lower Ejection Factor after mitral valve repair

[renoron]

About two weeks ago, I traveled to Cleveland to have a robotic-assisted mitral valve repair. During surgery, they shocked me for v-tech (sp?) three times (I'm unclear if it was 3 separate events, or 3 shocks to control one event). The valve repair was successful.

My ejection factor before surgery was 65%, but post-surgery, an echo established it at 45%. I don't see my cardiologist for another 10 days, and in the meantime, was wondering what could have caused the reduction in my ejection factor. Could the shocks have affected the strength of the heart muscle? Is this sometimes a side effect of such surgery?  Thanks!

[SB69]

Hi Ron,
I came across this website and was happy to see that your surgery went well. I have a scheduled mitral valve repair surgery coming up this August with Dr. Mihaljevic. How are you doing today?

Jo Ann

[Momto3]

WOW!  This is just amazing to me!  I cannot believe the DaVinci robot is being used for valve repairs...that's awesome!

I'm so glad to hear you are recovering so well...I am absolutely amazed at the workings of the human heart.  

My biggest fear about a potential surgery is the ventilator.  I keep reading how important it is to breathe "with" the machine and not to work against it.  I've also read that some people have no recollection of the tube/vent at all!  That's sounds good to me.  

How long have you known about your valve?  How quickly did things progress?  I've known about my MR for about 25-30 years and so far, all's well.  Hopefully, it will stay that way : )

Thanks for sharing your success story!

connie

[Lil711]

It was great to read all of these comments on mitral valve repair. I had my surgery kjanuary 23 at UCLA with Dr. Shemin. He also used the da Vinci robot. My EF was about 55 before the surgery (it had gone down from 65, one of the reasons I knew it was time for operation) and was at 45-50 after the surgery. My surgeon feels this will "remodel" itself as the valve heals. Five weeks out I am doing anything I want to, go to the store, drive, walk, do some work, but I do find I get tired and on days when I "overdo" I pay for it later and need to just rest. My heart and I get tired! I do feel I get out of breath more when I walk than before but I am also out of shape.  :)  I am 62 and hope that after a couple more months I will be my old self. I guess the heart really does need time to heal. I was at UCLA Med Center 5 days, one night in ICU, hated the ventilator but only was aware of it for about an hour then they took it out. I did go into afib on Day 2, the most common "complication" but was put on Amiodarone (hope to be off of it in another month) and metropolol (I used to take propranolol) and converted out of afib in about 36 hours.  
Lil

[renoron]

It was definitely better when I was able to sleep through parts of that day with the tubes still in, or had a fresh enough dose of pain meds that I was pretty much out of it. Maybe my throat is overly susceptible to gagging, but that was definitely not my favorite 24 hours! :)

Follow up will be local. It would be nice to have it with those familiar with the process, but I guess that's really not an issue, being that post surgery concerns are pretty much the same no matter the method used to get to this point. As I mentioned before, there are drawbacks (as I see it) to the way things are done back there,  communication being one. I really think a consultation with the surgeon or at least the cardiologist I interviewed with before the surgery would have been good. The EF issue being "mentioned" to me by the floor nurse during discharge seems a topic best handled by a cardiologist, it would seem to me--I didn't even know what the ejection factor was! She just gave me the numbers and said, "so you may have heart failure...", and gave me a shrink wrapped binder entitled "Living with Heart Failure".

My room mate was a great little 84 year old guy who had traditional mitral valve repair, and his family mentioned "the bakery" to me. They offered to smuggle something back for me, but I was having a hard time trying to get someone to walk me down to security so I could get some cash out of my wallet, so I never did take them up on the offer, unfortunately.

Dr Mihaljevic seemed a great guy. I only saw him once, the evening before surgery for about 5 minutes. He had an easy manner, laughed and smiled, answered my questions, was very reassuring. He was running about two hours late and had just gotten out of surgery when I saw him, and I remarked about his very long day. He smiled and said it was just a normal day, and he had two more surgeries to go. (It was 5:00pm by then.)

Thanks again for your well-wishes! Let me know if I can answer anything else about CC or the surgery for you.

