Getting confused - Questions re: Ross and other options - Severe AR

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MdaPA

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I met 3 more doctor alreday all suggest mechanical and one suggest inspiris.
Last i went to this doctor because this hospital only perform ross
One another doctor suggest minimally invasive methods. What's u r thought on minimally invasive method with mechanical valve.
Is this correct?
You got the following surgical opinions for your AV:

2 for mechanical valve (traditional OHS)
1 for mechanical valve (minimally invasive)
1 for tissue valve (Inspiris Resilia)
1 for ROSS procedure

No one mentioned an option for repair?

Did they explain and do you understand the pros and cons for each option?
 

pellicle

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One more question if i choose minimally invasive method for avr then any difference in output compare with ohs??
Nothing significant. I haven't seen any studies showing its better, but this may emerge over time. You should read these articles. This one covers type in good detail

This one is interesting for analysis of some outcomes.


Conclusions: Aortic valve replacement through a right anterior minithoracotomy surgery resulted in a reduced infection rate, diminished postoperative bleeding and blood transfusion requirements, reduced occurrence of new onset of atrial fibrillation, and shorter intensive care unit and hospital stays.​

although they seem to have slightly different conclusions if you examine the details I can't say that there is much in it

Results: For propensity score-matched patients, hospital mortality was 1.0% in the aortic valve replacement through a right anterior minithoracotomy group and 1.4% in the aortic valve replacement group (P = 1.000). Stroke occurred in 0.5% versus 1.4% (P = .615), myocardial infarction occurred in 1.4% versus 1.9% (P = 1.000), and new onset of atrial fibrillation occurred in 12.8% versus 24.2% (P = .003) of patients in the aortic valve replacement through a right anterior minithoracotomy and aortic valve replacement groups, respectively. Postoperative drainage was 353.5 ± 248.6 mL versus 544.3 ± 324.5 mL (P < .001) and blood transfusion was required for 48.8% versus 67.3% (P < .001) of patients in the aortic valve replacement through a right anterior minithoracotomy and aortic valve replacement groups, respectively. Mediastinitis occurred in 2.8% of patients after aortic valve replacement and in 0.0% of patients after aortic valve replacement through a right anterior minithoracotomy surgery (P = .040). Intensive care unit stay (1.3 ± 1.2 days vs 2.6 ± 2.6 days) and hospital stay (5.7 ± 1.6 days vs 8.7 ± 4.4 days) were statistically significantly shorter in the aortic valve replacement through a right anterior minithoracotomy group. Aortic valve replacement through a right anterior minithoracotomy surgery resulted in reduced postoperative morbidity (odds ratio, 0.4; P < .001) and postoperative bleeding and blood transfusion requirements (odds ratio, 0.4; P < .001).​

If you pick a mechanical, I would pick St Jude. I personally have ATS, I'm not concerned as both have good solid performance history.

I would want to get to the bottom of the why. I'm willing to bet its BAV. When you have surgery I would ask them to show you the report on the removed diseased valve.

Best Wishes
 
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Chuck C

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What's u r thought on minimally invasive method with mechanical valve
Hi.

About 7 months ago I had AVS to replace my aortic valve with a mechanical valve using a minimally invasive procedure. I chose mechanical because, given my age of 53, if I went with a tissue valve it would have meant future surgeries down the road, which was not something which I wanted. Going mechanical means taking warfarin daily for anti-coagulation. I have not found this to be any problem at all.

I was also very happy that went with the minimally invasive procedure. It was the method preferred by my surgeon and it meant a quicker recovery time for me, at least in some respects.
 

Shanith

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Is this correct?
You got the following surgical opinions for your AV:

2 for mechanical valve (traditional OHS)
1 for mechanical valve (minimally invasive)
1 for tissue valve (Inspiris Resilia)
1 for ROSS procedure

No one mentioned an option for repair?

Did they explain and do you understand the pros and cons for each option?
No one mentioned repair
Yes they explained the pros and cons
Now i think better mechanical because I don't want other surgery and even i dont want this one too.
As per your data there is no difference in both invasive and ohs right??

