Mitral Valve repair question

[cp172]

Hi Guys,

I am three weeks post surgery and was cleared to return to work yesterday. All restrictions were lifted by surgeon with the caveat that I listen to my body and refrain from going to the gym for 60 days.I am doing great.I do find it interesting that when I cough (without my cardio bear being hugged) I never know what will hurt. Lately it feels like a hundred bee strings on my back. Surgeon says this is result of his moving nerves and once they heal I will be good as new.

My mitral valve was repaired (congential defect) by partial use of the daVinci surgical system.The procedure was minimal invasive. A ring was installed at the valve site and a broken chordae removed and replaced by an extra chordae. The surgeon says I have 0 regurgitation. A maze was also done. I have been taken off warfain and sotalol. Blood pressure, heart rate and sinus rythem have all been excellent (knock on wood).The surgeon indicated that the repair should last decades. Has anyone else had such surgery and how long did your repair last?

To all you VR members who told me the wait was worse than the surgery. You were right.

 

[Adrienne]

I had a mitral valve repair in October 2005 along with a partial maze procedure (left side maze). I had two cordae replaced by Goretex cordae and a synthetic ring put around the annulus. I had a lot of calcium deposits (probably because of endocarditis in 2004), so the surgeon did a sternotomy, and he ended up having to do a very complicated repair. He said that if he had done a minimally invasive procedure from the side, he would have had to replace the valve (oh, he also had to patch up a patent foramen ovale which is like an atrial septal defect). He told me it should last at least 20 years. I told him it had to be at least 30 years since there is longevity in my family!! He answered saying, Oh, it'll last 30 years. Actually, with all the calcium deposits and the risk that more develop as I age, I do worry about that. However, in your case, the surgeon is probably right when he says decades.

 

[MikeHeim]

There are people on this site that have had mitral repairs last for a very long time and I'm sure they'll be along shortly to share their stories. One caveat when looking at stats regarding repair longevity: the use of the plastic ring to help the valve keep it's shape is relatively new (I'm sure I'll be corrected, but I think its use has only been common for the last ten years or so), and is designed to significantly help extend the lifespan of the repaired valve.

 

[Adrienne]

CP
If I remember correctly I read somewhere that there is a 5% failure rate each year for mitral valve repair. That means that 5% of the valves may need to be repaired again or replaced by an artifical valve each year. That doesn't really tell how long a particular valve repair will last. A person's over all health plays a big factor in this so I feel those are very good odds. I'm more concerned with maintaining a healthy life style. Otherwise the chances are better that something else will "get you" before your valve goes bad. I trust my surgeon did the best repair possible and I'll get many, many years of good service from the old ticker.

If there is a 5% failure rate each year, wouldn't that mean that in 20 years all repairs will have failed? Am I interpreting those statistics wrong or could you have read something different than that?

 

[WayneGM]

I had a mitral valve repair with a Simplicit-T ring, but not exactly the same surgical procedure. I didn't have a diseased heart, just torn chordae, and I was told by Dr. Tirone David that failure under these circumstances was very rare and the repair should last forever.

 

[MikeHeim]

I have a couple things to add. First of all - I haven't seen the 5% statistic, but regardless, the cumulative "odds" of a 5% annual failure rate over twent years is computed by (1-0.05)^20. That formula will calculate the odds that your repair will have not failed and comes to about 35.8%.

Here is the study I usually site (the most comprehensive one I have found), and gives a much lower failure rate:
http://circ.ahajournals.org/cgi/content/full/104/suppl_1/I-8

The final note I had about repairs is that the failure rate is not spread evenly over time. That is, most of the people who have repairs fail have them fail very quickly - usually within the first few months. Reaching the one year point is crucial and is typically an indication that the repair will hold for a long, long, time. The reason for the high failure rate within that first year is that (especially those who have had significant ventricular enlargement) a surgeon has to repair a valve for what the heart will look like when it is healed and reshaped. The more the heart has to reshape, the more difficult that task becomes - the plastic ring helps in this respect. Once the heart has healed and the repair is holding, there is nothing preventing a long life for the repair overall.

Best wishes.

 

[cp172]

Thanks Guys,

Your comments make me feel good that maybe the repair will last a long time. It is amazing what our surgeons can do.I hope you are all doing well.

 

[cp172]

Gkenney,

Thanks for the articles. They were most helpful!