this is a question for all my mitral valve repaired brethren. my natural valve some how went from no leakage to severe leakage within six years. now i'm reading that quite a few people have had to have replacements after their repairs failed. so is there anything we can do? i know diet and exercise are good for the heart anyway. but is our repair just in the hands of fate or how good our surgeon was? i never want to have OHS again, so i'm wondering is there anything i can do to keep the sucker repaired. they are supposed to last longer than replacements i thought.
keeping those repairs repaired
- Thread starter ryen0
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Jkm7
Well-known member
sorry...... I removed my post as I originally misread yours.
debster913
Well-known member
I am so with you!
I had mitral valve repair in June '06. My valve had gone from bad to worse almost overnight. My cardio said I was leaking moderately in April the previous year--twelve months later, my valve was in dire need of surgical intervention. My valve, though, was leaking from birth. My valve is myxomatous, which means that at some point in my life, I was going to need surgery.
It does seem like many "repairees" here have needed replacements after repairs, and that does scare the four-letter word out of me. I know you're more recently out of surgery than I am, and like you, I was pretty anxious about the vague threat of re-op in the months following my surgery. Although, like I said, having to have another valve surgery scares me, it doesn't frighten me as much as it did in, let's say, December 2006.
Anyway, I think the skill of the surgeon, the condition your valve post-op, how your heart heals, scar tissue, and all that lovely stuff really determines the long-term outcome of your repair. I've read that anterior leaflet (the front) repairs have a higher rate of re-op than posterior leaflets. There's a journal article about it on the American Heart Association website. I'm not sure why, but I think it's because the front part of the valve has to withstand a lot more pressure than the back one. I had anterior leaflet repair myself.
Don't concern yourself too much with whether or not you'll need another valve surgery. Just focus on living. That's what I try to do, not always with success, but I do my best. My thought is, if you need another surgery, then you do. I really don't think there is anything you yourself can do physically to prevent another surgery.
Take care of yourself and focus on the positives: you're alive, you made it through valve surgery, and you're growing stronger and healthier every day!
Of course, if you have any concerns, always address them with your cardio. Or you can call mine!
Debi (debster913)
I had mitral valve repair in June '06. My valve had gone from bad to worse almost overnight. My cardio said I was leaking moderately in April the previous year--twelve months later, my valve was in dire need of surgical intervention. My valve, though, was leaking from birth. My valve is myxomatous, which means that at some point in my life, I was going to need surgery.
It does seem like many "repairees" here have needed replacements after repairs, and that does scare the four-letter word out of me. I know you're more recently out of surgery than I am, and like you, I was pretty anxious about the vague threat of re-op in the months following my surgery. Although, like I said, having to have another valve surgery scares me, it doesn't frighten me as much as it did in, let's say, December 2006.
Anyway, I think the skill of the surgeon, the condition your valve post-op, how your heart heals, scar tissue, and all that lovely stuff really determines the long-term outcome of your repair. I've read that anterior leaflet (the front) repairs have a higher rate of re-op than posterior leaflets. There's a journal article about it on the American Heart Association website. I'm not sure why, but I think it's because the front part of the valve has to withstand a lot more pressure than the back one. I had anterior leaflet repair myself.
Don't concern yourself too much with whether or not you'll need another valve surgery. Just focus on living. That's what I try to do, not always with success, but I do my best. My thought is, if you need another surgery, then you do. I really don't think there is anything you yourself can do physically to prevent another surgery.
Take care of yourself and focus on the positives: you're alive, you made it through valve surgery, and you're growing stronger and healthier every day!
Of course, if you have any concerns, always address them with your cardio. Or you can call mine!
Debi (debster913)
Ryen0:
My assumption is that long-term success of a repair depends a lot on the original damage to the valve and the repair experience of the surgeon.
One surgeon told my husband that if, after repairing the valve, he got X leakage upon doing a TEE while still in the OR, it would work. If the leakage was past a certain point, he'd replace the valve.
My husband's mitral leaflets were described as in excellent shape. He only had to have repairs done to 2 or 3 chordae. Therefore, we anticipate those holding for a lifetime.
