fixing by way of CABG. I have read some of the threads on the site and noticed some members having a valve replacement with possibly and aorta replacement, but has anyone had a procedure where valve, aorta and a multi- CABG have been done all at the same time.

I am 58 and do need to lose at least 10-12 kg I feel before my surgery and wanted to gain some advice on what to expect.

Thanks

Yep!

Discovered the aneurysm (5.1cm) during a routine calcium score ordered up by my primary care doctor.. went back and did a second CT with contrast to confirm the aneurysm. Then they followed with an echo and determined the valve had to go as well. Although not named specifically by my surgeon, I ultimately had a Bentall procedure, with replacement of the valve and the aortic root. During my pre-op visit with the cardiologist, they ordered up a cath scan which they performed the night before surgery. Easily explained as "the hood will be open, we might as well check".. sure enough my check engine light was on and so they scheduled up the cabg (single) using my right mammary artery.

Lost a bit of feeling around my right breast area, but otherwise you'll never know. The doctors and staff took lots of xrays the first few days but that was of the valve and the aorta I'd guess. Seems like the cabg part is fairly routine these days. Recovery was a week in the hospital, then 3 or 4 weeks at home before I felt like working from home. 6 weeks to being released to drive and back to the office. I'm 3 years out, have had some routine scans but not scheduled for another cath as of yet. I'm sure they'll want to go back and look again as he said i had approaching blockage on another artery that they'd end up stenting. The only real hinderance is from the meds, and they're not bad. Pressure stays low with the metropolol, bleed a little longer with the warfarin, CRS (can't remember sh*t) with the statin, but they all keep it humming.

All the usual rules apply.. lose weight, stop eating carbs, no smoking, exercise, etc. Read the forums, lots of good information here, about the warfarin, the clicking, the thumping, etc.

As I said before, the alternative is almost certain death, so basically there is NO alternative.

 

[V__]

Hi,

Welcome to forum. I think you are doing the right thing, thinking ahead It's always a pleasure to see that.

obviously with the longer and more complex the surgery is the risks go up exponentially so its just trying to come to terms with that and keeping me head together.

Whilst I appreciate that all surgery comes with risks the level and scope of this one which lies before me is rather concerning, as its 3 main areas that the surgical team will need to attend to and thats if nothing goes wrong.

There is no way around that, the more problems to address, the more risk. But, at the same time, some folks more "complicated" issues. For example, the valve-sparing surgery looked more complicated to me than the aortic aneurism "fix". And, if one has an aneurism rupture, that gets precarious very quickly...

For some surgeries there are risk calculators that can allow you to estimate the risk for you (as opposed to a "typical patient"... who could be very different from you).

As others have said, CABG is rather routine. It's the most frequent kind of heart surgery, and the surgeons are very skilled/practiced in it. As my cardiologist put it, "bread and butter for them". Also, long-term CABG has slightly better survival odds than stenting, although it's more complicated. Since you are going to have the surgery anyway, that's a good chance to address the issue with the best method possible.

It's quite a list you have, but from your perspective it's one operation and one recovery, and to get all those things fixed at the same time will be fantastic.

I think this is a quite important point. The huge benefit of the tests performed is that you actually know about the several issues. A lot of them appear to be "silent problems" that are usually not tested for in annual physicals or routine testing. So, in a way, it's a strike of luck to find all of them out. And now they can be addressed!

I am 58 and do need to lose at least 10-12 kg I feel before my surgery and wanted to gain some advice on what to expect.

You'll do well ... and that you're taking the steps to do (don't over do) the fitness pre-surgery bodes really well for your success in recovery.

I would strongly concur with establishing a habit of routine exercise. This will be needed in recovery, but there is no reason to wait. And also with taking it reasonably easy. Your issues are still with you. And it's not good for the aneurism to get to high blood pressure. Which can be triggered by stress, high exertion and fatigue. So... no powerlifting for now Walking is very good though.

 

[pellicle]

@Jase_101

Walking is very good though.

as is also cycling if you use the gears to keep a nice fluid cadence.

I recommend even a basic wallmart bicycle (on cycle paths and in quiet streets or parks if you're a newbie). Set up the seat height properly too ... 15 min a day is a good start.

 

[Jase_101]

Thank you for all the sound advice which I am taking note of and following. I spoke with my surgeon recently who basically said the same, that I must not exert myself too much and raise my blood pressure. I have been advised walking and dieting are what I should focus on and trying to ensure I am well and fit enough for my surgery which is planned for early March 2024.

My head does spin a little when I think about the %'s like 3-8% chance of death, 3-6% chance of stroke as its a big operation and also the potential impaired renal function once its all done.

I have the next 10 weeks to prepare and ensure I have reduced my weight suitably and got myself ready both physically and mentally for the surgery.

Thank you again to everyone for taking the time to reply and offer advice.

Many thanks
Jase

 

[pellicle]

I have the next 10 weeks to prepare and ensure I have reduced my weight suitably and got myself ready both physically and mentally for the surgery.

a friend of mine had CABG done last year, sure it was rough, but now a year later he's only looking forward.

From my perspective (can't emphasise this enough) there is quite an amount of hysteria and panic in the lead up and (not in your case) no thought to what happens over the next 15 years. Its as if everyone loses sight of the fact that the continue living after the surgery, as if the surgery is the end point.

Its not.

1 year from now you probably won't even remember half of what you were panicked about because its like "Italian driving"



Best Wishes

 

[Survived03]

I have the next 10 weeks to prepare and ensure I have reduced my weight suitably and got myself ready both physically and mentally for the surgery.

If you reduce the weight and physically feel better I promise you that you will go into surgery with the highest confidence. The reward will be feeling better and living longer. You have studied the risks now move past that and on to the goal. I wish you luck from now through recovery.

 

[ChuckM]

My head does spin a little when I think about the %'s like 3-8% chance of death, 3-6% chance of stroke as its a big operation and also the potential impaired renal function once its all done.

That time between my cardiologist explaining things to me, the thoracic surgeon finding the opening in his schedule and then finally having the surgery, was probably some of the longest in my life. Amazing how much weight you can lose when you've got one thing on your mind, all the way through surgery and into recovery. I bet I dropped 40 lbs when it was all over. Gained a good bit of it back once I started feeling better. Wife is on a mission to get it back off.

 

[Jase_101]

Thanks very much for the advice and its hard not constantly think about all the negative aspects and what if's!

My focus will remain on getting the weight off and trying to be as fit as I can possibly be (with an unwell heart) for the surgery and each kg I drop I feel will improvement.

Take care
Jase

 

[pellicle]

Thanks very much for the advice and its hard not constantly think about all the negative aspects and what if's!

Such direction of thinking is meaningless, nothing you think about is anything within your control.

So unless you enjoy spinning your wheels in the mud instead focus on what your role is. Don't feed the beast of anxiety unless you want to be it's slave.

 

[Timmay]

I wanted to clear something up after reading Chuck’s reply.

There are two people in this thread.

Jase, 58 (thread starter)
Jim, 51

Jim, who is 51, has elected a tissue valve. Not the recommended choice for that age.

Jase, the guy who started this thread is 58 and doesn’t seem to have made a choice yet.