Heart surgery

[susky65]

Hello,
Looking for some good opinions, not guarantees.
My dad is 78, has been in great health until the Spring, when he just wasn't feeling good. End up he went into the hospital in late September for a week with Congestive Heart Failure. They took 19 lbs worth of fluid out, did all the imaginable heart tests and bottom line his heart is working at 25%. They sent him home and his hospital cardiologist said he would need to have an aortic heart valve replacement. He's stubborn, and refused any surgery so they gave him meds to keep the fluids down, but now a month later he is filling back up and has come to the conclusion that to have a chance to live normal again he must have the surgery. He's just scared of dying on the table. There are no other issues medically other than this problem. We've researched other good cardiologists for a second opinion, and they all agree. I have found one of the best cardiothoracic surgeons in Florida to perform any procedure.
All that said, I have done a lot of research on the subject and found other than direct open heart surgery there are other less invasive procedures as well. We will find out from the surgeon which one he is a candidate for.
Essentially, we're all scared. I would like to hear from an experienced cardio physician, or surgeon what he may be facing. Most of all, since this is all new to us and we have talked to all those people who have an opinion "Oh, it's just routine now, he'll be fine" I'd like to hear a professional opinion about the risks of surgery, what MOST prognosis's are in getting through the surgery (If you can use just basic percentages please), and what he can expect (In general) for the next 5 years or so it would be greatly appreciated. I know knee surgery can be risky...and I am not underestimating this of course. That said, how successful is it in one, making it off the table from what you have seen, and two how will this surgery help him feel? I can tell you now from his heart being so damaged he is just tired all the time and it can't pump enough to keep the fluid out. Can we expect, if all goes well that an 85% heart rate is feasible afterwards?
If you wish, for a longer reply can be sent to my email address at ***@****. Thanks for any help.

[susky65]

Yes, Thank you....I did go the Doc forum and they said they weren't taking anymore posts there- so post here. Hello?
To try to touch on all your posts; My father quickly changed his mind about having the surgery after he went home and started retaining water again. Understand, the man is smart, in good shape (other than this) but a little old fashioned and stubborn and thought the medication would help the heart- he now realizes that is not the case.
There are other post complications, I know. I am doing as much research I can and am almost getting to the point to be everything but a licensed cardio or cardiothoracic guy. PE's, pneumonia, stroke....all and more heard of. I try to keep it to a low roar when talking to him about it :-).

Great idea about a list. They live 900 miles away and I want to be there for the next visit to ask all the questions that I've found out and you have graciously posted.
Thank you

[skydnsr]

With all due respect to 68survivor, the problem with trying to treat the heart failure with medication only is that the valve disease will continue to progress, and while your father is trying to find ways to put off the surgery, his heart muscle could sustain permanent damage.  There is a point at which the patient no longer benefits from valve replacement surgery.  If he were in his 80's and frail, and if he were therefore not a good surgical risk, it might make sense to try to extend his remaining time on earth with medications, but with his being 78 and in otherwise good health, I would go for the gold ring. He should definitely talk to the surgeon, at least.  If your father were already past the point at which the surgery would help him, I don't think the cardiologist would have referred him to a surgeon.  Yes, there is a risk to the surgery, but without the surgery, aortic valve failure is a fatal proposition.  Facing surgery is scary, but sometimes you just gotta do what you gotta do.  Smiley2000 and I have both been there and are still here to talk about it.  Again, best wishes for a successful outcome for your father.

[68Survivor]

Hello again.
I meant to add that before starting Ivabradine I was having to use 3 pillows for sleeping  and was coughing up blood stained sputum (haemoptysis) . Now at least my chest is clear and I can sleep comfortably flat.
Again , all the best.

[68Survivor]

Hello,
One avenue that might be worth trying is the addition of a drug called Ivabradine manufactured by a French Pharma Company called Servier. I think it was coming up for approval in the USA this year. The requirements are that the individual be in Sinus rhythm and have a resting Heart Rate above 75(?) BPM. I have been on this drug for almost 2 years with an Ejection Fraction of only 10%. Some details on it can be found here:
http://en.wikipedia.org/wiki/Ivabradine
Hope this helps.

[Smiley2000]

Hi there,

Firstly, good on you for being pro-active and supporting your Dad and doing research on his behalf.  None of us here on this Forum are experts, so we can only give you our personal opinion and you should still take a list of your questions and concerns to your Dad's Thoracic Surgeon.

I was 31 when I had my open heart surgery to repair my mitral valve and it took me 2 years to get back to a good cardio-shape.  I was pretty sick before the operation and had heart failure, pulmonary hypertension and enlarged heart.

These days the Thoracs will tell you that the operation itself is routine heart surgery and prognosis good.  Unfortunately there are complications of fatal blood clots that can occur post-surgery and he can develop Pneumonia from the lung-machine.  

But it does count in his favour that he is in relatively good health now - apart from the fluid and low cardiac output.  He will not get better and have a full normal life, without the surgery.  An EF of 25% is pretty low.  Without the operation, his CHF will get worse and his EF will not improve.  1-2 years post op he can expect to have an EF of 45% or even better.

I hope this was of any help to you.  All the best with the big decision.  Will keep you and your Dad and family in my thoughts and prayers.

[skydnsr]

Sorry, but there aren't any experienced cardio physicians or surgeons posting on this board.  This is a lay forum.  However, I have experienced aortic valve surgery as a patient.  From what I have read, the success rates for aortic valve replacement are about 95 - 98% when the operation is done at a center that has a program dedicated to aortic surgery and when there are no complications such as an aortic aneurysm.  The success rates are somewhat lower (although I can't quote you exact numbers) for operations done at less specialized centers and on patients whose needs are more complicated.  The prospects for your dad to experience a return to normal heart function after the surgery will depend largely on whether his valve problem has existed for a long enough period of time that permanent heart damage has occurred.  The surgeon should be able to give an opinion about how well his heart can be expected to recover after the valve is replaced.  In my own case, I was in Class IV heart failure prior to my surgery, and now I am in no kind of heart failure at all, so my surgery was very successful.  Best wishes to your father on his upcoming surgery.