time of recovery and location of surgery

[Ted]

I am in need of an aortic valve replacement very soon..

I have a million questions but let me start with a few here..
I am 54 yrs old and believe that a homograft is what I want.
and that I want to do it in CLeveland..

I live 1800 miles from there and wonder what happens after the operation..
can I use my same cardiologist. here . and if I have problems postop will they be able to take care of it locally? and can I ride home in a car afterward.

Also I am wondering if some of the more recent health problems I am having could be as a result of my valve which is down to 1 cm sq...
I have been having back and muscle spasms..and hip pain . and also chronic prostatitus which has been bothering me for 20 yrs.. could that possibly improve with a new valve?

I have no adema and I am in excellent health other than those problems..I excercise and walk daily

One doctor told me I need this now and another a few months ago said I could maybe last a few more years.. how do you know when it is time..

When does damage to the heart muscle become permanant?

thanks

Ted

[Ted]

I just received some bad news at the orthepedic doctors office yesterday..

Not only do I need a new aortic valve very soon but my hip joint is worn out.. I am too young for all this stuff and I have always been a very active person..

My question to the doctor here is.. which operation should I do first..

would hip surgery soon after heart surgery be a danger to my new valve .. or more of a danger than to my old valve that works but is stenosed to 1 cm..   with a bad hip joint I could not walk like I want to after surgery either .. I am confused and discouraged by all this.. Up until a few weeks ago I was walking 3 miles every day of my life.. hiking building houses etc

Can I do all of this? or will it kill me


Ted

[Todd]

Good Choice on the Homograft - I was lucky enought o have my valve repaired last year (The Toronto Hospital, Dr. Tirone David)- my main problem was an ascending aorta aneurysm.  Homograft was my replacement choice if repair was not possible.  Three months after surgery I was playing hockey again - I hope your recovery goes as well - I'm 34 now.  Listen to your body, push yourself a little but don't over do it!  That long of a drive would concern me after surgery - I had a 5 hour drive 7 days post op and it was not a problem - I just placed a towel folded up across my chest where the seat belt goes - If you do travel by car - leave lots of extra time.  I still think flying would be better option.  Good Luck!

[Gary]

Once again, Thanx for your response. I will contact Yacoub, if you have his number, please post it.

[Gary]

Mario, I found the source material; no need to post it.

[Mario]

Hi again Gary,if you would like to have more info on homovitals the man to contact is DR Sir Magdi Yacoub from England who has done a study on people recieveing homovitals. In his study they tried to see the effects of HLA mismatching and what role it plays in the late results. Data is still coming in and they are still not sure if the homovitals will have a better late result than regular cyropreserved homografts. As for my recovery I am back into karate and keeping up quite nicely. I still do not think I could run a marathon because I have not done much physical activity in the past 9 months. If I would have to pick as to what is the biggest difference between "before" and "after" my surgery, is that before my surgery my heart would really be pumping to keep up 20 minutes into an hour class whereas now I could do the whole hour class without feeling my heart pumping. If I tire out it is because I still am not in shape after the surgery and not because of the valve leaking. Being into competitive karate is one of the reasons I got picked for the Quality of Life Study at the hospital. Gary everyone recovers at their own pace and everyone manages pain differently but for me the surgery was not half as bad as I originally thought. Again best of luck to you.....Mario

[Gary]

Thanks for the response, Mario.  I have looked at the Hong
Kong and Australian protocols for sterilizing these live tissue valves and I am still very much interestd in going that route.

The results posted seem as good or better than any other surgical procedure and the longevity is very attractive, provided statistics from other countries can be taken at face value. I was wondering how, in this country anyone, whether or not they are a VIP, gets on the wait-list.  I can find no one who will tell me.  Some people are getting these valves and I sure would like to know how. They only last for 9-10 days after being harvested and then must be, frozen?  Discarded? There has to be something in place to allocate these valves to avoid wasting them.

I'd like to know, even if not for this impending operation, but for the second operation which has to be done within 5-10-12-15 years, depending.
  
