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Is a 3rd open heart surgery safe?
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Is a 3rd open heart surgery safe?

My mother is 59 years old. In 1983 she had her aortic valve replaced with a St. Jude's valve. In 1998 she had a pacemaker put in. In 1999 she had her mitral valve replaced with a St. Jude's valve. Since that time she has been anemic and since January of 2001 she has been jaundice. Her liver enzymes are high and she has uncontrollable itching, which she has been told is being caused by the jaundice. She has seen blood drs., liver drs., her family dr. They all suggest that the mitral valve should not have been replaced with a St. Jude's valve. It is "chewing up the red blood cells" which in turn is making her jaundice and giving her the liver problem. She has an appointment to see her cardiologist in a few days. These drs. are all suggesting that she have open heart surgery again to replace the mitral valve with a different kind of valve that won't "chew up the red blood cells". They all seem to think that a pig valve would be a better alternative to the St. Jude valve. She is very upset at the thought of having open heart surgery for a 3rd time. Is that possible? She is otherwise a very health person. She doesn't smoke or drink. Since she turned forty she has had a complete hysterectomy, both hips replaced, her gall bladder removed and the heart surgeries. I think she just can't stand the thought of another surgery. Do you have any thoughts on this problem?

Also, why would the surgeon have used the St. Jude valve for the mitral valve replacement when it seems that the literature and disscussion of the drs. all indicate that it should not have been used when the Aortic valve was already replaced with a St. Jude's valve? What info I've found seems to say that if both valves are replaced one should be mechanical and the other natural.

        

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Dear emery,
It is possible that mechanical heart valves can cause a 'hemolysis' or destruction of red blood cells leading to anemia and jaundice.  Tis diagnosis is usually made only after other potential causes have been excluded.  Unfortunately the only treatment is replacement of the mechanical valve with a tissue valve.  A third open heart surgey, while presenting some challenges, is not unusual here at the Cleveland Clinic.  Her doctors may wish to refer her to a center with experience in 3rd time open heart surgery if that is not available in your area.  

It's difficult to say that a mechanical valve was not a good choice in 1999 for the mitral position because many people have two mechanical valves and do not have hemolytic problems.  Generally mechanical valves last longer and if someone is already taking coumadin a mechanical valve is used.  However, with 20/20 hindsight perhaps a tissue valve should have been used.
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