Question About Subsequent Surgeries

[cbdheartman]

Someone below mentioned having a third OHS and that there could be risks/issues because of scar tissue. Can anyone give me some background on that? Is that one reason why the docs want to hold off the first surgery as long as possible?

 

[DavesMom]

Hi there,

I mentioned that in my case a redo is risky because of scar tissue. To make a long story short, scar tissue has caused my right ventricle to become stuck to my sternum. This does NOT happen to everyone so please don't let me cause you undo worry.

You can PM me if you have any other questions. But let me emphasize again: this doesn't happen to everyone so don't let me worry you.

Cheers,
Michelle

 

[Nancy]

Joe had three valve surgeries and needed a fourth.

The first surgery in an uncomplicated case with an otherwise healthy person has a 1-2% mortality rate, and the lower number with a good surgeon. That was the case for Joe.

When Joe was faced with a second surgery, he was still fairly healthy, and was quoted about the same mortality rate as the first surgery.

When he faced his third surgery, he had many medical issues, but they were controllable. His cardiologist was loathe to recommend surgery, and dragged his heels for a very long time. Joe was not a person to fool around (triple type A personality), and he was quite symptomatic. He spoke directly with his surgeon, and also his cardiologist and forced the issue.

Instead of opening up the sternum again, the surgeon did a HeartPort surgery through the side.

He was quoted a 15% mortality rate.

He actually did very well with this surgery.

Along the way, Joe also had two serious lung surgeries, one on one side for a benign tumor, and one on the other side for a pleural peel.

Then his tricuspid started acting up, and he also developed an enlarged aortic root. Along with that, his overall health deteriorated, and he had Pulmonary Hypertension which complicated things a great deal.

As far as getting a 4th valve surgery, no one would operate on him at this point, and his symptoms were handled medically. His doctors all told him very frankly that a 4th surgery was not an option and that he would not make it off the table. Eventually, he developed multiple organ failure.

This might not happen the same way for others, but it demonstrates how one's overall health can influence subsequent surgical outcomes.

And it is why it is impossible to predict what will happen to you in the future.

Many of the questions you are seeking answers for really have no answers, and won't until the actual time arrives.

 

[Lynlw]

AS Davesmom said, the scarring issues are the internal scars that can make other surgeries more difficult, either your heart can get fused to the sternum (Justin's was fused to his sternum before both he 4th and 5th OHS) and just all around tougher to cut thru and see the various parts easily. BUt I doubt that would be why Svensson adived to wait, because the leading centers, particularly those that operate on kids born with CHDs have alot of experience operating on kids/adults that have multiple redos and the safests ways to do everything. (Many of the more complex congenital heart defects, need 2 or 3 surgeries before the kid is in kindergarden) Actually one of the reasons CCF has been doing more and more tissue valves is because THEIR stats for redos are great. (the other is the newer tissues last longer) I don't know it for a fact, but would guess unless something goes drastically wrong, by the time you would need your third surgery (this is your first right?) either replacement will be done by cath or very min invasive and the surgeons will have even more experience operating on people that have 3 or more surgeries. (at least at the leading centers) So all this is to say, that might play a small part in Svensson and the other surgeon who suggested to wait, but I can't imagine it played that big of a part (unless I'm worng and you've already had surgery, I know we (CARDS, SURGEONS, ME) tried to put off Justin's 4th surgery as long as possible, and scarring played a small part in the reason why, the main reason was trying to give him a chance to reach full height) This is not to say scarring isn't a huge issue, I know surgeons get nervous about operating on Justin anymore, but he's had 5 OHS and just turned 21, you just have to be sure to go to the best where both the surgeon and the staff have alot of experience dealing with multiple redos (3 or more) people and hope for the best.

 

[dick0236]

Someone below mentioned having a third OHS and that there could be risks/issues because of scar tissue. Can anyone give me some background on that? Is that one reason why the docs want to hold off the first surgery as long as possible?

In my opinion, doctors hold off surgical correction until the risk of not doing surgery outweighs the risk of doing surgery.

Modern valves are designed to last lifetimes. Reops are usually necessary because some new issue develops. I have not required any further surgeries because my problem was "fixed" and, fortunately or lucky, I have had no new issues. You can go thru all the "what ifs" and drive yourself crazy...I know because I did. The best we can do is get it "fixed when it breaks" and live our lives until, if or when, we need to "fix it again".

My latest "what if" is that my valve may last until I am in my 80s (beyond its 50 year design life) and what decision will I make concerning surgery in my 80s. On the other hand, I have put this valve thru "hell" and it continues to work....so maybe it will take me the rest of the way.

 

[MrP]

With BAV and ascending aortic aneurysm, five years ago I decided on a mechanical valve with composite Dacron graft to greatly lower risks for another sugery down the road. I most definitely do not want a redo operation.

Valve repair and aneurysm resection will most likely mean a redo operation for you, and BAV replacment with tissue valve at your age will guarantee one or more surgeries down the road since tissue valves calcify faster in younger people.

 

[Gail in Ca]

Dr Miller told my husband it took almost 4 hrs just to get into the sternum and start on the heart valves! This was due to the scar tissue from 2 previous OHS. Apparently, dealing with scar tissue is what makes redo's so risky. Both my surgeon and the chief surgical resident and the PA told me this. I was clueless before this and thought it would be easier for them to get into me because I had had my wires out from the 2nd surgery over 8 yrs ago. He said the wires really were nothing to worry about, it was the scar tissue.
This is why Dr Miller is so much in favor of mechanical valves for the 1st surgery, if at all possible. My 3rd OHS took 12 hours!
( I am not the only one in my family who wondered about bathroom breaks for the poor surgeons!)

