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Heart Disease (Expert Forum)
timing of operation and misc...
Answered by
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timing of operation and misc...
by Ted, Dec 31, 1999 12:00AM
I have a couple more questions..
1st... If I have an aortic homograft installed complete with the root as is (I think) typical.. and then in 5
yrs it fails and needs replacement... Am I then mandated to use the same type replacement valve the next
time.. I am picturing the process and it seems to me that there would no longer be the possibility of using
a mechanical valve if I did not think I could stand repetitive surgerys ..
and
2nd.... I realize that doctors are reluctant to say how long this homograft valve will last and I futher
imagine that the reason for this may be due to all the variables .. sometimes one may last 5 yrs with no
explanation of why it did not last 15 or 20 .. and another may last 15 with no explanation of why it lasted
that long.. but I wonder... surely there must be some average life based on nothing but how many valves
were replaced and how long they lasted..
can I even get that figure.. ??or is there something else here that I am not seeing which would preclude
that information from being dispensed.. It seems to be a reasonable bit of information to have when
choosing a valve type.. How long have homografts been used? and is the data from pure numbers of
cases insufficient to make significant assumptions? .If that is the case ... is there not even a small
sampling of performances to date??One thing concerns me... is the medical community doing these surgerys and then disconnecting themselves from the collection of statistical information which would be the following of these cases to not only reoperations or postop problems but to the eventual death of the patient by these or other causes??
another question..
The doctors that have diognosed my problem have admitted that it is more of an art than a science deciding
when to do surgery..
I have learned A couple of major barometers of this timing .. Are you having symptoms from this yet and..
what does the valve sound like.. is there a distinctive click upon closing..
My valve is 1cm sq.. and I think the audible sound is a little concerning>>I futher think that the cardiologist is
assuming I may be having symptoms.. I think so my self sometimes but then I also do not.. I told
him that I experienced tightness in my chest only upon very hard exertion.. and then it was a mild
tightness. which went away immediately upons stopping the exertion...I have no shortness of breath really or less than my wife has who has no heart problem..
My concern is now and has been for sometime.. is it really time to do this?? I know I can't be operating at
peak efficiency and definetely have some limitations that I would not have with a good valve but what are
the dangers of waiting another year or 6 months .. other than of course the minor consequence of sudden
death ;-)..If that did not happen would I not just be moving the time of resurgery back a little further..
Just a thought .. your comments please..
1st... If I have an aortic homograft installed complete with the root as is (I think) typical.. and then in 5
yrs it fails and needs replacement... Am I then mandated to use the same type replacement valve the next
time.. I am picturing the process and it seems to me that there would no longer be the possibility of using
a mechanical valve if I did not think I could stand repetitive surgerys ..
and
2nd.... I realize that doctors are reluctant to say how long this homograft valve will last and I futher
imagine that the reason for this may be due to all the variables .. sometimes one may last 5 yrs with no
explanation of why it did not last 15 or 20 .. and another may last 15 with no explanation of why it lasted
that long.. but I wonder... surely there must be some average life based on nothing but how many valves
were replaced and how long they lasted..
can I even get that figure.. ??or is there something else here that I am not seeing which would preclude
that information from being dispensed.. It seems to be a reasonable bit of information to have when
choosing a valve type.. How long have homografts been used? and is the data from pure numbers of
cases insufficient to make significant assumptions? .If that is the case ... is there not even a small
sampling of performances to date??One thing concerns me... is the medical community doing these surgerys and then disconnecting themselves from the collection of statistical information which would be the following of these cases to not only reoperations or postop problems but to the eventual death of the patient by these or other causes??
another question..
The doctors that have diognosed my problem have admitted that it is more of an art than a science deciding
when to do surgery..
I have learned A couple of major barometers of this timing .. Are you having symptoms from this yet and..
what does the valve sound like.. is there a distinctive click upon closing..
My valve is 1cm sq.. and I think the audible sound is a little concerning>>I futher think that the cardiologist is
assuming I may be having symptoms.. I think so my self sometimes but then I also do not.. I told
him that I experienced tightness in my chest only upon very hard exertion.. and then it was a mild
tightness. which went away immediately upons stopping the exertion...I have no shortness of breath really or less than my wife has who has no heart problem..
My concern is now and has been for sometime.. is it really time to do this?? I know I can't be operating at
peak efficiency and definetely have some limitations that I would not have with a good valve but what are
the dangers of waiting another year or 6 months .. other than of course the minor consequence of sudden
death ;-)..If that did not happen would I not just be moving the time of resurgery back a little further..
Just a thought .. your comments please..
Doctor's Answer
by Cleveland Clinic, MD, Jan 02, 2000 12:00AM
, Jan 02, 2000 12:00AM
No, you don't have to have the same type of valve in a repeat surgery. If fact many people who started with a tissue valve choose to have a mechanical valve the second time for your very reasons. There is plenty of statistical information and a good medical librarian can help you find it but statistics are not individuals. No one can say for sure how long the valve will last in you - thus a range. As far as timing goes it is an art and waiting is OK but not for too long. In general with aortic stenosis if there are any symptoms the time to operate is sooner rather than later. Hope this helps. Keep a list of questions to bring with you!
I am trying to visualize where they would do this..I am going to have this operation in CLeveland soon...
and from looking at the thorax.. it seems to me that they would still cut the sternum but not all the way to the top nor all the way to the bottom.. leaving some..(maybe half of the sternum )connnected and thus not causing nearly the structural loss during healing..
Also I assume that the abdominal muscles would remain attached to the bottom of the ribs, would not need dissection... and that the pectoral muscles on the right side would be separated and the incision would be between the ribs below the muscles..the incision would be the longest on the two lateral distances...
Am I correct or if not.. can you briefly tell me how it is actually done?