Surgery considerations

[nickm3]

Hello everyone I'm new to the list I had need to schedule AVR surgery very soon and was looking for a few opinions. I had previous AVR with a homograft back in 1998 which was necessary because of endocarditis subseqeunt to viral meningitis. Anyway the homograft is giving up with severe regurgitation and needs to be replaced.

The Surgeon that performed the first OHS was Dr. Addonizio at Abington Hospital, and while he did a great job I didn't really choose him as we just happened to be at the same hospital. I now have a little time to be selective and was wondering what are the Key elements that I should look for in a Doctor and Facilty for my AVR surgery?

I have talked with Doc Addonizio and the people at the Porter heart valve institute (at Abington Hospital) about the redo and am impressed with their program but not sure I even asked all the right questions. One thing they mentioned and I was surprised to learn is they are one of the very few facilties that have a cardiologist (he happens to be my regular cardio.) present during the operation. I know that is not a bad thing but does anyone feel it is a significant advantage?

I am 48 years old and he basically left the choice of valves up to me, but recommended against another homograft leaning towards the either a tissue valve or mechanical. With the mechanical he then gave a choice of either the ST. Jude or the On-X. Since I would rather avoid have another replacement 15 years or so down the road I was leaning towards a mechanical and probably the On-X.

The other Dr./Facilty I was considering is Br. Bavaria at the Univ. of Penna Hospital in Philadelphia.

Would appreciate any insight that might help in my decision.

 

[Mary]

Welcome Nick to VR.

I believe that the top surgeons typically have their own top-notch surgical team, so in my opinion, the facility is less important than the surgeon.

I don't know anything about the Philadelphia area, but others do, and they will be by to chime in with their knowledge and experiences.

I believe that your reasons for choosing the On-X are valid so all in all, it sounds like you're well prepared.

Please keep us updated on how your situation progresses.

 

[Karlynn]

Welcome! It's always better to be in a position where you can plan - as you learned the hard way! Considering you were 38 when you received the homograft, you got about the average expected time for it for someone your age. So I'd consider it a success.

Both the St. Jude and the On-X are good choices. One is tried and true, the other is new with some really nice possible promises. I have a St. Jude. If I were to need to have it replaced right now (thank goodness it's looking pretty after about 16 years) I would seriously consider both options - but admit I would probably lean to the On-X. Not necessarily because it may require little or no anticoagulation in the future (I question whether or not that will apply to those getting it installed now and wouldn't want to place all my eggs in that basket), but because the structure itself is very promising for lack of clot formation.

AlCapshaw (you can find him on the members list) has posted quite a bit about the On-x and has a contact with that company that people have been pleased with the helpfulness provided that person. So he'll either pop in here, or you can look through his past posts to find the information.

I'm glad you found us.

 

[WayneGM]

Welcome to the VR community. Sorry for the circumstances but glad you found us. I can't help you with valve choice as I had a repair. However, I'm sure others will be along shortly to offer up information and insights. Again welcome, and best wishes.

 

[Superbob]

At age 48, mechanical makes sense and the On-X is getting a lot of good reviews. That's not an expert judgment, just an observation. If you did a search on this site, bet you would find lots of info on the On-X and other options. Check out all the options, and decide what's best for you.

Welcome to the forum and all best wishes to you.

 

[nickm3]

Thanks for the welcome everyone, it sure was nice to find this site with so much information, and past experiences that are shared.

Nick

 

[ALCapshaw2]

Welcome aboard Nick,

For my pending MVR, On-X is my First Choice with the STANDARD St. Jude as my Second Choice. It's always a good idea to have a Plan B, "just in case". Personally, I would NEVER consider the St. Jude REGENT Valve.

Call Catheran Burnett at 888 339-8000 ext 265 or e-mail at [email protected] She is the Education and Promotion Manager at On-X and will send you an EXTENSIVE Information Package with lots of information and data comparing the primary mechanical valves.

Catheran has been in the 'Valve Biz' for many years starting as a Surgical Nurse and then working for 3 of the Major Manufacturers.

'AL Capshaw'

 

[Philip B]

Valve Choices

Valve Choices

I agree with those who have indicated that both the On-X and the St. Jude valves being good choices.

For the needs and concerns I had as AVR surgery became a reality, my surgeon felt the St. Jude would be a better choice. We engaged in an extensive dialogue about valve options. In the end, I was confident that the St. Jude was my best option.

Many of us have no problems with offering our opinions; however, I strongly recommend that you engage in dialogue with your surgeon and cardio doc about the options and potential issues as you make your decision.

-Philip

 

[Bina]

Hello Nick and welcome to this fabulous group.
I'm sure either the St. Jude or On-X will do you well.

 

[AJ Golf]

Ross Candidate?