One surgeon who suggest minimally invasive alreday done minimally invasive mechanical for one state chief Minister in india.so i hope i can believe him
 

Shanith

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Hi.

About 7 months ago I had AVS to replace my aortic valve with a mechanical valve using a minimally invasive procedure. I chose mechanical because, given my age of 53, if I went with a tissue valve it would have meant future surgeries down the road, which was not something which I wanted. Going mechanical means taking warfarin daily for anti-coagulation. I have not found this to be any problem at all.

I was also very happy that went with the minimally invasive procedure. It was the method preferred by my surgeon and it meant a quicker recovery time for me, at least in some respects.
Ok..the one who performed minimally invasive who done this method for one state minister also so i think i can believe him
 

Chuck C

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Ok..the one who performed minimally invasive who done this method for one state minister also so i think i can believe him
I would expect that a state minister is going to generally have a top notch surgeon do their surgery, as they likely have the luxury of choice that others might not have.
 

pellicle

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Ok..the one who performed minimally invasive who done this method for one state minister also so i think i can believe him
if I was you (and not me) then knowing what I know now (having had 3 OHS) I'd
  • opt for mechanical
  • opt for minimally invasive (which you should not be surprised if it turns into full OHS on the day)
  • pay attention to the management of INR with the dilligence that someone who finds themselves diabetic pays attention to their blood sugar (except that they need to measure multiple times per day, we only need once per weeek)
  • opt for warfarin not sinthrome
Best Wishes
 
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Shanith

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if I was you (and not me) then knowing what I know now (having had 3 OHS) I'd
  • opt for mechanical
  • opt for minimally invasive (which you should not be surprised if it turns into full OHS on the day)
  • pay attention to the management of INR with the dilligence that someone who finds themselves diabetic pays attention to their blood sugar (except that they need to measure multiple times per day, we only need once per weeek)
  • opt for warfarin not sinthrome
Best Wishes
What is sinthrome?
Warfarin have any effect on male reproductive system?
Why u had 3 ohs?
Your in mechanical valve for how many years?
 

pellicle

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What is sinthrome?
it is the anticoagulant that is most commonly prescribed in India. I believe warfarin is better

Warfarin have any effect on male reproductive system?
none ... you may want to just check any (all) information you may have about it because I'd say 99% of what you've heard is wrong. Warfarin does not cause:
  • baldness
  • erectile dysfunction
  • feeling cold
  • going grey
This is a good thread to read from here:

Why u had 3 ohs?
when I was young I was diagnosed with BAV, it wasn't called that then because they didn't know. When I was 10 I had a surgery to "repair that". This surgery was able to get me through till 28 when I had a second. This was homograft. At 47 I had a 3rd because i) an aneurysm had developed on the aortic artery, and my homograft valve was starting to fail. So I had a surgery then which replaced the valve with a mechanical and a Dacron graft on the aorta.

I strongly suggest you go back and read my first post again as it seems you know know more and that will be a good read. You may then see why I was bamboozled by the surgeon apparently getting the materials that tissue prosthetic valves are made of confused with the material used in repairing aneurysm ... part of why I said "run, don't walk"

Your in mechanical valve for how many years?
approaching 9 years. So far it is performing entirely as expected and I am on 2 year follow ups now. Of the things which will go wrong in my life I'm quite certain that the mechanical valve will not be one of them.

I would also suggest to you to read my blog post on warfarin and refer to it as you understand what each of the concepts are (which you won't until you are living it) Managing my INR (some practical tips observations and theories)

There is a lot of misinformation on warfarin (any of the coumarin drug families of which Warfarin and Sinthrome are members), complete bullshit in the main. Sinthrome is Acenocoumarol and has a very short half life while Warfarin has a half life of about 2 days ... again much of this will make more sense as you go through it, no panic, plenty of time.