 

[laurad37]

I just had my 3rd OHS... It took the doctors about 3.5 hours just to get through the scar tissue and get to work inside. It is not a reason to put off surgery. My surgeon told me ahead of time that getting through all of my scar tissue would be his biggest challenge. But he did it. I had my pulmonary valve replaced, tricuspid repaired and a right side Maze procedure and the entire surgery took about 8.5 hours. That's including the 3.5 it took to get through the scar tissue.

 

[laurad37]

Dr Miller told my husband it took almost 4 hrs just to get into the sternum and start on the heart valves! This was due to the scar tissue from 2 previous OHS. Apparently, dealing with scar tissue is what makes redo's so risky. Both my surgeon and the chief surgical resident and the PA told me this. I was clueless before this and thought it would be easier for them to get into me because I had had my wires out from the 2nd surgery over 8 yrs ago. He said the wires really were nothing to worry about, it was the scar tissue.
This is why Dr Miller is so much in favor of mechanical valves for the 1st surgery, if at all possible. My 3rd OHS took 12 hours!
( I am not the only one in my family who wondered about bathroom breaks for the poor surgeons!)

I wasn't so worried about the bathroom breaks as them eating something during the 10 hours they were with me.

 

[cbdheartman]

So this is a real issue. Wow. I never knew about this. But still people don't think this is a reason not to do it?

 

[zipper2]

Was an issue for me and ONLY( LOL) my second surgery
1st was 17 years ago and just from 17 years ago my scar tissue
was so bad ,my surgeon who wasnot available to do it said it'd be his first and last time doing ohs on me cus scar tissue was so bad,turned out he got hit by a car and cus broken leg couldnt do it.But he said 8 hours,other surgeon was 4ish hours. So depends on surgeons experience too.
but another surgeon did it and my heart was plum in middle stuck to my sternum when he opened me up,which the 1st injured surgeon didn't tell me. Didn't realize scar tissue was an issue either till my 2nd surgery.

Even if ,IF a 3rd time to find a surgeon to do it if need be would be hard here in Canada.

BUT I'M NOT PLANNING A 3RD EITHER. Boy oh Boy

zipper2 (DEB)

 

[pamela]

Sometimes the alternative isn't very attractive. (read DEATH) Valve choice is personal and no matter which way you and your surgeon choose to go, there is always a risk of re-op or the need for long-term ACT. Two things are certain though...

(1) Without surgery your valve will continue to perform poorly, eventually causing the above mentioned DEATH alternative; and; (2) nothing is ever certain.

Take Heart,
Pamela.

 

[cbdheartman]

Sometimes the alternative isn't very attractive. (read DEATH) Valve choice is personal and no matter which way you and your surgeon choose to go, there is always a risk of re-op or the need for long-term ACT. Two things are certain though...

(1) Without surgery your valve will continue to perform poorly, eventually causing the above mentioned DEATH alternative; and; (2) nothing is ever certain.

Take Heart,
Pamela.

If it were my valve, I'd not be having this conversation right now. It is this darn aneurysm. But I guess you mean the valve down the road...not looking forward to that.

 

[laurad37]

I agree with what Pamela said. I would worry more about what happens if you dont have the surgery rather some some scar tissue that the surgeons deal with on a daily basis.

 

[pamela]

I had aortic root dilation along with the pannus. My surgeon managed to complete the surgery in record time and thus far, I am satisfied with my heart health. Don't forget, untended aneurysms are historically more lethal than valve surgery... Candid discussion with your surgeon should allay any concerns over re-op and surgical complications.

Take Heart,
Pamela.

 

[cbdheartman]

I had aortic root dilation along with the pannus. My surgeon managed to complete the surgery in record time and thus far, I am satisfied with my heart health. Don't forget, untended aneurysms are historically more lethal than valve surgery... Candid discussion with your surgeon should allay any concerns over re-op and surgical complications.

Take Heart,
Pamela.

what is pannus?

 

[Ross]

what is pannus?

Pannus is a medical term for a hanging flap of tissue

 

[ALCapshaw2]

Since you are doing so much Medical Research, it would be beneficial to purchase a Medical Dictionary. They range from Very Expensive Bound versions to relatively inexpensive Paperback Versions.

Pannus Tissue Growth is often throught to be a reaction of your vessels to having an artificial valve sewn into the vessel. It has been reported by recipients of both Tissue and Mechanical Valves. The tissue can 'impinge' or block the motion of Mechanical Valves. The On-X Valve is the ONLY valve I am aware of that has a Barrier to retard / prevent Pannus Tissue impingement of the leaflets.

'AL Capshaw'

 

[pamela]

what is pannus?

I defined this on a thread started by Westie in Heart Talk:

First, pannus isn't scar tissue. It's fibroid and consists of cells your body uses to build the scaffold for your connective tissue bits to heal and grow. Because of the proximal incision on your aorta close to the valve, the blood may be slightly turbulent and leave your antibodies and signalling cells confused as to what job they're to do.

So, your autonomous healing mechanisms go to work and actually deposit those sticky cells on the structures of the prosthetic heart valve rather than keeping them dissolved in the blood, on call for when they'll be needed to build a sticky framework for the blood to clot against and start wound healing.

Take Heart, pannus is rare the TTE may give an indication of a problem, but a trans-esophogeal echo is the definitive test since the fibriod nature of the pannus means it's more echogenic than a blood clot, which can behave in similar ways, but with much more serious possible consequence in the short term compared to the pannus.

 

[marilyn]

Could you tell me what kind of symptoms you had with the tricuspid. Mine is mod/severe. I have blockages that cause me symptoms, so I am not sure I would recognize the symptoms of the tricuspid valve. Also, the mitral valve regurgitates. It is moderate.