Mitral Valve Repair vs Mitral Valve Replacement

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H

Harmony

Well-known member
Joined
Jan 10, 2005
Messages
145
Location
New York, NY
Seven months ago I had my MV repaired wirh minimal evasive surgery. They did not cut the breastbone only cut on top of right breast and I believe under right breast. I believed this was the best way to go. However in the past months [ have read about many people who had MV repair and within a year needed MV replacement. I am worried this may happen to me. My Cardio and Surgeon tell me I healed well and every thing is back to normal. My echo is like someone who has had no valve problems. I spent 15 days in hospital after surgery and when I came home had horrible GI problems. Spent weeks in ER . So I am worried about future surgery
 
As in everything - there are no guarantees. Surgeons do repairs if they believe they will last a long time. Some don't. If the surgeon didn't think a repair would last long for you, my guess is that they would have just done a replacement. My advice is to rejoice at your good echo and live life. You will know if/when your valve is beginning to fail.

Best wishes!
 
Harmony,
I had a MV Repair in Feb 2007. I was told it was best to keep my native valve if the surgeon deems a repair is appropriate. My last echo showed some increased leakage but nothing that concerned my cardiologist. I view my current cardiologist as fairly conservative in his approach so if he tells me not to worry I listen. He said my heart size was normal, as was the EF. I feel great so that's important. I am an active person who exercises on a regular basis so that says a lot.

We just have to take it one day at a time and see what our heart decides to do and stay in tune to any changes. The other important factor is having a cardiologist you trust.

Chris
 
That was my worst nightmare and I told that to my cardio and surgeon.
I was very worried about having a failed repair.
No guarantees in OHS just like in life. I was more relieved than not when I woke and learned my surgeon had tried the repair, decided it was not going to be good and proceeded to replace with tissue valve......as we had discussed in advance.

Certainly hope all the repairs here are good ones.
 
I think almost everyone that had OHS has thought at one time or another "what if it doesn't work". I am in the same boat as you and had my mitral valve repaired just three weeks ago. The surgeon stated during our pre-surgical meeting that studies show 90% of repaired mitral valves are free from further surgical intervention for 20 years. I've been thinking about your exact same concern for the last few days, as have others who recently had MV repair that I've emailed. According to your post, you sound like your doing just fine. Just know, there are other people with the same thought in the back of their mind. No guarantees and all you can do is hope that 1) the repair sticks 2) if it fails, they have an easier way fix it the next time :eek: .
 
The metric I was given was that 1/2 of 1% of repairs fail annually. Which I believe would mean that there is a 20% chance that the repair will fail in 40 years (just some rough math - I'm no statician, but I believe that's what it works out to).

I was also told that replaces were failing at closer to 1% annually. Which lead me to believe that the a repair was almost twice as reliable as a replace.

Is this different from what others were told?

Being on this side of the mountain now, I have to concur - my biggest fear is a failed repair requiring a reoperation. I'm hoping to continue to live a lifestyle that minimizes those odds (ie. heart healthy diet, heart healthy exercise, etc...)
 
deano89 said:
think repairs depend on the skill of the surgeon if you had a good experienced surgeon it should last a life time but evrything we make or do from a dvd player to a heart valve there will be a small percentage failure rate
Click to expand...


Have to consider the condition of the valve when you go for surgery as a huge factor.
Where the damage is, what sort of damage..... lots of variables. Some valves are not suitable for good repair.
My surgery was at Mass General (consistently rated one of the top five heart centers in the U.S.) and my surgeon was one of the most experienced heart surgeons there.
 
Does the type of mvr matter? In my case they removed a bad chordea and replaced it with an extra one.
 
cp172 said:
Does the type of mvr matter? In my case they removed a bad chordea and replaced it with an extra one.
Click to expand...

Here is a passage from the article Marcia58 sent:

"David and colleagues also presented 20 year follow-up for patients (operated between 1981 and 2001) using a variety of repair techniques, including conventional Carpentier techniques and gortex neochordoplasty, and found 96%, 88% and 94% freedom from re-operation rates at 12 years for posterior, anterior and bileaflet prolapse respectively."

That line was particularly important to me as I had two chordae replaced by Gortex neochordae.
 
MaryC said:
Harmony,
I had a MV Repair in Feb 2007. I was told it was best to keep my native valve if the surgeon deems a repair is appropriate. My last echo showed some increased leakage but nothing that concerned my cardiologist. I view my current cardiologist as fairly conservative in his approach so if he tells me not to worry I listen. He said my heart size was normal, as was the EF. I feel great so that's important. I am an active person who exercises on a regular basis so that says a lot.

We just have to take it one day at a time and see what our heart decides to do and stay in tune to any changes. The other important factor is having a cardiologist you trust.



