Second opinion confirms surgery...sort of

[DaveEM]

Hi All,

Well, after the noteworthy episode of having to stop running and feeling tightness in my chest, I made an appointment with my cardio. He said that I should get the AVR "before the New Year". I immediately got a second opinion from a cardio in a different practice. The second cardio agreed with the diagnosis, but would have preferred I waited longer to feel more pronounced symptoms. Puzzled, I asked why, and she explained that since I'm 52 y.o., I would likely need another AVR in 15-20 years and that the longer I can wait the better. I then asked, best case scenario, how long I reasonably could expect to wait before requiring surgery. She said 2 years. So, I asked it seems that it's a toss up between having a second AVR at 70 or 72 -- what's the diff? She didn't have a good response, and said that my cardio's plan was "textbook." Go figure! So, at the end of it all, she said she could support my cardio's recommendation. I'm not quite sure why my "logic" (such as it is) was instrumental in persuading her that my cardio was correct. Didn't give me a warm fuzzy. Anyway, I will likely have AVR the week of 8 December. I'm still settling on a surgeon, but hope to have that pinned down soon.

Dave

 

[kfay]

You should only need a second surgery in 15-20 if you are planning on using a tissue valve. If you go mechanical, it could conceivably (probably) last the rest of your life. The only other difference to take into consideration is that with the mechanical, you will need coumadin for life, with the tissue, it isn't necessary unless you develop something like a-fib.

I would really start surgeon searching at this point and get his opinion. They tend to be a little more aggressive and I think the feeling these days is to get something repaired before permanent damage may be done to you heart.

Kim

 

[Cooker]

I agree with Kim .... if you go mechanical chances are you will not need a second surgery ... you are healthy now ... none of us know what our health will be 15 to 20 years down the road ... I chose mechanical to avoid a second surgery if possible ... if I had gone tissue there was no doubt that I would need a second surgery..... coumadin/warfarin is not a big deal ... I have had no trouble with staying in range ... good luck with your choice ... whatever it is it will right for you.

 

[ChouDoufu]

Puzzled, I asked why, and she explained that since I'm 52 y.o., I would likely need another AVR in 15-20 years and that the longer I can wait the better. I then asked, best case scenario, how long I reasonably could expect to wait before requiring surgery. She said 2 years. So, I asked it seems that it's a toss up between having a second AVR at 70 or 72 -- what's the diff? She didn't have a good response, and said that my cardio's plan was "textbook."
Dave

wrong answer! it's her response that's textbook. seems the cardio types
want you to get as much mileage as possible out of your present valve.
but in my opinion, they're basing that on 1950's medical technology, where
the risk of surgery could be greater than non-treatment. so she's
answering without really thinking. so you have to balance waiting another
year running the risk of sudden death syndrome, against risk of reoperation
a year earlier, at 70 rather than 72. but all things considered, wouldn't
a reop be better at 70 since you'll probably be in slightly better health?

 

[Eva]

My cardio recommended surgery within 6-12 months, others said 12-18 months. When I met with my surgeon to seek his opinion, he asked me about my symptoms and his advice was 'the sooner the better'. My husband quetioned that advice without him looking at my records, echo report/CD, etc. His answer was: 'I go by symptoms'!

I am glad I did not wait, as my valves were completely worn-out and the surgeon was surprised how I was functioning before surgery!

 

[Lionheart]

Dave,

Cardiologists generally follow guidelines that describe the condition of your valve and its function which they measure with echo cardiograms and other tests. The guidelines for management of patients with valvular disease. identify when valve replacement is suggested. Some doctors are conservative but the recent trend is to treat more aggressively to prevent additional problems.

You said that you stopped running. Have you slowed down over the last few years and attributed it to aging? That's what I did with cross country skiing and playing soccer. After a long day skiing I would come home exhausted and grumpy. I denied symptoms because the decline was so gradual. My cardio recommended surgery last August based on declines in my aortic function and an enlarged left ventricle that was overworking to compensate for the defective valve.

I'm 53 and chose a tissue valve that was replaced in March 2008. I'm glad that my cardiologist suggested that it was time for surgery. Now that I've got my new valve I have much more energy and feel better than I have in years.

If you have doubts or further questions go back and talk to your cardio with a list of questions or consider getting a third opinion from another local source or on-line. You have the right to feel comfortable with your decision.

Good luck and take care,
John

 

[abbanabba]

Good on you for asking the sensible questions and making a decision that works for you. I've had 5 years of fighting to get surgery done sooner rather than later and was given much the same reasons as you - "we want to hold off on surgery because of the need to reoperate". I think I finally got through to my current cardio when I said "that's fine, but I've been waiting 4-5 years already and am losing the best years of my life. Let me worry about what might happen in 10-15 years in 10-15 years!" That seemed to get the message through!

Good luck with getting your surgeon sorted and your date cemented.


A : )

 

[ALCapshaw2]

SYMPTOMS are a Sign of Damage being done to your heart.

The worse the symptoms, the worse the damage to your heart muscles and walls.

SURGEONS like to operate BEFORE the damage becomes PERMANENT and cannot be corrected even if the valve is replaced.

With the high rate of success for Valve Replacement Surgery, the latest thinking is that it is Best to get the problem FIXED before there is lasting damage.

Get your next Option from from a CardioThoracic SURGEON. Surgeons seem to have a better understanding of Valves and Valve Replacement than Cardiologists whose primary function is to Diagnose the Problem and can only medicate to 'postpone' the inevitable.

'AL Capshaw'