Mitral Valve Repair Failure - Now What?

[onset]

Hello, I wanted to see if anyone has had a similar experience and/or thoughts on my situation. I'm a healthy 50 yr old women diagnosed with severe mitral regurgitation 7 yrs ago, which was treated with meds and followed with echos. On Dec 14, 2012 I had a mitral valve repair done at the Cleveland Clinic-did fine after surgery. Had my first follow-up echo last week which showed severe regurg and EF 40%, this was followed by TEE basically showing the same thing My cardiologist insists I need a re-op to address ongoing regurg within the next 3 months. My TEE was sent to Cleveland for review and I plan to meet with surgeon to discuss , also plan to get a few second opinions. BTW - I was asymtomatic before the initial repair and am still am.

After everything settles I anticipate having the following options; have the valve replaced now or do nothing and replace if/when I become symptomatic.

Thanks

 

[Boston Tiger]

Wow, what a tough situation. I think your plan to talk to the surgeon and get some second opinions is the only way to go. If the doctors are unanimous with their decisions, then you really won't have much of a choice. The question will come down to whether your heart is being damaged by the regurgitation from the failed repair. Best of luck.

 

[Jkm7]

I am so sorry to read this.
That was my worst nightmare.
My great Mass General surgeon wanted to do Mitral Repair and I was very leery about it. It is not common but definitely not unheard of for a repair to fail soon after surgery. We discussed it and seeing this was my second OHS with him (the first had nothing to do with this valve), I totally trusted him but he knew I worried a lot about the repair not holding.

He and my anesthesiologist tried hard to repair it, they weren't satisfied with it and went ahead and implanted tissue valve as had been my wish.

When I woke and my surgeon described what they had done, I was relieved.
It's lousy news for you to get but if it is any consoloation, it Does happen and has happened to others.
It sounds you have no choice but to go ahead with a replacement surgery.

Keep in mind there is a point of no return when you can have waited too long and the valve/your heart suffers so much, it is too late. I am sure your cardio can discuss this with you better than any of us here.

Sending you the very best wishes.
Let us know how it is going for you.

 

[normofthenorth]

"It is too late" may be a bit too dramatic, or fatal sounding, IMHO. Usually waiting too long for a valve repair-or-replace "only" means that the heart has adapted to the bad valve so much, that some of the adaptations aren't fully reversed after the valve job. E.g., the LV gets bigger and stronger (thicker-walled), and it may not return to normal afterwards. That can cause problems, but they're not usually anything like fatal.

Relatively recently, it was still unheard-of for anybody to get a valve job before they had symptoms. Now that's shifted, and much more weight is given to the results of echo cardiograms, MRIs, and TEEs, etc. Physically, that trend is all good, though I think that recovering from OHS/HVR would be psychologically harder for most patients without any pre-op symptoms.

 

[Jkm7]

Actually, only speaking for what my cardio said to me at the time we discussed the fact I needed a second surgery was "there is a point of no return". Exact words.

 

[catwoman]

What exactly was the problem that led to the repair? The Cleveland Clinic & Mayo Clinic pioneered repair jobs.
Nine years I was told I needed valve surgery and was told to go to either the Cleveland or the Mayo, because if it could be repaired, I'd be able to get it done at either place. I stayed in Texas for surgery, but a repair wasn't in the cards -- my surgeon tried a repair, did another TEE on the OR table and had to replace the valve.

Like others, I suggest you consult the surgeon and get a 2nd opinion from both another cardio & another surgeon.

There are several very good heart hospitals in STL, where you live. I'm sure you can get a good 2nd opinion there.

Good luck.

 

[Marty]

My advice. Find a good experienced surgeon. Request implant of mechanical St Jude. Repeat repair very risky for long haul. At your age you would very likely need repeat surgery if you opted for tissue valve. Learn warfarin. We can help.
Purchase INRatio monitor and self test. After a while you can self dose.

 

[Lynlw]

Actually, only speaking for what my cardio said to me at the time we discussed the fact I needed a second surgery was "there is a point of no return". Exact words.

From most things I've read or talked to docs about, I don't think you were being "overly dramatic" at all since IF you wait "too long" not only can the heart NOT recover fully, but there IS an increased rate of cardiac related or even sudden death (or strokes), Even in patients with severe Mitral regurge who are asymtomatic. My guess would be since the Ef is lower, chances are the risks of fatal outcomes or a stroke are even higher. Altho of course alot depends on what the problem is with the Mitral valve, but with severe regurgitation and left ventricle problems there can certainly be a time it is too late to help.

Onset, I'm sorry to hear your repair failed so soon. Have you heard back from CCF yet? I also would reccomend getting other opions too. It's hard to guess what to do without knowing more info. as catwoman asked what was your problem that needed repaired and what kind of repair did you have? How do your results now (left ventricle size and vol, EF etc) compare to before your surgery? Has there been any improvement or are things even worse now than before surgery.

 

[onset]

I've learned a lot over the past week. I did hear back from Cleveland, and bottom line, I just happened to fall into that 1% of repairs that fail. So, I've come to terms with that. I've had second option from both a local cardiologist and cardiothoratic surgeon. They feel it's not urgent that i have surgery right away, both recommended waiting least 6 months. So, as of today I plan to have valve replacement in July or August and opt for a tissue valve. Not sure where I'll have the surgery, St Louis or Cleveland. That's the next decision to be made.

Thanks everyone for you support, this is an awesome group.

 

[Lynlw]

I've learned a lot over the past week. I did hear back from Cleveland, and bottom line, I just happened to fall into that 1% of repairs that fail. So, I've come to terms with that. I've had second option from both a local cardiologist and cardiothoratic surgeon. They feel it's not urgent that i have surgery right away, both recommended waiting least 6 months. So, as of today I plan to have valve replacement in July or August and opt for a tissue valve. Not sure where I'll have the surgery, St Louis or Cleveland. That's the next decision to be made.

Thanks everyone for you support, this is an awesome group.

Sorry to hear it did fail, but glad to hear they got back to you soon and didnt make you wait around and worry about what is going on. I know how disapointing, to say the least it is too find out you (or in my case a Loved one) need surgery again MUCH sooner than you ever thought possible. I can't help you on the choice of where to have surgery, both places have really good surgeons and going for them, like closer to home or have the same surgeon who knows exacty what he did etc.