Aortic Stenosis / Repeat Surgery

[ifred2000]

I'm a 62 yo male with a history of heart valve problems because of rheumatic fever. I had a CMV in 1971 and MVR with St. Jude mechanical valve in 1986, since then I’ve been taking blood thinner drugs and diuretics. Now I’ve been diagnosed with aortic valve stenosis (valve area = 0.94 cm2) and severe tricuspid regurgitation. I  have CHF symptoms (swelling of abdomen, shortness of breath with moderate activity, cold feet) and atrial fibrillation. My EF  = 40-45%, LA = 5.8cm, Ao root diam. = 3.3cm, IVSD = 1.5cm, LVPWd = 1.5cm, LVIDd = 4.2cm, LVIDs = 3.6cm, FS = 14%, LVOT diam. = 2.3cm, LVOT dimension = 4.1cm^2. I am also anemic with Hematocrit = 34.1. I’m healthy otherwise:
1) Dr. Richard Lange at Johns Hopkins recommended a surgery as soon as possible, another cardiologist believe that I can wait till the valve area is around 0.8 cm^2. How soon do I need to have the surgery?
2) A colonoscopy was recommended before catheterization; however, the anesthesiologist believes the opposite should be done since more information about my heart condition is needed. What are the anesthesia risks in this case?
3) In general, what is the open heart surgery risk for patients in my condition?

thanks

[Cleveland Clinic]

fred,

thanks for the post.

Giving advice over forum is hard enough when you are talking about surgery on a single valve. The fact that this is a redo operation and you have multiple valves involved makes it immpossible.  Richard Lange is an outstanding cardiologist and has excellent clinical skills. I would refer a family member in the Baltimore area to him and would trust his opinion.

If you are not having frank bleeding, there would be no contraindication to catheterization.

The major risk of surgery are the same as for your first surgery with the most important being stroke, MI and death. The overall risk for any second surgery are higher and factors specific to your case include your history of heart failure, afib and tricuspid regurgitation.

You are always welcome to seek a second opinion here at the clinic.

good luck

good luck

[DottyCece]

I had a re-do within 11 months of my first MVR surgery.  I too had atrial fibrillation and Congestive Heart failure symptoms and pulmonary hypertension as well as tricuspid regurgitation.  I too wrote these MDs at Cleveland and was told basically the same things you were,  I did have the surgery and did very well.  There are increased risks with a re-do but I felt so much better after the surgery.  It lasted about three months when I went into more severe heart failure and had to have a biventricular pacemaker, ICD and all the drugs.  My EF went to 30% but it is up to 40% now.  I still have lower leg edema, SOB with activity so things are not perfect but certainly a lot better.  What I found also with the re-do surgery is that not a lot of MDs want to have much to do with a re-do at least this soon after the first.  My first valve was not put in correctly.  Needless to say, I found a new very excellent surgeon who came very highly recommeded.  I also went to a different hospital and things went very smoothly.