If the leaflets had been myxomatous (tissue degeneration), that might have been another story.
My assumption is that long-term success of a repair depends a lot on the original damage to the valve and the repair experience of the surgeon.
One surgeon told my husband that if, after repairing the valve, he got X leakage upon doing a TEE while still in the OR, it would work. If the leakage was past a certain point, he'd replace the valve.
My husband's mitral leaflets were described as in excellent shape. He only had to have repairs done to 2 or 3 chordae. Therefore, we anticipate those holding for a lifetime.
If the leaflets had been myxomatous (tissue degeneration), that might have been another story.
MikeHeim
Well-known member
There are just too many variables from repair to repair to have any scientific links between personal behavior and valve repair lifespan. From what I've read, there are a few general things, such as avoiding power lifting, smoking (which harden arteries), binge drinking (which narrows arteries), etc. that are often indicated to extend repair life. Unfortunately, these are some of the same things that are indicated for the general population to avoid heart problems, so I don't know if any of them really make a difference.
By far the biggest factor in repair lifespans has to do with the actual surgery itself. In general, most repairs that fail seem to fail pretty quickly (within the first year). As I understand it, the surgeon has to make a call when performing the repair as to how the heart will look after it reshapes post-op. If the heart reshapes in a way that is unexpected by the surgeon, the repair could fail and fail quickly. This is exacerbated by how complicated the repair was to begin with. In general, the easier repairs are on one leaflet where the chordae are still intact. If your repair includes both leaflets (as mine did), the chordae are not intact, or both, your repair is much more complicated and more susceptible to failure. In fact, many surgeons will make the decision to replace a valve and abandon a repair mid-surgery if they find things are more complicated than they expected - which is why everyone getting a repair needs to have a backup plan in case such an event takes place.
The surgeon also has to be very careful to not make the valve opening too small during the surgery with the Annuloplasty ring that is installed around the valve opening. This is a careful balancing act. It makes perfect sense that the surgeon wants to make the valve opening slightly smaller during the surgery as it is much easier to have the repaired leaflets cover a smaller hole than a larger one and gives them much more room for slight errors. The flip side, however, is that as your tissue regrows over the ring, it is possible for the valve to become stenoic if it was too small to begin with – which is another cause of repair failures.
If the above sounds really complicated, it’s because it is. If you are considering a repair, it is extremely important that you find a surgeon who does A LOT of them. It is also important for you to understand how complicated your particular case is. If your one and only goal is to avoid another surgery, my personal advice would be to go ahead and get the valve replaced. However, a good repair has the potential to last a LONG time and there is some good data to back it up. Feel free to read this article:
http://circ.ahajournals.org/cgi/content/full/104/suppl_1/I-8
The best news is that the article above (obviously) covers valve repairs done in the 70’s and early 80’s. Valve repair surgery has come a very long way since then (for instance with the implantation of the Annuloplasty ring) that should make these stats even better.
I wish you the best in your choice going forward.
By far the biggest factor in repair lifespans has to do with the actual surgery itself. In general, most repairs that fail seem to fail pretty quickly (within the first year). As I understand it, the surgeon has to make a call when performing the repair as to how the heart will look after it reshapes post-op. If the heart reshapes in a way that is unexpected by the surgeon, the repair could fail and fail quickly. This is exacerbated by how complicated the repair was to begin with. In general, the easier repairs are on one leaflet where the chordae are still intact. If your repair includes both leaflets (as mine did), the chordae are not intact, or both, your repair is much more complicated and more susceptible to failure. In fact, many surgeons will make the decision to replace a valve and abandon a repair mid-surgery if they find things are more complicated than they expected - which is why everyone getting a repair needs to have a backup plan in case such an event takes place.
The surgeon also has to be very careful to not make the valve opening too small during the surgery with the Annuloplasty ring that is installed around the valve opening. This is a careful balancing act. It makes perfect sense that the surgeon wants to make the valve opening slightly smaller during the surgery as it is much easier to have the repaired leaflets cover a smaller hole than a larger one and gives them much more room for slight errors. The flip side, however, is that as your tissue regrows over the ring, it is possible for the valve to become stenoic if it was too small to begin with – which is another cause of repair failures.
