Just wondering, what considers a surgeon to be "experienced". How many valve replacements does he have to do to be considered, of good experience? I'm referring to aortic valve and aorta replacement surgeries. But, seriously, would it be 25, or 75, or more than 1 or 200? What would you say?
What is an experienced surgeon???
- Thread starter Angel
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Hi Angel,
When I asked my surgeon how many aortic valve surgeries he had done he said, "Around 1,500".... so that was good enough for me. I'd try to find a surgeon who has done at least more than several hundred. My surgery was over 10 years ago and I'm still tickin' along..!
When I asked my surgeon how many aortic valve surgeries he had done he said, "Around 1,500".... so that was good enough for me. I'd try to find a surgeon who has done at least more than several hundred. My surgery was over 10 years ago and I'm still tickin' along..!
daveguy14
Well-known member
I don't think there's a magic number, but a surgeon who has done just a few hundred has not done a lot of heart surgery.
Angel, it's a good question, and one I didn't ask. The doctor I had has been in this area for around 20 years, has an outstanding reputation and is at a busy hospital, so I pretty much went by that. I don't know where you live, or if you're having surgery in a smaller city, or larger city. I agree with what Dave posted. I think I'd want to hear over a thousand.
ks1490
Well-known member
In addition to asking them how many they've done overall, ask them how many they are currently doing per week. That will give you a sense of how current they are on techniques, if they are an active surgeon, etc. Ask about their support team - how many residents, nurse practitioners, etc., do they have working with them?
a4wanman
Well-known member
Others - I believe Ross is one of those - will mention aortic surgery is more complex than valve replacement. I felt a lot better when a few on this forum mentioned my surgeon was the one to go to in the south east for aortic surgery.
Daren
Well-known member
Angel, I think its wise to also ask not just how many the Surgeon has done, but what his failure rate has been,(number that had to be re-done or replaced). Its sometimes hard to get them to talk about that,but any good Surgeon should be willing to discuss that with you... Daren
Philip B
Well-known member
Experienced
Experienced
What's experienced? Perspectives vary. I often wonder how heart surgeons get experienced if everyone opts for the ones who've been doing 300 surgeries a year for the past 30 years. Keep in mind the newbies have to spend extensive time working with experienced surgeons before taking command their own surgical team. This said, I wouldn't be thrilled to be a new surgeon's first OHS.
As noted in a previous post, it's a good thing to know that the surgeon's team is experienced. I think having confidence in your surgical team to bring you through with a good outcome helps.
-Philip
Experienced
What's experienced? Perspectives vary. I often wonder how heart surgeons get experienced if everyone opts for the ones who've been doing 300 surgeries a year for the past 30 years. Keep in mind the newbies have to spend extensive time working with experienced surgeons before taking command their own surgical team. This said, I wouldn't be thrilled to be a new surgeon's first OHS.
As noted in a previous post, it's a good thing to know that the surgeon's team is experienced. I think having confidence in your surgical team to bring you through with a good outcome helps.
-Philip
I PERSONALLY, wouldn't choose a surgen who mainly does CABGs and not many Valves, especially if you need part of your Aorta replaced.(which is moore complex than just a valve replacement and there are surgeons that specialize in Aorta's. of course it depends on what his not many is, if he has been operating 10 years and does at least 1 aortic valve/graft replacement a week, that would be quite alot of experience. So with out more numbers it would be hard to guess.
To answer your first question, I would definately want more than 25-75 total. I beleive, (could be wrong) that 150 is a good starting point to be considerred "experienced", especially since not as many people have valve replacements as theydo CABGs. And others said, IF I was asking about experience I would definately want to know their success stats, you don't want someone that has done alot, but doesn't have a high success rate.
Do you feel comfortable with your surgeon?
Good point, especially since the newer surgeons, would be up to date on the latest techniques ect compared to some older local surgeons (who aren't in large teaching centers)
I always ask "how much of the surgery is your surgeon doing and how much is being left to residents/fellows?". My first surgeon wrote on the surgical report about "being in the room performing and or supervising". HUH?
I'd want to know exactly performing what and supervising what?