Best Wishes
 

Shanith

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it is the anticoagulant that is most commonly prescribed in India. I believe warfarin is better



none ... you may want to just check any (all) information you may have about it because I'd say 99% of what you've heard is wrong. Warfarin does not cause:
  • baldness
  • erectile dysfunction
  • feeling cold
  • going grey
This is a good thread to read from here:



when I was young I was diagnosed with BAV, it wasn't called that then because they didn't know. When I was 10 I had a surgery to "repair that". This surgery was able to get me through till 28 when I had a second. This was homograft. At 47 I had a 3rd because i) an aneurysm had developed on the aortic artery, and my homograft valve was starting to fail. So I had a surgery then which replaced the valve with a mechanical and a Dacron graft on the aorta.

I strongly suggest you go back and read my first post again as it seems you know know more and that will be a good read. You may then see why I was bamboozled by the surgeon apparently getting the materials that tissue prosthetic valves are made of confused with the material used in repairing aneurysm ... part of why I said "run, don't walk"



approaching 9 years. So far it is performing entirely as expected and I am on 2 year follow ups now. Of the things which will go wrong in my life I'm quite certain that the mechanical valve will not be one of them.

I would also suggest to you to read my blog post on warfarin and refer to it as you understand what each of the concepts are (which you won't until you are living it) Managing my INR (some practical tips observations and theories)

There is a lot of misinformation on warfarin (any of the coumarin drug families of which Warfarin and Sinthrome are members), complete bullshit in the main. Sinthrome is Acenocoumarol and has a very short half life while Warfarin has a half life of about 2 days ... again much of this will make more sense as you go through it, no panic, plenty of time.

Best Wishes
Thanx for reply
.i m attachingmy last echo report.you please check and tell me how much i can wait with this report.
Currently i have symptoms like when the heart beat i feel it beats with full force so i am feeling the beat in other part of the body also just like if i sitting freely or lying down then the body will also shake with heartbeat
 

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Shanith

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Thanx for reply
.i m attachingmy last echo report.you please check and tell me how much i can wait with this report.
Currently i have symptoms like when the heart beat i feel it beats with full force so i am feeling the beat in other part of the body also just like if i sitting freely or lying down then the body will also shake with heartbeat
 

pellicle

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.you please check and tell me how much i can wait with this report.
I am not skilled in interpreting these sorts of reports. The other things you mention sound like stress responses to me, but then I can't be certain.

I recommend be guided by the doctors, all they are asking of you is to make a choice of how to proceed (which method), not when to.

Best Wishes
 

pellicle

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Also when you reply put the things you want to say OUTSIDE of the QUOTE /QUOTE block

{QUOTE="Shanith, post: 911238, member: 17659"]
Thanx for reply
.i m attachingmy last echo report.you please check and tell me how much i can wait with this report.
Currently i have symptoms like when the heart beat i feel it beats with full force so i am feeling the beat in other part of the body also just like if i sitting freely or lying down then the body will also shake with heartbeat
do not write in here
{/QUOTE]

write out here

(I have deliberately damaged the block so that it won't be converted.
 

Shanith

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Thanx for reply
.i m attachingmy last echo report.you please check and tell me how much i can wait with this report.
Currently i have symptoms like when the heart beat i feel it beats with full force so i am feeling the beat in other part of the body also just like if i sitting freely or lying down then the body will also shake with heartbeat
 

Chuck C

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tell me how much i can wait with this report.
Is your cardiologist telling you that it is time? You've had several surgical consultations, thus the different recommendations you have received, as far as which procedure to use. Are any of these consultations telling you when you need surgery?

If they are telling you soon, then I would get it soon and not delay.

I am more well versed at aortic stenosis vs aortic regurgitation, but here is what jumps out at me from your echo.

- It indicates that your LV ejection fraction (LVEF) has dropped from 65% in the last echo to 55% now. That is not good and something that is generally watched closely.

-Your left ventricle is upper normal sized- this is likely enlargement that occurs to overcome the regurgitation. When there is regurgitation, not all the blood that is supposed to make it out to your body, which it vitally needs, makes it out to your body with each pump. The left ventricle compensates by pumping harder each beat- and to do this it will generally enlarge- as it must add muscle to pump harder. Think about how a weightlifter's muscle's get larger the more he exerts himself and the harder he lifts. It is similar to that, but it is not good for your heart to enlarge. You indicate that you feel your heart beating harder, like it is beating full force. I suspect that this is why you are feeling this.

