Risk for Heart Attack or Stroke after Surgery

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Dominic11

New member
Joined
Dec 27, 2011
Messages
3
Location
Columbus, Ohio
I am over 8 months out from successful Ascending Aortic Aneurysm repair surgery. I am 30 years old and otherwise in great health and condition. They kept my BAV in place for now as the surgeon felt it was in good shape. My question to you all is...Are those of us that had a similar surgery at a much greater risk for a heart attack or stroke post surgery than other non-cardiac individuals? If so any info on the risks and why? Thanks and God Bless!
 
I don't think heart attack (MI) risk is significantly elevated, esp. if (like most of us BAVers) you have clean coronary arteries. Stroke risk is definitely elevated by A-Fib (a common complication) and by ACT (e.g.,Warfarin). The simple fact of major surgery, and disruptions to big blood vessels like the Aorta, creates some risk of bleeding and/or thrombosis, which does bring some elevated stroke risk. I think it's esp. concentrated in the first few months, but I've got no data and I think I've seen none. IIRC, the new non-invasive TAVI system of AV replacement has shown somewhat higher stroke risk than OHS, but maybe no higher overall mortality.

I'm sure there are some good studies or even meta-studies out there, to quantify the risks. I've got (and have discussed here) a fancy study that summarizes the Toronto results with many patients who received one particular tissue valve, but that's not right on point for you. Among these 1134 patients followed for a long time (mean 12.2 yrs, up to 25+ yrs for a few), 622 had died, and only 31 had died of stroke, which doesn't sound elevated to me. 89 patients had experienced a stroke, and 34 had TIAs. Mean age (at op) was 67 +/- 11 yrs, and we oldsters do get strokes. . .

I think other studies have shown that (e.g.) AVR (mech or tissue) does not significantly shorten life expectancy, overall, so I don't think there's much "room" for "a much greater risk for a heart attack or stroke post surgery than other non-cardiac individuals". None of us gets a guarantee for any part of this, of course, and the long-term mortality rate is 100%. . . but I'd say "No." FWIW.
 
Hi Dominick, Since yo are 8 months out from surgery, have your own native valves and didn't mention having Afib or being on any meds for it, my guess would by you aren't at any increased risk of stroke or heart attack than someone your age who didnt have surgery. Heart attacks are usually caused by plaqu build up in the coronary arteries blocking blood to the heart muscle and usually , but of course not always people wih BAV tend to have clean arteries, my guess would be if you have plaque build up they would have told you and started meds suggested you change your diet, so there is a good chance you have less odds of having a heart atack than many other people who dont know they have plaque build up.
 
I agree with Lynlw.
If you have clean arteries, maintain a healthy life style, exercise and eat well, keep your cholesterol and weight in good ranges and DON'T smoke...... depending upon whatever genetic factors you may have, your risk of MI is probably no different than anyone of your contempories who never had the surgery you had.
 
Dominic, what my surgeon & cardiologist say is that in the weeks after surgery, one has an elevated risk of stroke but that decreases over time. By six months past surgery, they said you have no special risk if your recovery was uneventful. As for heart attacks, just as Lyn said, those are caused by block arteries and that would have been checked before your surgery so they could perform bypasses if needed. If you have any doubts, ask your cardiologist what was found. There is a lot of information available in your medical records than doesn't always get passed along to us. You might also consider asking your family doctor to review the surgical records.

Larry
 
Oh, they were around 67 years of age

Yes, around 67 avg age when they got the HVR, and avg ~79+ when the last followup "snapshot" was taken. Those are mean numbers, and about half were older, including much older. So we'd expect many of them to have died, even w/o the HVR.

Meanwhile, it's still the case that we're all writing the same opinions - ours or our Docs' - but it's all opinions! In my post at the top, I kept writing "I think", hoping that somebody else had some data. Then Lyn agreed with my opinion, using the word "guess" a lot. The main verb after Lyn is "agree".

All these consensual opinions may be true, but the scientist in me would love to see some evidence. (The skeptic in me remembers when we all "knew" what caused stomach ulcers, etc. etc.)
 
Well, I've got an opinion also, but a slightly different one this time, and with limited evidence of sorts:

My surgeon touched on this topic when discussing stroke risk with prosthetic valves. He said that my native BAV (which was moderate to severe stenotic) actually posed a slight stroke risk, although very low, a fraction (1/5) of a percent. Now, since he was about to replace it, I didn't much care at the time, so didn't grill him further on the matter. But I was curious about it later, and since it did seem to make reasonable sense that it might be slightly higher than non BAV folks, I tried to research a little further. I found several limited study (20 patients or less) reports that linked BAV to stroke, but if memory serves, all were in the presence of moderate to severe calcification. Further, these were not official studies, these were patients who had stroke events, that were subsequently analyzed because they also had BAV and no other contributing factors. Now, with that said, the analyses did seem reasonable and appropriate and not completely out of left field (like saying that BAV causes diabetes because in a case study of 1 (me), it happened), and if/when I have time (admittedly a struggle of late), I can try and track them down.

Of course, back to the point on evidence, any thorough study establishing evidence of stroke risk in a given patient group usually involves a major intervention. In other words, when a large group of patients are having their valves replaced as one example, or taking an anticoagulant for A-Fib as another, it makes perfect sense to find out what everyone wants to know - is the intervention successful and what are the risks of things like stroke. However, if normally functioning BAV patients are walking around with at worst a fraction of a percent chance of stroke that perhaps happens only in the presence of valve deterioration (when the valve would be replaced anyway), there just doesn't seem to me to be much cause to put together a comprehensive study, particularly when there aren't any sponsoring entities (valve manufacturers, drug companies, etc) with a stake in the results.

So, who knows for sure. My surgeon may just be right, or maybe not. Maybe I was at a higher risk of stroke than the other non-BAV 35 year olds out there. But even if true, there are many causes of stroke, and having a BAV (particularly a non-failing one) would seem to be pretty low on the list of risk factors compared to some of the others (elderly, smoker, etc). So Dominic, sorry for such a roundabout answer to your very basic question, but I would think that as your situation currently exists (8 months out, valve in good shape, otherwise good health), your stroke risk is either equal to your non-BAV clone, or perhaps, just maybe, fractionally higher. Big picture, not worth worrying about.

Everyone else covered heart attacks and post-surgery impact, I agree with the above. As for your aneurysm graft, your native tissue overgrows it, supposedly the blood in your aorta doesn't even "know" it's there after awhile.

Dominic - Since your procedure is somewhat unique (aneurysm graft only - valve sparing), I'm curious, what post-surgery medications are/were you on? For instance, some tissue valve recipients are given Warfarin for 3 months, some are given just the long term Aspirin 81. I've never really thought about what might be done for an aneurysm graft with no valve? That may inform relative to stroke risk.
 
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After surgery I was prescribed, and still take, the following.....

25MG of Metoprolol
5MG of Lisinopril
325MG of Bayer (only for a month after surgery but I still take it)
 
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