I'd want to know exactly performing what and supervising what?
ALCapshaw2
Well-known member
To help put things in perspective, 90% of Heart Surgeries are for Coronary Artery Bypass Grafts (CABG).
These are the Bread and Butter of Local / Regional Heart Hospitals.
The remaining 10% are for Valve Replacement and less common issues such as BAV, Aneurisms, Aorta, etc.
It is my understanding that 2% of the general population has BAV but most go through life not even knowing that.
For Valve Replacement, I'm thinking that someone who does 100/year is pretty experienced. The Top Valve Surgeons at the Major Heart Hospitals do 200 or more.
Surgery of the Aorta is considered to be (much?) more complex than 'mere' Valve Replacement Surgery, especially if it involves the Aortic Arch which is extremely complex. I don't have a good feel for how many it would take for a surgeon to be considered 'very experienced' in that procedure. Certainly more than a few per year. 20? or 50? per year? I just don't know. The most experienced Aorta Surgeons are most likely to be found at the Major Heart Hospitals.
FYI, Aortic Aneurisms are often associated with Bicuspid Aortic Valves so you may find more members who have had Both Surgeries in the BAV and Connective Tissue Disorder Forum.
IF I needed Both AVR and Aorta Replacement, I would definitely be talking with Surgeons at one or more Top Rated Heart Hospitals. It would help to know what part of the country you are located in to be able to make more specific recommendations.
The #1 Rated Heart Hospital is the Cleveland Clinic. Dr. Svensson is the head of their BAV and CTD department.
U.S. News has a list of the Top 50 Rated Heart Hospitals. The link to their list has been posted several times on these forum. Hopefully someone can provide that link.
Mayo Clinic, Texas Heart Hospital, Brigham & Womens and Mass. General Hosp., both in Boston,
UCLA, Stanford, Duke in NC, Emory in Atlanta, UAB in Birmingham AL, Vanderbilt in Nashville,
are all highly rated Heart Hospitals.
'AL Capshaw'
These are the Bread and Butter of Local / Regional Heart Hospitals.
The remaining 10% are for Valve Replacement and less common issues such as BAV, Aneurisms, Aorta, etc.
It is my understanding that 2% of the general population has BAV but most go through life not even knowing that.
For Valve Replacement, I'm thinking that someone who does 100/year is pretty experienced. The Top Valve Surgeons at the Major Heart Hospitals do 200 or more.
Surgery of the Aorta is considered to be (much?) more complex than 'mere' Valve Replacement Surgery, especially if it involves the Aortic Arch which is extremely complex. I don't have a good feel for how many it would take for a surgeon to be considered 'very experienced' in that procedure. Certainly more than a few per year. 20? or 50? per year? I just don't know. The most experienced Aorta Surgeons are most likely to be found at the Major Heart Hospitals.
FYI, Aortic Aneurisms are often associated with Bicuspid Aortic Valves so you may find more members who have had Both Surgeries in the BAV and Connective Tissue Disorder Forum.
IF I needed Both AVR and Aorta Replacement, I would definitely be talking with Surgeons at one or more Top Rated Heart Hospitals. It would help to know what part of the country you are located in to be able to make more specific recommendations.
The #1 Rated Heart Hospital is the Cleveland Clinic. Dr. Svensson is the head of their BAV and CTD department.
U.S. News has a list of the Top 50 Rated Heart Hospitals. The link to their list has been posted several times on these forum. Hopefully someone can provide that link.
Mayo Clinic, Texas Heart Hospital, Brigham & Womens and Mass. General Hosp., both in Boston,
UCLA, Stanford, Duke in NC, Emory in Atlanta, UAB in Birmingham AL, Vanderbilt in Nashville,
are all highly rated Heart Hospitals.
'AL Capshaw'
There ARE ALOT more heart patients that are treated for blocked coronary arteries than valve patients. BUt from what I've read that might help with the stats you are looking for, is there are about 400,000-500,000 CABGs each year in the US (according to the AHA In 2006, an estimated 448,000 inpatient bypass procedures) and about 90,000 valve surgeies (repairs and replaceents). each year.