Since it's been 4 months that you've had your AV replaced, are you ready to run the marathon?  How has your convalescence been going?

[Mario]

Hi Gary I had my surgery at The Montreal Heart Institute and the surgeon was Dr Raymond Cartier. Both the hospital and the surgeon surpassed my expectations and I have signed on to a study group on the quality of life after aotic valve surgery. I also read your post inquiring about Homovital valves.All the literature I have read show excellent results with some lasting upto 25 years. However the Dr is correct in that the demand would be next to impossible to satisfy. Also from what I read only a handful of select surgeons doing studies on homovitals can be lucky enough to be accomadated or if you happen to be a V.I.P. Gary do not forget that the downside of the homovital valve is the increased risk of disease transmission. I feel more data should be studied before jumping on this bandwagon afterall some surgeons were betting their careers on the Ross Procedure awhile back. Best of luck to you....Mario

[Cleveland Clinic, MD]

I don't think we are doing the homovital (non-preserved graft) here.  The supply is short enough for the homograft (preserved graft) as it is.

[Gary]

Is it possible to obtain a homovital valve at CC?  How does
one obtain a donor valve of this type?  Is it fantasy to
consider this option in view of the low incidence of donor organ availability?  Would it make sense to get on list, presuming such a one exists?

[Cleveland Clinic, MD]

Dear Mario and Gary - Thanks for your comments.  All the surgeons here are excellent but the senior surgeons are Drs. Lytle, McCarthy and Cosgrove.

[Gary]

Very timely to hear from you.  I too have decided on the homograft, same age as above poster, and have been to CC for consult.  Who did the surgery? Did you have it performed at CC?

[Mario]

Hi Ted, saw your post and I would like to put in my .02 cents worth. I had a homograft put in in May 99 and it really was not that bad. Wanting to have it done at the Clevland Center is very wise. The better the surgeon and the center, the better the results will be. The best surgeon should be your main priority. Some delicate  coronary or valve surgery sometimes require that there be a stich per millimeter, very delicate procedure if you ask me so the surgery will only be as good as the surgeon. At your age all data points to at leat 15 years of good service from the homograft.Riding home by car should not be a problem as long as there are frequent rest stops along the way. Your local cardio should not have a problem following up with a copy of your file. Ted as to when is the perfect time to have the surgery is the million dollar question. You will have to work closely with your DR on this one. He will propably monitor your heart and he will keep an eye out for changes such as increase in size, your job will be to report any worsening of symptoms such as fatique, palpitaions, swelling of the ankles. If you have a competent cardio put your trust in him and your gut feeling. The hospital stay varies from one patient to another but about 6 days is the average. YOu will be in good hands at the Clev Clinic...best of luck...Mario

[Cleveland Clinic, MD]

Dear Ted,

Thanks for your questions.  WE have people come here from literally all over the world and are used to these sort of questions.  I have tried to answer each below.

Q: can I use my same cardiologist here and if I have problems postop will they be able to take care of it locally?
A: Yes.  Many people will receive their follow-up care back home and most post-op problems can be taken care of locally.

Q: can I ride home in a car afterward.
A: 1800 miles would probably be too far to drive after surgery.  I would recommend flying several days after the hospital release here.

Q: I have been having back and muscle spasms..and hip pain . and also chronic prostatitus which has been bothering me for 20 yrs.. could that possibly improve with a new valve?
A: Possibly but probably not.

Q: One doctor told me I need this now and another a few months ago said I could maybe last a few more years..
     how do you know when it is time..
A: The timing of surgery is more of an art than a science and depends on many factors.  I would recommend coming out for a surgical evaluation before scheduling the surgery.  You can make an appointment by calling the number below and asking to see one of the "valve" cardiologists such as Dr. Griffin or Dr. Garcia.

Q:When does damage to the heart muscle become permanant?
A: Once the damage is done it is usually permanant.  This is why it's important not to wait too long before surgery.