If the above sounds really complicated, it’s because it is. If you are considering a repair, it is extremely important that you find a surgeon who does A LOT of them. It is also important for you to understand how complicated your particular case is. If your one and only goal is to avoid another surgery, my personal advice would be to go ahead and get the valve replaced. However, a good repair has the potential to last a LONG time and there is some good data to back it up. Feel free to read this article:
http://circ.ahajournals.org/cgi/content/full/104/suppl_1/I-8
The best news is that the article above (obviously) covers valve repairs done in the 70’s and early 80’s. Valve repair surgery has come a very long way since then (for instance with the implantation of the Annuloplasty ring) that should make these stats even better.
I wish you the best in your choice going forward.
good to know i'm not the only one worried! i'm trying my best to do like you deb and go back to normal life and try not to think about it. but i just feel for all those who's repairs aren't holding up after i've read so many times that a repair is the gold standard and should last a very long time. i believe i had a barlow type valve with bileaflet prolapse. i really have no idea what that means. my surgeon put in like fourteen chordae and an annual ring and said that it should be a permanent repair. i did go from having a very loud murmur to no murmur at all. having another echo next week, so i guess all you can do is keep an eye on how it holds.
Thanks for the info mike. The choice was already made though, i had a repair done by the davinci robot back three months ago. Dr. Murphy is one of the leading surgeons with this robotic repair of the valve. After my surgery he said that it went perfectly i guess mainly because i was so young and that it should last the rest of my life, of course anything can happen. i'll be tickled pink if it just manages to last twenty or so years.
twinmaker
Well-known member
This is a good question, and I one that I really didn't think about. My mitral stenosis was due to Rheumatic Fever (which I never knew I had) and my repair was done in 1974. The surgeon went in and cut the scar tissue away. He told me at the time that the repair would only last for 10 years at the max. Mine lasted 7 years. My symptoms gradually reappeared before that time. My replacement was done in 1981. I was very young when my repair was done...22 years old and I just took it as gospel that it would have to be replaced in the future. I guess the doc knew what he was talking about because my repair was done in San Francisco and my replacement was done in Omaha. Two different doctors in two different places. There was no question that my valve needed replacing in 1981 from all the pre-surgery tests. I should research why this happened I guess. Maybe it was because of the Rheumatic Fever or maybe because surgery and procedures just weren't that advanced back then in the dark ages. Anyway, I'm hoping your repair lasts you forever! LINDA
Anyway, I'm hoping your repair lasts you forever! LINDAtwinmaker
Well-known member
I did a bit of research just now, and it seems that in the case of Rheumatic Fever, many patients who have had a repair go on to have a replacement. The residual effect of Rheumatic Fever can keep on affecting the valve even after repair. I might add that during those seven years between surgeries my husband and I were able to have our family (a girl and twin boys). I guess the surgeon was buying us some time to do that before the replacement with a mechanical valve. Thank God he was thinking about those things. At our young ages, we were just in shock about the whole thing. LINDA
MikeHeim
Well-known member
Can't believe I missed that in your original post. Sorry!
I am also in the camp that would be happy if my repair lasted 20 years or so. I have had symptoms re-appear off an on in the three years since my surgery, but when I go in to get it checked out, I am always told that everything looks great and eventually the "symptoms" go away on their own. Try not to freak out as bad as I do if this happens, and eventually you will gain more confidence.
Best wishes going forward.
Thanks Linda and Mike. I really feel blessed that i was able to get a repair over replacement. Mine wasn't due to illness, i was born with prolapse. And it pisses me off to no end that every doctor before this said that i should grow out of it and probably would never need surgery. Then bam, out of nowhere it's leaking severe. That is what put the thought in my head that maybe there is something i can do to keep the same thing from happening to my repair. I'm just wanting twenty years, cause at least then i can see my kids grow up!
Herburban1
Well-known member
Thanks you everyone for answering yet another one of my questions I have moderate holosystolic prolapse involving the posterior leaflet.15 days to go.....
