My dad's having valve surgery!

  Help..my 61 year old father is considering heart surgery.  He was born with a congenital heart defect and had left ventricular myotomy and myectomy for obstructive hypertrophic cardiomyopathy at NIH in 1981.  My understanding is that the cardiomyopathy remained after the surgery.  Over the years since he has developed diabetes, galstones, chronic a-fib, neuropathy, and has a history of CHF and recurrent pleural effusion.  He has always been lead to believe that his health options were somewhat limited because his heart could not withstand anesthesiology.  Recently, the story seems to have changed, his surgeon is saying that the risk is not a much as he has been lead to believe and that my dad has a 99% chance of surviving surgery and feeling better.  Specifically, surgery is recommended to replace the mitral, aortic, and tricuspid valves, due to increased fatigue upon exertion and shortness of breath.  His most recent heart cath demonstrated severe MR, mod. AI and some tricuspid insufficiency with mod. pulmonary hypertension.  It also showed evidence of the hypertrophic cardiomyopathy, a small LV cavity and possible vegetation on the MV, yet all blood cultures were negative.  His EF is about 70%.
  With such a high probability of recovery my dad sees this as a second chance (he is not a candidate for a heart transplant).  I am concerned that the doctor may not have fully reviewed my dad's history, has overstated the expected positive outcome, and that my dad may be taken a higher risk than he realizes.  Are these realistic concerns, or am I just being overly protective.
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Dear Alison,

Thank you for your question.  Although I can't comment directly on your father's risk for surgery I can say that open heart surgery has become a "routine" procedure.  Surgical techniques have improved dramatically over the years and surgeons are undertaking more and more complex cases.  Of course your father's overall poor health and prior surgery place him at a greater risk of complications including death but this risk may be worth it to him.  I would also recommend that he have the surgery at a major medical center with a surgeon who has extensive experience in these type of cases.  If he is interested in the Cleveland Clinic I would recommend Dr. Bruce Lytle.  Hope this answers your question.  Please feel free to write back with any additional questions.
Information provided here is for educational purposes only.  Only your doctor can make specific recommendations.  If your would like to be seen at the Cleveland Clinic please call 1-800-CCF-CARE.