-Your regurgitation is moderate/severe

-You have started to have left ventricular diastolic dysfuntion. It is mild at this point, but that generally means your getting closer to needing intervention.

The echo was done June 18, so that is 4 months ago, so your condition may have worsened since then.

With those factors noted above, I would tend to believe that you are approaching your time and some may even say that now is the time. If your medical team tells you that it is time for surgery, I would not delay. The last thing that you want to do is wait too long and cause irreversible damage to occur. You are young. Putting off surgery for 6 months at the risk of causing irreversible damage is not something that you want to do. Which is just to say, when your medical team tells you that it is time, then don't delay.

I am posting a link from the Cedar Sinai website regarding symptoms of aortic regurgitation. It sounds like you already may be experiencing one of the symtoms, which I put in bold. Make sure that you are communicating with your medical team and that they are aware of this. And be sure to let them know if you epxerience any other symptoms. There are some symptoms which would be an indication for immediate surgery. Your June echo indicates that you are experiencing chest discomfort. I am not clear if that is based on what you already described or if that falls into the category of another symptom listed, which is Chest pain or tightness with exertion. See below.

What are the symptoms of aortic valve regurgitation?
You may not have any symptoms from mild aortic regurgitation. If the condition becomes more severe, you may develop symptoms that worsen over time. These may include:

  • Shortness of breath with exertion
  • Shortness of breath when lying flat
  • Fatigue
  • Unpleasant awareness of your heartbeat (palpitations)
  • Swelling in your legs, abdomen, and the veins in your neck
  • Chest pain or tightness with exertion
Sudden severe aortic valve regurgitation is a medical emergency, and includes symptoms such as:

  • Symptoms of shock (such as pale skin, unconsciousness, or rapid breathing)
  • Severe shortness of breath
  • Abnormal heart rhythms that make the heart unable to pump effectively
 
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Shanith

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Is your cardiologist telling you that it is time? You've had several surgical consultations, thus the different recommendations you have received, as far as which procedure to use. Are any of these consultations telling you when you need surgery?

If they are telling you soon, then I would get it soon and not delay.

I am more well versed at aortic stenosis vs aortic regurgitation, but here is what jumps out at me from your echo.

- It indicates that your LV ejection fraction (LVEF) has dropped from 65% in the last echo to 55% now. That is not good and something that is generally watched closely.

-Your left ventricle is upper normal sized- this is likely enlargement that occurs to overcome the regurgitation. When there is regurgitation, not all the blood that is supposed to make it out to your body, which it vitally needs, makes it out to your body with each pump. The left ventricle compensates by pumping harder each beat- and to do this it will generally enlarge- as it must add muscle to pump harder. Think about how a weightlifter's muscle's get larger the more he exerts himself and the harder he lifts. It is similar to that, but it is not good for your heart to enlarge. You indicate that you feel your heart beating harder, like it is beating full force. I suspect that this is why you are feeling this.

-Your regurgitation is moderate/severe

-You have started to have left ventricular diastolic dysfuntion. It is mild at this point, but that generally means your getting closer to needing intervention.

The echo was done June 18, so that is 4 months ago, so your condition may have worsened since then.

With those factors noted above, I would tend to believe that you are approaching your time and some may even say that now is the time. If your medical team tells you that it is time for surgery, I would not delay. The last thing that you want to do is wait too long and cause irreversible damage to occur. You are young. Putting off surgery for 6 months at the risk of causing irreversible damage is not something that you want to do. Which is just to say, when your medical team tells you that it is time, then don't delay.

I am posting a link from the Cedar Sinai website regarding symptoms of aortic regurgitation. It sounds like you already may be experiencing one of the symtoms, which I put in bold. Make sure that you are communicating with your medical team and that they are aware of this. And be sure to let them know if you epxerience any other symptoms. There are some symptoms which would be an indication for immediate surgery. Your June echo indicates that you are experiencing chest discomfort. I am not clear if that is based on what you already described or if that falls into the category of another symptom listed, which is Chest pain or tightness with exertion. See below.

