minimally invasive aortic homograft replacement

[Ted]

I am scheduling aortic valve replacement in the next 2 months at your clinic.. I intend to have a homograft replacement and the surgery will be minimally invasive.. My coronary arteries are clear..

My questions are..

Do I need to donate some of my own blood.. or is the blood loss not that significant..?

When the minimal invasive surgery is used.. is it more or less trouble when the surgery is needed again? or the same? and can it be done the same way again?

And the length of time the valve lasts.. I have heard everything from 7 yrs to 20 yrs.. I know there are no absolute answers but is it unrealistic to expect to get 15 yrs out of this valve..

Do they not expect them to last longer than porcine .. and do porcine valves not last 10 yrs on average??

Also the depression thing after surgery concerns me greatly..is this something that lasts forever or just a few months post op?

I have had some problems with that before ..does that mean I will more likely have serious problems ?

Does the minimal invasive surgery  cause less back problems due to not opening both sides as much??I understand sometimes there are back problems due to patients keeping their shoulders slouched to avoid pulling on the sternum.. any truth to that??

Thanks ahead for your reply..

Ted

[Ted]

Marilyn

You have been through a lot..

do you have an email..? i have a couple more questions i would like to ask

Thanks for your comment


Ted
my email is ***@****

[MARILYN H.]

i have the same problems as you. I was in here looking for answers myself and found your answers, I to have wondered just how long the homograft lasted? I have had 4 open heart and i"m 45 now i was told 2 yrs ago when i had the graft put in it would last up to 8 to 10 yrs. i have had the synthetic (pig valve it lasted 13 yrs. then the mechancial which only lasted 7yrs because of scar tissue that developed around it, is then when i hd to have it replaced. I was told the mechancial would last 15 to 20 yrs , but i was not given that time for this one. i am wondering how many times can one person under go these sugeries? and how come they don"t last. and what will they use next time? i hope everything goes well with you i feel somewhat like a pro at it. and i can tell you you will be fine. and you will get a little depressed i to went through that, it doesnot last forever.we are very blessed, it could be worse. PS ANOTHER THING YOU CAN TELL WHEN YOU ARE SICK, GO WITH YOURSELF. NOONE CAN TELL YOU HOW YOU FEEL. THE SIGNS ARE FATIQUE, SHORTNESS OF BREATH ,AND MAYBE ALITTLE PAIN IN YOUR CHEST .ALSO SWELLING IN YOUR ANKLES AND HANDS THATS WHAT MINE WERE.

[Ted]

It probably looks as if I am responding to myself.. but I thought of 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..

A couple of barometers of timing are .. 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 sound is a little concerning>>I futher think that the cardiologist is assuming that 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..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..

thanks..

Ted

[Ted]

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??

Thanks for your encouraging note on my surgery in Cleveland..


Ted

[Cleveland Clinic, MD]

Best wishes for your surgery.

[Ted]

Thanks for your comment Susan.. I still have a million questions but I am slowly getting some of them answered and I also realize that many will either never be answered or not until I have my own personal experience with this stuff

[Susan]

Ted, I had my aortic valve replaced last February with a St. Judes mechanical.  At just about 10 months now, I have really noticed in the last couple of months all of the positive effects of the surgery.  I recovered rather quickly from the general surgery part, but has taken a while to get my breath back and to get past the fatigue thing (but then I went back to work at 6 weeks and have been very busy with that so that may have slowed some recoup down).  I can honestly say, however, that I never really had a problem with depression.  A few sad moments perhaps but mostly due to coming to terms with being a "heart patient".  However, I am too thankful for the positives and realize how lucky I am compared to so many others.  Not having tons of family to stand in my corner, I also realized that God was there through it all and thank Him every day for the good health I am enjoying as a result of the surgery.  So if I were to offer any advice, don't worry about the "depression thing".  Spend your energy (what you will have and as it increases!)on your physical recovery and the rest will fall appropriately in place.  Good luck!!

[Cleveland Clinic, MD]

I can give you some general answers but your doctors here will be able to give you more exact answers based on your history.

Q: Do I need to donate some of my own blood.. or is the blood loss not that significant..?
A: Most patients do not require blood transfusions.

Q: When the minimal invasive surgery is used.. is it more or less trouble when the surgery is needed again? or the same? and can it be done the same way again?
A: I would say about the same, perhaps a little less trouble.

Q: And the length of time the valve lasts.. I have heard everything from 7 yrs to 20 yrs.. I know there are no absolute answers but is it unrealistic to expect to get 15 yrs out of this valve..
A: Doctors hate to give exact estimates (thus the 7 to 20 range) however 15 years is in that range and possible.

Q:Do they not expect them to last longer than porcine .. and do porcine valves not last 10 yrs on average??
A: True, but some porcine valves only last 5 years.

Q: Also the depression thing after surgery concerns me greatly..is this something that lasts forever or just a few months post op?
A: To use a famous "doctor expression" it depends... Some people never have any depression, most for a short period and some for longer periods.  I guess the important thing is to watch for it post-op and get treatment if needed.

Q:Does the minimal invasive surgery cause less back problems due to not opening both sides as much??I understand sometimes there are back problems due to patients keeping their shoulders slouched to avoid pulling on the sternum.. any truth to that??
A: ???