Why is the surgeon refusing this surgery?

My dad was diagnosed several months ago with Mitral Valve Prolapse & after several tests was told his mitral valve needed to be replaced.

A little background...He has been fighting fluid buildup over the last year. He will build up alot of fluid & gain about 30 pounds then have to go into the hospital, get put on a higher strength diuretic & a catheter & drain the fluid. He gets sent home for about a month, then start the cycle all over again.

He also has some venous stasis ulcers on his lower legs that he has been having trouble getting to heal for the last year or so. One foot has healed completely but the other just will not heal.

His original surgeon told us that the main cause of all his problems was more than likely due to his bad mitral valve & that once replaced, he should see major improvements.

Open heart surgery was scheduled for about a month after his appointment with the surgeon but sure enough, the fluid buildup came back before the surgery date & the surgeon postponed the surgery. Dad gets out of the LTC hospital today that he has been in for the last 20 something days while removing the fluid. Yesterday, the surgeon called & refused to do the surgery.

I do not understand why she is now refusing to do the surgery! Anyone have any ideas on this?

[banglamom]

Is the md refusing altogether or postponing again?  Having your dad have bad chf problems now makes him not a good surgical candidate.  No md wants to take someone in to surgery that doesn't have optimal chances of coming through.  Their reputations are based on the successes of their surgical interventions.  Taking high risks can hurt their  successes.  It would be better to wait a while until he is more stable anyway.  Getting a second opinion is never a bad idea, but neither is waiting if he has any chance of getting stronger in the meantime.  Don't just think about it from the surgeon's perspective, you don't want your dad to be taken in for surgery if he is not in good condition to start with.  It makes the odds against him.  Recover well and then go for surgery.  

[NTB]

>  He also has some venous stasis ulcers on his lower legs

is he very sedentary? that sounds like he might be at risk for Deep Vein Thrombosis. DVT is a big enough, and serious, problem that the US Surgeon General has instituted a campaign against DVT and it's deadly followup consequence of Pulmonary Embolism.

[kenkeith]

There is a very high risk with surgery for an individual with heart failure.  This happens when a patient has significant mitral valve regurgitation, and an operation may not be able to preserve left ventricle functionality.  The risk when weighed against the benefit is contraindicated.  

Your father should be put on medication: a diuretic to remove fluid build up, and meds to reduce the heart's workload.  If your father's medication is effective, there may be a re-evaluation for surgery.

[bassadict69]

Dad is already on the diuretics & am not sure about anything for his heart.

What kills me is that at his original meeting with the surgeon, she said all his problems was a result of the bad valve & how it was effecting the circulation throughout his body since with each beat of his heart, rather than pumping a ventricle full of blood out to the body, half the blood was being pumped back up into the atria. She told us that after the surgery, most of his problems should be history.

That is what is throwing me off! If that is the source of his problems...lets fix it.Otherwise, he will continue getting worse rather than better! If there are some risks that are unknown to us, I wish she would fill us in on them rather than just saying no, I am not doing the surgery.

He sees his cardiologist today & should be getting referred to another surgeon. He is actually doing ALOT better now than he has in a long time. We do know however, it will be short lived if the main problem is not fixed.

[banglamom]

CHF problems are a chronic problem but the intensity waxes and wanes.  If he is already doing much better, then he is a better candidate.  Timing is an important component of this decision.  A great surgical candidate with a fever... not going to surgery.  I'm sure in the long term he will be better off with the repairs done, but the short term has to be considered too.  It is a long difficult recovery for many too and being older a bit more debilitated makes the recovery harder as well as the surgery.  I hope he gets to get it done soon, under optimal conditions and that he recovers quickly.  Blessings.

[Encephalomalcia]

The question is now that he has had all this fluid buildup and having 30 lbs removed (an extreme amount and very hard on the kidneys) how are his kidneys functioning?  The kidneys can make the valves worse, and the heart can make the kidneys worse.  If the surgeons were to be aggressive and do the surgery, he may end up with Cardic shock were all the organs shutdown including the lungs.  The surgeons need to make sure that all organs are functioning perfectly besides the heart.  If there are two or three organs not functioning perfectly, then there is a high chance of cardiac shock (which means he will be hooked up to machines to be kept alive).  Cardiac shock is really tough to see one go through.  This happened to my Mom.  She lost all of her blood after surgery to replace the Mitral valves and fix the triscupid valve along with arteries (which they were unable to get the artery in the back of the heart fixed).  She suffered extremely for 3 weeks.  There was nothing more the surgeons could do for her.  I still have nightmares and this happened in August of last year.  She passed away Sept. 3, 2008.  This is a big, big surgery.  You have to really consider that is life so bad now that there is no other option.  Meet with many heart surgeons before and make sure that there is a living will in place.  Take your time in making your decision.  

[bassadict69]

Kidneys are functioning fine. That is one thing the ltc hospital he just got out of checked regularly & checked just before discharge. All is fine there!

His cardiologist is referring him to another surgeon & hopefully we will find out today when his appt is with this new surgeon.