Question re: prognosis post stents and mitral valve replacement

[cw0076]

Hi, I know this is not likely something that can be answered definitively but would appreciate any thoughts/others experiences.

My dad  (age 67) had heart attack last week requiring 2 stents. Subsequently (48-72hrs later) it was determined he also required mitral valve replacement. He opted for mechanical valve.  

He has had a number of "complications" or "hiccups" in his recovery thus far while in hospital including requiring 2 transfusions, lung collapse, low blood pressure, irreg heart beat.

He was discharged yesterday and saw his GP today. He was d/c with a variety of meds including 3 anti-coagulants.  GP felt that this put him at extremely high risk for bleeds.  SHe also advised he should get nitro and have it with him at all times.  She also said his life expectancy was 10yrs if he took good care of himself and was lucky.  

The last part shocked my family because they had never indicated life expectancy would be affected if he had a good recovery.  

Unfortunately my dad is an x-smoker so this is impacting everything and now they are also saying there are signs of COPD.

So I guess my question is whether others here have been told their life expectancy is going to be cut short due to these events.  My dad is committed to having a healthier and happier lifestyle and hopes not to have to take all these meds long term and switch over to alternative/natural options (that are well researched). My partner is a herbalist and natural health specialist so he will be a great resource in the time ahead.

Thank you and I wish you all health and strength.

[cw0076]

Thank you. Yes, this is one of the many questions they have for the cardiologist next week.  Honestly, I think that the fact that his life expectancy may be impacted by this may not be surprising. However, what most disturbed me was that the GP decided to share this on a first visit post discharge from hospital. Considering the correlation between mortality and depression, I feel that presenting this info is quite disheartening. I thank you for looking at the bigger picture and that there are many factors that can play a role.

[CCFHeartMD24]

Life expectancy is based upon a number of factors, and in many circumstances, is only a poor estimate based upon aggregate data from a large number of patients.

Without knowing anything else about your father, a mitral valve replacement does not necessarily give him a 10 year life expectancy. There are many patients with mechanical valves (with a history of coronary stents) who live for decades with a good quality of life.

Again, life expectancies are at best a poor estimate, but if this is something that has taken your family aback, you may consider a second opinion from your cardiologist.

[cw0076]

Thank you CCFHeardMD25. I will refer to the WOEST trial and inform my dad to mention to cardiologist. He was d/c from hospital yesterday and saw GP today and she reviewed hospital course and d/c meds. While she is not prescribing them she did refill the rx from the hospitalist. He will see cardiologist next Tues.  I guess my biggest surprise what that she said my dad would be lucky if he had 10yrs in him. If that were the case then I wonder why the surgeon would have even given him the option of mechanical vs tissue valve....since the durability of the valve options wouldn't really come into play.  If my father had been given this prognosis I think he would have opted for the tissue valve so that he possibly have one less medication.  Yes, smoking cessation and lifestyle changes are in order and I think he is committed. I think we are all still in shock. Thank you again for your advice and expertise.

[CCFHeart MD25]

Mechanical valves require therapy indefinitely with warfarin (also called Coumadin) with NO exceptions. Coronary stents require treatment with anti platelet agents. There is some new data (I would suggest you ask your cardiologist about treatment options, specifically the WOEST trial in The Lancet). His anti platelet and anti coagulation therapy should be determined by your cardiologist and not your GP. This gets to be quite complicated. Gong forward, smoking cessation is gong to be a must for your father. Good blood pressure, cholesterol management, a healthy diet, and exercise are all extremely important to maintain a healthy lifestyle.