What are the symptoms of aortic valve regurgitation?
You may not have any symptoms from mild aortic regurgitation. If the condition becomes more severe, you may develop symptoms that worsen over time. These may include:

  • Shortness of breath with exertion
  • Shortness of breath when lying flat
  • Fatigue
  • Unpleasant awareness of your heartbeat (palpitations)
  • Swelling in your legs, abdomen, and the veins in your neck
  • Chest pain or tightness with exertion
Sudden severe aortic valve regurgitation is a medical emergency, and includes symptoms such as:

  • Symptoms of shock (such as pale skin, unconsciousness, or rapid breathing)
  • Severe shortness of breath
  • Abnormal heart rhythms that make the heart unable to pump effectively
Thank you for the explanation

Not pain i feel like some weight is there in the chest.
How to understand abnormal heart rhythms

Can't sleep free. Because when the heart beats, i feel the full body shakes

first they said within 3 months .so after three months i asked again how much i can postpone. They said 3 months.but now i think its time for intervention
 

Chuck C

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first they said within 3 months .so after three months i asked again how much i can postpone. They said 3 months.but now i think its time for intervention
I agree with you. There is nothing to be gained by waiting three months. You are also beyond the 3 month point, from when they already told you that. And, the echo is 4 months old. So, if they told you three months, nothing to be gained from waiting and potentially a lot to be lost from waiting.
You are young and it would be expected that you would have complete remodeling of your heart and return to normal LV function following recovery. The important point is to not wait too long, and it sounds like you don't intend to.
Good for you for seeking multiple surgical opinions and for taking it upon yourself to do your due diligence with respect to the best options regarding the choices that are before you. Seeking multiple medical opinions is alsways wise, as well as seeking input from others who have gone through the procedure, facing the same choices that you face.
 

Shanith

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I agree with you. There is nothing to be gained by waiting three months. You are also beyond the 3 month point, from when they already told you that. And, the echo is 4 months old. So, if they told you three months, nothing to be gained from waiting and potentially a lot to be lost from waiting.
You are young and it would be expected that you would have complete remodeling of your heart and return to normal LV function following recovery. The important point is to not wait too long, and it sounds like you don't intend to.
Good for you for seeking multiple surgical opinions and for taking it upon yourself to do your due diligence with respect to the best options regarding the choices that are before you. Seeking multiple medical opinions is alsways wise, as well as seeking input from others who have gone through the procedure, facing the same choices that you face.
Thank you.
How to understand the abnormal rhythm how i feel if i have this symptoms
 

pellicle

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How to understand the abnormal rhythm how i feel if i have this symptoms
truly understanding these things is the area for proper skilled medical personnel. Proper ECG's need to be done.

But for what you have described it seems to be something like this

I have had those in the past, but mostly around the time of my second surgery (before and after).

My surgeon was not concerned about them, probably because he had the ECG's to go by. (Note these are called EKG's in America because even though its electro cardio gram nuances of pronuncation by Americans make them confused with EEG which is electro encephalo gram, which is a brain wave scan).

These things while annoying are not problematic.

I would just make your personal choice as to which surgery and which institution will do it and get it done.

Sooner is better than later
 

vitdoc

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My surgeon was not concerned about them, probably because he had the ECG's to go by. (Note these are called EKG's in America because even though its electro cardio gram nuances of pronuncation by Americans make them confused with EEG which is electro encephalo gram, which is a brain wave scan).
The Germans were pioneers in the development of electrophysiology and deemed the test EKG which is based on the Greek kardia.
So the test has been frequently called EKG. At some point the English equivalent of ECG was also used due to the English spelling for kardia being cardia. Not sure we’re this EEG vs ECG came along. I think it might be apocryphal and rehashed. The official name of the test in the US according to the cardiology bodies is ECG but EKG is still very common.
 
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