Ron





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[Momto3]

WOW!  That doesn't sound too bad (except for the tube part!!).  If I have to go through surgery, I'm going to let them know wellllll ahead of time I'd rather not feel (or remember) the tube.  I know they want you to be able to breathe on your own before removing it, but we'll have to come to some sort of agreement...LOL

I cannot believe you were driving your Miata the 8th day after surgery!  That is amazing!! I hope that each day brings more improvement!  Do you have to fly back to Cleveland for your re-check, or can you visit your local doctor?  When my husband had his surgery in Ohio (we relocated to NC a few years ago) he was able to follow-up locally.  On one hand, that's convenient.  On the other, it would be nice to speak directly with the surgeon/physician who was directly involved in the surgery.

We are from Cleveland and I've been to the CC; it's like a city!  I remember sitting in the cardio waiting room and they were moving people like Disney!  Bummer on the cafeteria food.  BUT, if you go back ask where the bakery is!!  It is awesome!  It'll be much tastier after surgery ; )

Thanks for the name of the surgeon.  Did you find him helpful, thorough, friendly (I'm one of those who needs to have a doctor I can talk to...LOL)?  My husband, on the other hand, could care less.  He only thinks about the expertise.  I like both : 0

Thanks again!  Wishing you a terrific (and short) recovery!

connie

[renoron]

Thank you both for your responses!

It was two weeks ago yesterday that I had my surgery, and the pain truly has been minimal, mostly limited to a general soreness in my arm next to the primary incisions. I picked up a cold--I think from the guy next to me on the flight back last week--and even all the coughing the last couple of days hasn't been any more painful than it would have been at another time. The absolute worst part of the whole thing was gaging on the tubes they kept down my throat for 24 hours after the surgery--never did I have any intense pain, or pain that was more than a mild annoyance. With robotic surgery, I was released with no actual restrictions, my activities are allowed "as tolerated". I actually squeezed into my little sports car (a Miata) and drove to the store the day after I returned--which was the 8th day after surgery.

I am able to take deeper breaths now--I used to cough before when it got to a certain point. Unfortunately, with the lower EF I still run out of breath just as quickly, if not a bit sooner, than before the surgery. Other than that, recovery has been quite easy.

I understand Cleveland Clinic processes around 2000 patients a day all told, so it can get a bit impersonal at times, but overall, it was a very good experience. Communication, such as the way I found out about the EF issue, seems to suffer a bit. (Also, the Cleveland Clinic kitchen must truly be the source of all the "hospital food" jokes you've ever heard!)

My surgeon was Tomislav Mahaljevic.He's got a lot of experience in robotic mitral valve repair, and after spending a weekend researching the topic on the Web, decided he and Cleveland Clinic seemed to be the best choice. I just didn't want or think I could afford the longer recovery time in traditional open heart surgery.  

They do have me on a beta blocker (metoprolol) for now.

I've been told for years that I had a slight murmur, but earlier this year, my GP suggested it was time for an echo, which revealed the valve problem. I'd been tiring and running out of breath easier than in the past, but nothing severe.

Glad your husband fared well, Connie. Hope you don't ever need a valve repair, but if you do, I can't recommend robotics enough!

Ron

[Momto3]

Congratulations on the successful repair!!  I have a cardio at the CC in the event I need an MV repair (or replacement) in the future.  I didn't realize they were doing robotic MV repairs!!  That's awesome!  If you don't mind, who was your surgeon?  If you prefer, you can send me a private message.  My husband had robotic surgery (different procedure) last summer and it was incredible!  The robot is amazing and the recovery was not too bad.  How is your recovery going?

I agree with kenkeith, it will likely take some time for your heart to "recover" from the shock.  Not necessarily, the "shocks" for V-tach, but rather the trauma of the entire procedure.  I've always been told it's best to have the valve repaired before your EF goes down.  Did you have symptoms prior to the surgery, or was it caught on echo?  

Are you taking a beta blocker and/or an ACE inhibitor?  

Again, CONGRATS on the successful surgery!

connie

[kenkeith]

Your heart has experienced major stress and the lower EF is an estimate at a specific time.  Your heart will require a light afterload and time to heal.  There shouldn't be any cause for concern.  More importantly is how well you feel.