Introduction

[Vince]

Hello. I have been a quiet observer of this site for a while now and feel like I know many of you. Thank you all for your helpful insight.

I am 60 years old and was diagnosed with Aortic Valve Stenosis in April of 2011 with a valve opening of between 1.1 & 1.2 cm2. Another echo was ordered for 6 months later and that echo showed little change so the next echo was not ordered until 1 year later.

So here we are at 1 year later and this latest echo shows a valve area of .9 cm2, a peak gradient of 49 mmHg with a LVEF of 60%. Main symptom is fatigue, but there is some shortness of breath after a brisk walk around the block and some dizziness from time to time. Aside from the fatigue, the other symptoms (dizziness, shortness of breath) have been so gradual that it is hard to decide whether they are real or psychosomatic.

Anyway, the cardiologist tells me we are at a point where we could consider surgery at any time and he feels fairly certain it will need to be done within the next calendar year. My first reaction to immediate surgery was no way! Let's delay this thing! But after giving it some thought, I called him back to ask if it would be OK to just go ahead and do it in late January next year. He was agreeable so we moved forward with the angiogram and TEE which were done last Wednesday and then the appointment with the surgeon was last Thursday.

The angiogram showed no arterial blockages which was great news! But the TEE showed a valve opening of 1.1 cm2 which is much better than the .9 cm2 indicated in the previous echo of late October. The gradients were also slightly better (mean 25mmg and peak 44mmg). The ejection fraction was 55%. The TEE also showed thickened Mitral leaflets and mild regurg, something the previous echo did not show. Makes me wonder which echo to trust, but I think it is assumed the TEE is the most accurate.

When meeting with the surgeon he explained that in terms of risk management we were at a point where the risk of surgery versus the risk of waiting was about equal. He and the cardiologist are both in agreement that we can go ahead with the surgery in late January as originally planned. But they also say that given what the TEE shows, I could delay the surgery for a year and maybe even two years with the idea of keeping a close watch on symptoms.

The surgeon did not seem concerned about the thickened Mitral leaflets or the regurg. He did say that on some patients Mitral regurg improves after Aortic valve replacement.

It's a real tough choice! But at this time I am leaning towards just going ahead and getting it over with. But my mind changes on an almost hourly basis.

My final decision will be made at my next appointment with the surgeon on January 17 at which time we will discuss valve choices and set (or not set) a surgery date. As many of you have indicated, the waiting room and the decision to proceed or not to proceed may be the toughest part of this whole ordeal. . .

 

[escargome]

First, welcome Vince.
Now this is my opinion and only my opinion (like bellybuttons, everyone has one). Anyway, you seem to be an active person in otherwise good health. Were it I, I would go ahead and get it done now, while you are feeling strong and will recover I would hope quickly. That line between "do it" and "let's wait" is truly fine. Do your research so you have valid questions to ask the surgeon when you see him/her. I wish you well on this journey to a mended heart.

 

[dick0236]

Hi Vince. I am a believer in doing things "a little too soon, rather than a little too late". Keep a close tab on your condition and listen to the advice of your doctors. When it is time, git 'er dun. This forum can help take a lot of mystery and fear out of this surgery.

 

[healthandhope]

I don't know the measurements you give specifically so this is more a general statement. A second surgeon opinion might help clarify. I recently had two reviews/opinions and I found it gave me alot of confidence when they were the same.

 

[VegasBAV]

I assume you are getting a tissue valve? One thing to consider (which you probably have considered) is that if you wait a year you increase your chances (perhaps only slightly) of outliving the valve and not needing another surgery.

 

[epstns]

This one is so individual. . .

I can agree with VegasBAV in that the newest tissue valves are projected to last 15-25 years (or longer), depending upon the age of the patient at time of implant. At your age, that may or may not indicate a likely re-op, but most of the major heart centers will probably suggest a tissue valve for you. Once the patient is past 55 or 60, the rate of calcification of a tissue valve declines, so they last longer than they would in a younger patient.

The flip side is that the longer you wait, it may become tougher in recovery. I was even less symptomatic than you are - I was still jogging (albeit slower) until a few months prior to my surgery at age 63. The valve surgery went fine, but I developed rhythm management complications immediately after surgery, and 5 days later ended up with a pacemaker. Getting the pacemaker properly adjusted (for me) and adjusting meds took some time, and it really slowed my recovery. Even though I had been a grey-haired gym rat right up until surgery, I was not cleared for cardiac rehab until 12 weeks after surgery. The pace of recovery picked up then, but it hasn't been until the last few months that I've gotten back to my pre-surgery exercise levels - and I'm almost 2 years out now.

