88 year old malewith 4th degree mitral valve stenosis and sever aortic stenosis

[Norma J. Super]

I have an 88 year old father - excellent health - hospitalized in Pittsburgh - mitral valve stenosis with 4th degree regurgitation - severe aortic stenosis - 50% gradient - having prolonged episodes of SVT and VT - activity has decreased over last year to a walk of 1-200 feet brings on shortness of breath and now the arrythmia problems have become more frequent, more pronounced and more prolonged.  Surgical consult was less than encouraging - they believe he is to high of a risk - due to age alone - has no other medical issues - has been a hardworking farmer for past 70 years.  Medication for the arrythmia has been unsuccesful - have tried Lopressor - Topral XL - have just started him on Betapace.  I guess I'm just looking for another opinion - we're so close to Cleveland - but would need to quickly change insurance carriers to make the trip. I have read all of the previous questions related to this topic on this forum and have found no definitive answers as to risk factors in someone this age - also looking for "guesstimates" in post-operative recovery and degree of improvement on quality of life. I realize the information you have is only the basics of what I have relayed in this posting, but this is my only parent - we lost my mom on the table during mitral valve replacement surgery - I'm not ready to let him go yet if there's skill and technology this close.    Thank you so very much for your time and dedication.

[CCF CARDIO MD - DLB]

Your father is in a difficult situation. Severe aortic stenosis in particular tends to progress rapidly once symptoms have started. If he feels his symptoms are unbearable, you could consider getting a second surgical opinion here at the Cleveland Clinic. We do quite a bit of high risk surgery. However, both he and his family would need to realize that the risk of death (or major complications such as stroke or kidney failure)from the surgery in an 88 year old who requires a double valve replacement is not small, probably at least 25%. The recovery period in the hospital would be at least a couple of weeks and the overall recovery period would likely be several months. If he were able to get through the surgery and recovery period OK, his symptoms would likely be much better. Again, I would not recommend surgery unless his shortness of breath is truly limiting the quality of his life. Another option, if the SVT and VT episodes are what is bothering him, would be to visit a cardiac electrophysiologist to see if there is the possibility of eliminating the arrhythmia.

[Question to Norma]

Why did your mom die during mitral valve surgery?  How old was she?  Did she have heart complications before the surgery?  

I wish your family and your father the best when it comes to this decision.  I know it's hard.  I was through this with my father, and I know how difficult it is making such a decision.  How does your father feel about having the surgery?  My father did not want to have the surgery, and I abided by his wishes.

[norma]

Thanks for the comments - my mom died at age 64 - 3 years ago - different scenerio - she was critical - diabetic - one small stroke - misdiagnosed congestive failure/pulmonary edema - had a massive MI and was being sustained on an aortic balloon pump - wasn't strong enough to survive the surgery.  The opinion of CCF MD was almost identical to those in Pittsburgh so I guess we'll take those opinions.  My dad was willing to have the surgery but that was before they realized the mitral valve would have to be replaced also and the risks were so high - MD's in Pgh said 30% mortality.  I, like you, will abide by my father's wishes because in my deepest heart I know that decision is the right one.  I couldn't watch him live out any of the scenerios that were presented.  Thanks so much for your comments.  Not old enough to be here yet, are we??????

[Reply to Norma]

I'm 49 and was diagnosed with a leaky aortic valve and am facing surgery sooner or later.  I couldn't believe I have this problem at this age.  I've always watched my weight, exercised, etc., so I've been having a real problem coming to grips with this diagnosis.  My mom and dad both had heart problems, but these problems transpired when they were in their 70's.  I never dreamed that I would be facing heart disease a few years after they died.  If they were here, they would both be so upset and afraid for me, but it would be so comforting to have them here.  Just the thought of heart surgery makes me panic.  As I know you realize, appreciate and enjoy your dad every single minute you have him with you.

My cardiologists also are affiliated with Allegheny in Pittsburgh, but when it comes time for surgery I will have it done at Cleveland Clinic.

I'll keep you and your family in my prayers.