Ross Candidate?

You might also do a little research on the Ross procedure, it may be a possibility as well, as I had no idea about it till I got here on VR.com and
at 44 yrs old I'm feeling great about my decision.

Rckrzy1,

So, you had a good pulmonary valve to use in the aeortic position? I had considered it as well, hoping for a "lifetime" of service, but the cardio doc and surg doc nixed the idea for me. FYI, I'm 44 as well, going in on Aug. 31. Will be using some sort of tissue valve.

 

[Carolyn Russo]

Avr

Avr

Nick, Please read my post under Donna Marie
I'm 6 weeks out of AVR and I'm now doing very well.
My Surgeon was Dr. Karl Grunewald and Team
Surgery took place at Crozer Chester Medical Center in Delaware County.
The team is one of the 5 best in the nation.
Carolyn

 

[Arlyss]

You might ask the surgeon how many "redo" operations he has done that involved removal of a homograft. That is a very specific scenario. You would want to know that the surgeon is familiar with this exact surgery and anything that might be "special" about it.

The surgeon should review with you what if anything is unique about your "anatomy" inside, based on what imaging has shown him, what his first plan of approach would be, and what alternative he plans to use if that first choice is not workable for some reason.

When the surgeon reviews the risks of the surgery in his hands, and provides his statistics, it should be the results of performing this procedure, and not general statistics for others types of heart surgeries, such as bypass surgery.

So sorry that viral meningitis and then endocarditis injured your valve. I wish you all the best as you research your options.

Arlyss

 

[frankd]

Nick, since my background is similar to yours in some ways, I will share it, in case it helps with your decision. First AVR at age 39 with a tissue valve, the Toronto SPV (very new at the time). Fast forward 13 years, time for a redo at age 52. Decided on tissue again as I was extremely happy with my quality of life with the SPV. Ended up with a CE Perimount, a valve with a good 20+ year history. Some would call the CEP Magna an updated follow-on to the CE Perimount, but my surgeon wanted to put in something something with a proven track record if I insisted on a tissue valve again (I did). That was 2 years ago. Have not regretted the decision at all. I hike, bike, and ski. But... keep in mind that a the risks associated with a redo increase each time, so mechanical is something to carefully consider at your age, although of course I have no experience to share there.....
Best wishes,
FrankD

 

[nickm3]

Thanks for the input eveyone, I went for a second opinion from Dr. Bavaria at HUP and now leaning in that direction. He has extensive experience in aortic valve redo's and after talking with him am confident in my choice to go with a mechanical valve... most likely the on-x. I really want to try to avoid a third OHS 15 years or so down the road and I think the risk of another surgery is greater than the risk of clot or bleeding during that time. So right now I have a few tests to schedule and then will move forward.

Added note: Had a few brief syncope episodes recently, cardiologist thought just vagal type repsonses due to the regurgitation but ordered a heart monitor which ended up showing a class II heartblock. Bottom line is I ended up getting a dual chamber pacemaker last thursday (8/30/07) and am feeling much better now.

Nick

 

[Karlynn]

Glad you're feeling better. Best wishes with your upcoming surgery.

 

[Lynlw]

Thanks for the input eveyone, I went for a second opinion from Dr. Bavaria at HUP and now leaning in that direction. He has extensive experience in aortic valve redo's and after talking with him am confident in my choice to go with a mechanical valve... most likely the on-x. I really want to try to avoid a third OHS 15 years or so down the road and I think the risk of another surgery is greater than the risk of clot or bleeding during that time. So right now I have a few tests to schedule and then will move forward.

Added note: Had a few brief syncope episodes recently, cardiologist thought just vagal type repsonses due to the regurgitation but ordered a heart monitor which ended up showing a class II heartblock. Bottom line is I ended up getting a dual chamber pacemaker last thursday (8/30/07) and am feeling much better now.

Nick

I'm glad they caught that and you are feeling much better.
Dr.Bavaria is very good.Justin has had most of his heart sugeries at CHOP next door and alot of the staff practices at both centers. (his surgeon is Spray)Another really good thing about HUP and having a 2nd surgery, is they are one of the leading Adult with Congenital Heart Defect centers so not only the surgeon but the whole cardiac staff (nurses, anesth, ICU)have ALOT of experience with patients that have had multiple (4,5 ect) redos, so know how to deal with things that can come up w/ multiple surgeries, like scarring, and how to deal w/ them. Lyn

 

[dlangton]

I concur with your choice

I concur with your choice

If I were in your shoes, and I was last year, the On-X valve would be hard to resist as a first choice. It was my first choice too, but it isn't used much here yet where I live so I went with the surgeon's preference for porcine tissue. I have no regrets and think I did the best for myself, but I was older than you too, and the On-X in your case seems like a wise option.