My point is that from a medical and statistical viewpoint, you could probably wait a year or two. But from a quality of life standpoint, you may do better having surgery sooner rather than later. This is being said by the original "Let's see how long we can wait" patient. If you're in otherwise good health now and good physical condition, you will recover more rapidly now than you will in 2 or 3 years.

Whichever choice you make, keep a close watch on things and contact your cardio the moment anything changes. Keep us posted, too. We'll be here for you.

 

[Duffey]

I assume you are getting a tissue valve? One thing to consider (which you probably have considered) is that if you wait a year you increase your chances (perhaps only slightly) of outliving the valve and not needing another surgery.

As stated by Vegas, the potential of getting an extra year is one consideration. I'd also check with your insurance and make sure their criteria for replacement is the same as the surgeon's. I remember one member who faced insurance obstacles when he presented with similar numbers.

 

[tgmorris]

Your case sounds similar to mine in that I was diagnosed with Acute Aortic Stenosis with a BAV earlier this year. The Surgeon preferred to err on the side of caution and recommended going with the surgery (no real surprise there) rather than waiting and I had no issues with that based on all my test results. My cardiac cath came back clean other than the calcified BAV. I opted for a tissue valve even though it's likely I'll need future surgery as both my parents made it to their early 90's and I'm 61. Hopefully the replacement process will have improved even further in another 15-20 years

Both my cardio and surgeon indicated it was better to proceed a bit early rather than wait until real complications have set in as that can have a negative impact on the overall outcome. However, in the end, the choice is yours and you need to do what you are comfortable with. In my case my cardio said that at some point I had had a silent heart attack, with the theory being that a piece of the calcium had dislodged and traveled to block blood flow. The surgeon said that based on the test results I could go a while longer or drop dead in 2 months so that spurred things along for me even though I was virtually asymptomatic.

It's now 3+ months later and I'm feeling great. My last cardio visit resulted in me coming off all my meds other that a multivitamin and 81mg aspirin. He also said there was no reason to come back any sooner than 12 months later so I'm basically pretty happy at this point. :thumbup:

 

[Vince]

Thank you very much for all of your comments and insight. I definitely agree with those who have said " a little too soon is better than a little too late"! Many of your comments are very similar to those of my surgeon. That I am in good health now and a very good candidate for a successful outcome. If we wait, things could go down hill in a hurry. And with this thing hanging over my head, it is difficult to make plans for the future. There is a lot to be said for just getting it over with.

The surgeons statement that a bovine valve would likely last from 17-20 years was very encouraging. Especially since at this point I would very happy indeed to survive until I am 80 years old. And my wife and I both have a great deal of confidence in both the cardiologist and the surgeon which makes the decision a little easier.

The cautionary statement concerning insurance is also very much appreciated. We don't anticipate a problem, but we will definitely make sure to be approved before proceeding with surgery.

 

[dick0236]

.....There is a lot to be said for just getting it over with.

.......The surgeons statement that a bovine valve would likely last from 17-20 years was very encouraging. Especially since at this point I would very happy indeed to survive until I am 80 years old.

Makes sense to me.

"I would be very happy indeed to survive until I am 80" .....you probably will. I had to chuckle because I was hoping to live to 50 when they put mine in......and now I am pushing 80 LOL..

 

[pellicle]

Makes sense to me.

"I would be very happy indeed to survive until I am 80" .....you probably will. I had to chuckle because I was hoping to live to 50 when they put mine in......and now I am pushing 80 LOL..

great stuff! As the goals are attained new ones are set, and soon enough the impossible is already attained. Well done. I am hoping something like this can happen for my own goals...

 

[TomAlbers]

Vince, great advice from everyone. I am 46 and just had surgery number 2. This is just me, but back in June my cardio and I talked about doing the surgery in July or wait until December, I wanted to wait until next July. I don't know if waiting caused the issue, but my surgery was pretty difficult due to the calcification of my valve. I just wonder if I had made the decision to have surgery earlier if the valve would have calcified less. I had no real symptoms other than some fatigue, and I worked out religiously to make sure I was in good shape for the surgery. Looking back, again it's only me, but I wish I had not waited. Although, again I have no idea if waiting made the valve calcify more, but it sure didn't help .
Good luck with your decision and let us know if you have surgery in January.
Tom

 

[Vince]

Tom, Thanks for sharing your experience and it is good to hear you are doing well after your recent surgery.

We are still on track with the plan for surgery in late January. And I am also following your example in that I am increasing my exercise in preparation for surgery. Been taking a 2 mile walk everyday. And those walks are really highlighting the need for surgery as they wear me out and often require a nap afterwards.

Dick, Thank you! You help me appreciate that everyday is a gift, and we never know what the good Lord has in store for us. As some one once said, "it ain't over till it's over". My New Years resolution will be to work hard on following your example of one day at a time.

Best wishes to all for a great and fantastic New Year!