How to select a surgeon.

[Mark]

Has anyone helpful advice on choosing a heart surgeon? I have a cardiologist, and I know that surgery is on the horizon. should I just go with whomever the cardiologist suggests, or are there ways of determining who is "the best of the best of the best" in my area?

I live in Alaska, but I will likely have my surgery in Seattle.
Thanks.

 

[Johnny Stephens]

Hello Mark

I can definitely point you to a good surgeon in Seattle. I had my surgery done at the University of Washington by Dr. Ed Verrier, Chief of Cardiac surgery. He is considered by many to be the top valve surgeon here. Several of us on this site have had Dr Verrier as our surgeon, i.e. joy and mainframe. There may be others as well.

My cardiologist also recommended Dr. Alan Hall at Virginia Mason, but after we met Dr. Verrier we never bothered to meet with Dr. Hall.

Here's a link to a short bio on the UWMC website:
http://medical.mcis.washington.edu/uwp/search/doctorbio.asp?id=A008512

 

[Marty]

Surgeon selection?

Surgeon selection?

Mark, Its never a bad idea to ask your cardiologist who he would have do the surgery and where he would go if it was him having the operation. I did that and it worked out well. I stayed home and had the surgery at my local county hospital 10 miles from my house. I avoided the hassle of going to Hopkins, Cleveland or Mayo's and was home in my own bed the morning of the 4th postop day. My mitral valve was not reparable so I had a replacement with a St. Jude mechanical which so far( 4 years). has performed well. Finding my correct Coumadin dose was a bit of a problem and took a couple of months but now is routine.

 

[Bill Hall]

Mark - I was pretty lucky to find several recommendations from different sources to decide my surgeon. Most of the surgeons do this every day, so finding the best of the best may be unnecessary, depending on the complexity of your case. I looked for age and experience (schools, years doing surgery, etc). You can find that information in their biographies. Going to Seattle may be beneficial because you can get objective opinions of who is best.

 

[Nancy]

Hi Mark-

Sorry you have to do research on getting a cardiothoracic surgeon.

My husband has had 3 valve surgeries and 2 lung surgeries. His first (aortic valve replacement) was done in 1977. At that time there weren't too many doing the surgery. So he went to Boston to have it done. That's 3 and a half hours away from where we live. The mitral valve replacement and repair, plus his lung surgeries were done right here within a 15 mile radius of our home. Things have improved to that point, plus we are very fortunate to have an extremely gifted surgeon right here, Dr. Harry DePan. He did the mitral operations, and one of the lung surgeries, his partner did the other lung surgery.

Joe's heart has held up through some terrible, terrible medical problems. So we're very happy with heart surgery in this location. Dr. DePan was recommended by Joe's cardiologist, whom we have great respect for. So there you have it. If you have a good local man, it's a lot easier to stay local.

Plus the "handoff" to the cardiologist is seamless.

 

[Granbonny]

Trust your Cardiologist

Trust your Cardiologist

My Cardiologist told me and my family when he found my aneurysm...I can tell you who I would have to do it if it was me..I said who? and 10 minutes later stood at the foot of my bed, the best looking Doctor I have ever seen..and I said WHEN? Lucky, I only had to wait 3 days but never saw him again..Was out when they took me to OR..and his assistants took care of me during nmy 5 days in hospital..but I still dream of him Had to have been the best St. Joseph's in Atlanta..only 22 minutes on heart, lungmachine..and here I am 5 months later doing great Bonnie

 

[hensylee]

Think Zazzy had hers done in Seattle, too. Zazz, are you there?

 

[JenniferO]

Mark:

Just make sure the surgeon you choose does the particular procedure you have to have done has done it many, many times over.

I needed mitral valve repair and was really opposed to "settling" for mitral valve replacement. I saw several local cardiologists and two of the top local surgeons in Salt Lake City. The top local surgeons do the full range of cardiac surgery procedures including heart transplants, one has authored a cardiac surgery textbook and is nationally known for the Ross procedure. The other was the head of cardio-thoracic surgery at University of Utah where some of the first heart transplant surgeries were done and a very fine surgeo. However, each of these surgeons gaVe me only a 50-70% chance they could repair my valve. Also, each of them attempted valve repair only 2-3 times a month, many of which became valve replacements.

That wasn't good enough odds for me. I had previously researched Cleveland Clinic (along with some other medical centers and surgeons) where mitral valve replacement was done on a much greater volume. I ended up choosing Dr. Cosgrove at Cleveland Clinic who does as many as 4 valve surgeries a day and has 10,000 mitral valve repairs behind him.

My feeling is when you're in the hospital, doesn't matter if it's ten miles from home or 10,000, it's still not fun and you still just want to get to the end of it and go home. We spent two weeks in Cleveland and then flew home. About four days later, I spent two days in our local University of Utah Hospital for suspected TIA activity. Being in the local hospital was no better than being in the long-distance hospital. The most important thing, is that you have the best surgeon doing the job.

Of course, looks are not a criteria, but Bonnie, I'll put Dr. Cosgrove up against any other handsome surgeon any day! At 60, I still thought he was gorgeous!

