Questions posted in the
Heart Forum have been answered by doctors from The Cleveland Clinic Foundation.
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Subject: Re: mitral valve replacement Hello, my 70 y/o mother has just been told she must have her mitral valve replaced. She has a history of PAT's and also had profound bradycardia. The bradycardia was treated by placement of a pacemaker and the PAT's are being treated with Lanoxin. I am having trouble finding much information about how this surgery is being done. She is to have a Cardiac Cath done on Tuesday and then will be scheduled for surgery. Can you help me with some information about how this surgery will be done? I know that there are cadaver replacement valves as well as synthetic valves. What questions do we need to ask. I realize that with her history she is probably at much greater risk. Will this surgery require "cracking the chest" or can it be done in a less invasive way? Any help you can give me will be greatly appreciated. __ Dear Kathy, Mitral valve replacement involves a long mid-line sternal incision and a rib spreader while the patient is 'completely under' anesthesia-as is the case in the majority of open heart surgeries. There are minimally invasive procedures being done at some institutions (like The Cleveland Clinic)which simply decreases the size of the incision and sometimes changes the location of the incision. Not all patients are candidates for this new technique and as yet there is no solid evidence that this technique is in any way better than the conventional mid-line incision that although is a larger incision, it actually gives the surgeon a larger field of view. The elderly in general recieve the tissue valves rather than the artificially made valves, for two reasons mainly. Firstly, the tissue valves do not require any anticoagulation (with coumadin-a blood thinner) to keep the valve from clotting off, and this is very important for those patients who can not take the blood thinner, or are at a high risk for bleeding if they do take it. Secondly, the artificial valves are designed to last indefinitely, and the tissue valves tend to last 10-15 years, the cadaver valves potentially longer than the porcine valves. Now your grandmother is only 70 and if her health is such that her chances of living until 90 or more is good, then the surgeon may lean more toward replacement with an artificial valve. The main reason the catheterization is being performed is that it is a MUST that the surgeons know if there is any cornary artery disease, especially if there is enough that warrants bypass surgery which they would do simultaneously with the valve. Regardless, it is very risky to go in to open heart surgery with even just one significantly diseased vessel because with the stress that the heart is under, any damage (even a mild heart attack) in and around the time of surgery will likely cost the patient her life! Once the surgeon has the cath. information, he will decide on the course of events and your questions should be as such: 1. Specifically which valve are you choosing and why? 2.Does she also need bypass surgery with the valve? 3.How long will the surgery take-about how many hours? 4.What are her chances of death and major morbidity(likelihood of major event like stroke.)? Keep in mind that the average national morbidity and mortality(death)percentages for patients undergoing open heart surgery is 4%. Your grandmother's age is more of a risk than her PAT which may simply complicate her post op course a tad more than someone without,although some 50% of patients undergoing open heart get PAT in the 10 days or so after surgery (very common). Good Luck Information provided in the heart forum is intended for general medical informational purposes only, actual diagnosis and treatment can only be made by your physician(s). | |
