Prosthetic Valve Endocarditis

[Patrian]

Well... I was posting on here for my last surgery, aortic root and valve replacement with Edwards 3000 bovine valve. This was in 2007 or 2008... 6 years ago. My has the forum changed! I couldn't even locate my old username... maybe it's the new forum software?

Everything has been perfect since... In fact my recovery was amazing... driving in 3 weeks... back to normal in 6. Of course I was 27 then.

I have been confirmed with endocarditis on my valve with blood cultures and a TEE. It was a bit hard to detect because it is Staph epidermis which is luckily not very mean, but unfortunately sticky. I failed 6 weeks of vanc only, and am now on a mix of three... I have had to large blood clots as a result in my arteries that feed into my leg, one resulting in surgery to remove. I have been referred to Dr. Gonzales-Stawinski, formerly at Cleveland Clinic, now at Baylor university Medical Center in Dallas. He is supposed to be one of the best at difficult re-ops on valves. I am a bit concerned with his recommendation.. that is a full single peiece homograft root and valve. I am concerned about the long term durability, or lack thereof (remember I am 33 and this will be my third OHS). When asked about this, his thoughts are that homografts are proven resistant to reinfection compared to everything else AND that recent improvements in cath valve procedures would mean that in 5-10 years, my next surgery would be done without cracking the chest... This makes since, still I wonder if this is best.

The team is giving me a lower than usual mortality (10% versus 20%-30%) for this surgery as I have no other symptoms, am not sick, have not been sick, and am in good health with no other health issues.

This being said, I am less concerned about the actual surgery as I am the prospects of another infection and re-op... The cath options sounds good next time around, but this is only an option if the homograft root stay strong while the valve fails.

Any thoughts or experiences with this subject?

Thanks!

Oh, April 8th is the date for me... surgery #3... first was repair at age 5 (don't remember a thing) and 2nd was 2007

 

[Gail in Ca]

Four yrs ago, now, I also was treated successfully for Staph lugdunensis, the cause of my endocarditis. But, it had affected my aortic/graft and leaky mitral valves. My surgeon, Dr Miller, talked to me about the best options for me as it also was my 3rd surgery. He did mention the all in one homograph, but felt it would be my last option as it would only last about 10 yrs. He would only give me this homograph if the tissue was too badly damaged to accept another aortic mechanical inside a hemashield graft. He didn't mention having a cath 4th surgery. He didn't want me to have a 4th surgery. I was 54. When they got in there I had a lot of scar tissue, taking 3 hours to cut thru just to start the surgery. This was the most worrisome part of my having had mulitple surgeries for him, and he was very concerned while talking to me of my options. I would really look into having a homograph, if I were you.
I ended up getting a mechanical carbomedic valve inside a hemashield graft and he repaired my mitral valve. I came thru well. Dr Miller wants his patients to avoid repeat surgeries if possible. That is what I get from him. He has given me 24 yrs now. I have always trusted his expert opinion.

 

[Patrian]

Four yrs ago, now, I also was treated successfully for Staph lugdunensis, the cause of my endocarditis. But, it had affected my aortic/graft and leaky mitral valves. My surgeon, Dr Miller, talked to me about the best options for me as it also was my 3rd surgery. He did mention the all in one homograph, but felt it would be my last option as it would only last about 10 yrs. He would only give me this homograph if the tissue was too badly damaged to accept another aortic mechanical inside a hemashield graft. He didn't mention having a cath 4th surgery. He didn't want me to have a 4th surgery. I was 54. When they got in there I had a lot of scar tissue, taking 3 hours to cut thru just to start the surgery. This was the most worrisome part of my having had mulitple surgeries for him, and he was very concerned while talking to me of my options. I would really look into having a homograph, if I were you.
I ended up getting a mechanical carbomedic valve inside a hemashield graft and he repaired my mitral valve. I came thru well. Dr Miller wants his patients to avoid repeat surgeries if possible. That is what I get from him. He has given me 24 yrs now. I have always trusted his expert opinion.

Thanks for the reply!

The way I understand it, is that this is a recent change in thought for younger patients as surgeries through cath without opening the chest or cutting on the heart are not the same as a repeat open heart surgery. Cath procedures for valve replacement are a recent thing (outside of Europe). His idea is that the homograft will reduce the chance of a third infection and with the improvements in cath procedures, they will not have to open me up again unless something else goes wrong. They can in theory do 2-3 replacements via the cath as long as the root holds up. Today cath replacements cannot be done on mechanical valves as the stents cannot crush the mechanical valve to the side as with tissue valves.

 

[ottagal]

Thanks for the reply!

The way I understand it, is that this is a recent change in thought for younger patients as surgeries through cath without opening the chest or cutting on the heart are not the same as a repeat open heart surgery. Cath procedures for valve replacement are a recent thing (outside of Europe). His idea is that the homograft will reduce the chance of a third infection and with the improvements in cath procedures, they will not have to open me up again unless something else goes wrong. They can in theory do 2-3 replacements via the cath as long as the root holds up. Today cath replacements cannot be done on mechanical valves as the stents cannot crush the mechanical valve to the side as with tissue valves.

Hi Patrian,

Welcome back to the forum, but I am sorry to hear that you have to go through another surgery due to endocarditis. . I am by no means informed to comment on your surgeon's recommendation as I have only been through one surgery.

However, when you mentioned the 'cath' procedure for future re-do, it struck a familiar cord with me. I have an aortic bioprosthetic valve and will at some point need a re-op (hopefully not for awhile). My surgeon told me not to count on a transcatheter procedure for my future valve replacement as my current bioprosthetic valve does does not meet the criteria for valve in valve procedure at this point (it is a 21mm size) . This is something that you may want to ask your surgeon about.
Keeping you in my thoughts and wishing you all the best.

 

[WalkidianNY]

Hi patrian,
Just out of curiosity, how long did it take them to give u a diagnosis?
I'm asking because I was being cultured for 1 month with everything being negative (blood cultures, tee)
I wish luck with ur surgery!!!

 

[Bina]

wondering if Patrian made it into surgery today?
Best wishes !!

 

[pellicle]

Yes, me too.

Mate, for when you come out best wishes from this end.