 

[Mark]

Thanks for all the great advice. I'm new to the lingo here, so would someone mind filling me in on what a Ross procedure is? And a TIA activity?: confused:

I'm sure glad I found this group on the net. I don't know anyone locally who has gone for valve surgery, so you people are a real lifeline for me. I live in Juneau, which is pretty isolated. You can't drive here; you have to fly or take the ferry. The internet expands my world, so thank you all.

 

[Nancy]

TIA (Transient Ischemic Attack)

TIA (Transient Ischemic Attack)

I'll tackle TIAs, the Ross people will be along soon, I bet.

My husband has had about 16 TIAs. They are caused by a small embolus or emboli which break off sometimes from a heart valve and travel through the system. As they pass through the brain area, they can cause symptoms similar to a stroke. However, they usually do not cause permanent damage, and there won't be anything that shows up on tests in the ER. There is, however, some thinking that the cumulative effect of these can cause some permanent changes, so it is important to get them under control. I believe that people who experience these should go to the ER at once to be evaluated because it's hard to tell these from a full blown stroke.

Proper anticoagulation is important if there is a mechanical valve, damaged valve or irregular heartbeats. My husband's hasn't had any more TIAs since his mitral valve was "fixed", and also since he had a pacemaker implanted. I'm hoping it stays that way.

These are some of the symptoms which have manifested themselves during my husband's TIAs: loss of vision in one and sometimes both eyes, unintelligible speech, inability to understand what is said, forgetting how to wind up the garden hose, stabbing head pain, falling out of bed, loss of balance.

Take care,

 

[Zazzy]

Hello Mark,
Ann was close.. but my surgery was done in Spokane, Washington. Do you trust your cardio? If so I would listen to him as far as surgeons go... in a large medical community they usually know who is best at what.

Take care,
Zazzy

 

[hhardt]

Selection of surgeons

Selection of surgeons

My surgery was by a golfer with a single digit handicap. Thus a steady hand. Needs a good eye to putt well. He is the best according to what I learned through experience.

 

[joy]

Hi Mark! I had my surgery done at the UWMC in Seattle, and also had Dr. Verrier. I recommended him to Mainframe, and he used him also. He rules, and knows his stuff! If you need the number just send me a PM, and I can get that right out to you!

 

[John Cochran]

Mark,
I have a little different perspective on the picking of a surgeon. I think it is wise to first read up on the different kinds of valves and procedures, like the Ross Procedure, tissue valves, full sternotomy vs. mini-sternotomy, etc. Once you have an idea what these entail, you will be better equipped to discuss what your preferences are with a surgeon. "Best" is a relative term; if you choose a homograft, but the "best" surgeon reccommended has mainly mechanical valve experience, then you'd need to look some more. Too often surgeons reccommend what they happen to have a lot of experience with, not necessarily what might be the best for your life-style and particular situation.

Good luck in your search.

--John

 

[joy]

Mark, I hadn't gone into the different kinds of valves you can get, but I forgot to mention that Dr. Verrier doesn't do the homografts because he said they are still an experimental thing, and doesn't want to do that on his patients. He's done a lot of Ross procedures(over 100.) He put a bovine pericardial valve in my heart, and Johnny got mechanicals. He listened to my lifestyle, and mad his recommendation from that. He said my surgery went off without a hitch. Good luck!
Joy

 

[ALCapshaw]

SELF REFERAL in SURGEON SELECTION

SELF REFERAL in SURGEON SELECTION

The first step in finding a surgeon is a discussion and probable referal from your cardiologist. Hopefully, he will know enough about your history and lifestyle to point you to an appropriate surgeon with relevant experience with the type of valve you desire.

IF you want to compare surgeons, your cardiologist may or may not want to get involved. This is where a little initiative is needed to make a 'self referal'. A key ingredient in self referal will be your records and hopefully films of your latest catheterization, echo cardiogram, and / or TEE.

How to obtain these materials for potential surgeons to review?

I recently met a heart patient with a 'significant' heart history who used self referal to find cardiologists and surgeons with experience in the latest techniques. I was told that the cath and echo films are stored on CD roms which you can simply request from the hospital / lab that performed those tests ! With these CD's in hand, you can go anywhere in the country and talk with the best of the best in your fields of interest. What a novel concept !

'AL'

 

[BillCobit]

Picking a heart surgeon

Picking a heart surgeon

In opted not to go where my cardiologist directed me. The surgeon had great credentials, but told me my mitral valve was unrepairable and that it would have to be replaced. I didn't like that answer, so I got a second opinion from a surgeon at the Cleveland Clinic. The CC surgeon expressed confidence he could fix the valve. I made my decision at that moment to have surgery performed at the CC.

Turns out the repair was more difficult than anyone knew. There was a large perforation in one of the valve leaflets that hadn't been visualised on any of the echocardiograms. So repairing the "unrepairable" valve included an extemporaneous patch job. I feel great, and do not have the complications of an artificial valve. I'm very glad I "shopped around."