3 valve replacement/repair (Rheumatic Heart) 45 y/o

Posted By  CCF Cardio MD-SGM on March 29, 1998 at 16:13:03:

In Reply to: 3 valve replacement/repair  (Rheumatic Heart)  45 y/o posted by Annie on March 17, 1998 at 14:58:54:

: I will be scheduled for surgery at CCF very shortly.
  While I am grateful to have this done at the best center in the world,
  I just can't imagine how a surgeon can do mitral and aortic replacement along with
  tricuspid annuloplasty all in one surgery.  Is such an extensive procedure
  common at CCF?  Can anyone give morbidity/mortality stats for this triple procedure?
  I've had open mitral commissurotomy nine years ago and am lucky enough to
  have clean and clear coronary arteries.  That first open heart surgery went well
  and I obtained a lot of relief of symptoms, however, I did have trouble
  with post-cardiomyotomy syndrome about 10 days later.  The build-up of fluid
  around my heart from that was actually more painful than the surgical wound.
  I was told that this syndrome was an auto-immune syndrome.  Is it likely to
  recur?  Will it be worse the second time around? Thanks for any help you
  can offer.

[CCF Cardio MD-SGM]

_
Dear Annie,
Triple valve surgery is clearly more complex than single valve replacement or repair.  Numerous mechanisms have been proposed to account for the higher risk, but in essence, this tends to relate to longer times required on bypass pump as well as the increased injury to the heart muscle that is unavoidable.  Currently, mortality for this type of procedure is approximately five percent.  All complications  are undesirable, but I'm happy to tell you that most patients who undergo this surgery see substantial improvement in symptoms and heart function.  The fact that you're planning a second open heart surgery increases your risks somewhat, but you're correct that you're having this surgery done at the most experienced heart surgery center in the country-- and likely the world.  
Regarding the post-pericardiotomy syndrome that you experienced,  it's estimated that 10 to 40 percent of patients who undergo open heart surgery develop this problem.  Levels of antibodies can be measured to assess the degree of the body's inflammatory response, but I would predict that you risk of recurrence following the upcoming surgery is only slightly higher than usual.  As you know, there are good treatments to control the pain and discomfort of this problem.
Best of luck with your surgery.  Information in the Heart Forum is for general purposes only.  Specific diagnoses and therapies can only be provided by your physician.