I think there used to be a greater difference in the number of surgeries, but I believe about 1 million people have stents each year now, which cut way down on the nummber of surgeries.
I think the 10% valve and 90% coronary MIGHT be the percentages of patients most cardologists see, but many of the Coronary patients are treated with meds , caths ect.
I think there used to be a greater difference in the number of surgeries, but I believe about 1 million people have stents each year now, which cut way down on the nummber of surgeries.
I think the 10% valve and 90% coronary MIGHT be the percentages of patients most cardologists see, but many of the Coronary patients are treated with meds , caths ect.
Lyn,
Thanks for the numbers on that.
Thanks for the numbers on that.
My community cardiologist thought my surgery could be done just as well at the community hospital and said that they only refer the "more complicated cases" to the area teaching hospitals, like Stanford. Well, I went to Stanford just for an information consult with their top valve and aorta surgeon, and I'm glad I did.
Philip B
Well-known member
Teaching Hospitals?
Teaching Hospitals?
Hospital choice is certainly a personal preference. My surgeon actually gave me choices as he works in several hospitals. One of those choices was a teaching hospital which had a fairly large heart surgery unit. I really wasn't up for dealing with medical students so I opted to have surgery in a smaller non-teaching hospital. My experience was very positive.
-Philip
Teaching Hospitals?
Hospital choice is certainly a personal preference. My surgeon actually gave me choices as he works in several hospitals. One of those choices was a teaching hospital which had a fairly large heart surgery unit. I really wasn't up for dealing with medical students so I opted to have surgery in a smaller non-teaching hospital. My experience was very positive.
-Philip
I had a friend who is a pefusionist (sp) Runs the heart and lung pump a few hundered miles north of me. She went to school down in my area and she did some leg work when the first cardiologist said he wanted me to meet with a pacticular surgeon. Its good to know people who can get you references. I switched cardio surgeons and hospital all together. Do you due dillegence. Check how many hearts your hospital does also.
ALCapshaw2
Well-known member
My Local Hospital is a Very Good Regional Heart Surgery Hospital with 4 Surgeons.
They perform 700 to 900 Heart Surgeries annually, mostly ByPass Surgeries.
I have been unable to get them to provide information on the number of Valve Replacements they perform.
I know a local CABG recipient who has developed a Valve 'issue' whose wife is a Nurse.
She was finally able to get a number which seemed quite Low to my mind (considerably less than 100).
My Local Cardio refered me to the University of Alabama in Birmingham (UAB) which is a highly rated Heart Hospital for my AVR.
I'm glad that he did. There were some 'complexities' found 'when the surgeon got in there'
but this Heart Transplant Surgeon had the knowledge, skill, and experience to deal with them.
He probably saved my life.
Another thing to consider is the experience level of the Nurses and support staff.
If a Local Hospital performs mostly CABG's, will their nurses know how to recognize signs of problems that might be unique to Valve Repalcement Recipients and what to do for them?
They perform 700 to 900 Heart Surgeries annually, mostly ByPass Surgeries.
I have been unable to get them to provide information on the number of Valve Replacements they perform.
I know a local CABG recipient who has developed a Valve 'issue' whose wife is a Nurse.
She was finally able to get a number which seemed quite Low to my mind (considerably less than 100).
My Local Cardio refered me to the University of Alabama in Birmingham (UAB) which is a highly rated Heart Hospital for my AVR.
I'm glad that he did. There were some 'complexities' found 'when the surgeon got in there'
but this Heart Transplant Surgeon had the knowledge, skill, and experience to deal with them.
He probably saved my life.
Another thing to consider is the experience level of the Nurses and support staff.
If a Local Hospital performs mostly CABG's, will their nurses know how to recognize signs of problems that might be unique to Valve Repalcement Recipients and what to do for them?
daveguy14
Well-known member
Indeed, this has happened once to me too. Some docs have a chip on their shoulder and take offense at you going to a more experienced center than the one he works most closely with. I mean, if you went to the local hospital, odds are you would have been fine, but it's your life, not his.