Chris
Click to expand...


I quoted this because this is my (almost) exact experience. My mitral repair was in June 2006, and so far, so good. Like Chris mentioned, my cardio tends to be conservative and so if there is a need to be alarmed, then I'll also be alarmed. At my latest echo this September, my EF was good, my pressures were good, and my annuloplasty ring is working very well. I have a very mild leak, but my cardio was completely unconcerned about that and explained it as normal this far out after surgery. Like my very skilled surgeon, my cardio believes my valve will last me the rest of my life. :D And, I have a really awesome cardio who I respect. I trust his advice on so many things and feel comfortable sharing even heart-unrelated things with him. He's like a "big brother" to me. :cool:

As someone who has recently lost 25 pounds (all "bereavement weight" after my mom died in 2007) and has learned to love exercise, I feel better than I have in years, and I know this would not have been possible without the surgery. Sure, in the beginning, especially the first 6 months after surgery, I worried about my repair lasting. But like everything else in life, I can sit around worrying about things that likely will never happen, or I can go out and enjoy my life. I choose to enjoy life.

If my valve does fail again someday, then it will. There is nothing I can do about it. I'm not going to worry unless my cardio does...and if he does, then we know we have a real problem!

I know you've had a lot of worries Harmony, but you'll be fine. I hope you have a cardio who you trust and respect.

Besides, your echo report sounds a lot like mine after surgery, and that's great news! :D:D:D

Best,
 
No need to be alarmed, Harmony. My surgeon was not sure whether to repair or replace my valve, but once he looked at it, he decided to replace it. Responding to repairs or replacement differs from one person to another and what happened to others does not mean could happen to you. As long as your echos are good, enjoy 'todays' and do not worry about the far future.:)
 
I went with replacement but I needed an Aortic Valve replacement anyway. Asked surgeon to take a look to see about repair and they got about halfway through before they discovered some more damage and lopped off the valve :)

In the pre-surgery consults Dr. Sundt seemed confident that chances were good that I'd be surgery free in the future (barring complications, of course) for the rest of my life, repair or replacement.

AV repair doesn't have the same longevity, but that's as much due to lack of long term cases as it is less effectiveness, at least according to Sundt.
 
Adrienne said:
Here is a passage from the article Marcia58 sent:

"David and colleagues also presented 20 year follow-up for patients (operated between 1981 and 2001) using a variety of repair techniques, including conventional Carpentier techniques and gortex neochordoplasty, and found 96%, 88% and 94% freedom from re-operation rates at 12 years for posterior, anterior and bileaflet prolapse respectively."

That line was particularly important to me as I had two chordae replaced by Gortex neochordae.
Click to expand...

Adrienne,
Can you describe the various techniques? I am not familiar with them.

Many Thanks,
 
cp172 said:
Adrienne,
Can you describe the various techniques? I am not familiar with them.

Many Thanks,
Click to expand...

I think that when they speak about conventional Carpentier techniques, they are speaking about doing a resection of the mitral valve where they cut out the bad section of the leaflet and attach the two ends of the leaflet that were not cut out. This is what they usually try to do and what my surgeon first wanted to do. The reason he couldn't was because the P1 scallop of my posterior leaflet was too calcified to attach to anything (he wanted to cut out P2 and attach or slide P1 into P3). So, instead, since I had two chordae which were ruptured, he made Gortex neochordae and pulled down the posterior leaflet so that even though the thickened part of P2 which had originally made the valve prolapse was still there, he was able to pull it down enough to make it shut correctly (there is a mild leak now, but that is no big thing). So, that procedure would be Gortex neochordoplasty. My surgeon also put a ring around the valve which I think they all do.

That's about as much as I can tell you.
 
Mickey, Adrienne, Deb,

In case you're interested, you can see a clip of my MV repair here. About 19 seconds into the clip, you see my gortex replacement chordae. About 45 seconds in, you see my annuloplasty ring (AKA "my underwire heart valve") and you see the doctor test the valve for leakage.

It's not going to be exactly the same as yours, but maybe it can give you an idea....

Marcia

P.S. It's NOT real bloody.
 
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Thank you for all the nice replys. Very interesting. Guess it will take me a while to stop worrying. My Cadio of 13 years keeps telling me everything turned out fantastic. He said if I compared copies of last weeks echo and ekg with ones of someone who never had heart disease they could never tell the difference. My surgeon is head of Cardiothoracic Surgery at NYU Medica. I feel I picked the best surgeon. He told me he would do a repair and he did. He told me never did he think a repair was not possible. Guess I should stop worrying. I have been throught so much for the past 4 years..It is hard but I know I must try.Your help means a lot to me
 
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