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Aortic Valve Replacement: second cardiac surgery
My dad has been advised to get an Aortic Valve Replacement surgery ASAP.
I took his, Echo, ECG, and other reports to various doctors, and all of them suggest an immediate surgery since his aortic valves are "Severely Calcified" as per the report.
My dad is 68 now, and he had a CABG surgery three years ago. All the doctors are quoting a risk of about 5% since it requires a re-entry for the second surgery. Once doctor quoted the risk percentage at 10-15% and suggested him to continue on his medication instead of the surgery since the risk percentage is too high.
Since the re-entry procedure is risy for the second surgery, is minimally invasive approach better? Almost all of the cardiac surgeons that I met suggested that the minimally invasive approach is just a marketing gimmick and the traditional approach is safer. There is just one hospital in Bangalore (India) that does the minimally invasive procedure and that surgeon is confident of doing a safe procedure on my dad.
So I'm now confused whether to go with the traditional approach from the same doctor who performed CABG on him three years back, or go with the minimally invasive approach. Please share your feedback.
I took his, Echo, ECG, and other reports to various doctors, and all of them suggest an immediate surgery since his aortic valves are "Severely Calcified" as per the report.
My dad is 68 now, and he had a CABG surgery three years ago. All the doctors are quoting a risk of about 5% since it requires a re-entry for the second surgery. Once doctor quoted the risk percentage at 10-15% and suggested him to continue on his medication instead of the surgery since the risk percentage is too high.
Since the re-entry procedure is risy for the second surgery, is minimally invasive approach better? Almost all of the cardiac surgeons that I met suggested that the minimally invasive approach is just a marketing gimmick and the traditional approach is safer. There is just one hospital in Bangalore (India) that does the minimally invasive procedure and that surgeon is confident of doing a safe procedure on my dad.
So I'm now confused whether to go with the traditional approach from the same doctor who performed CABG on him three years back, or go with the minimally invasive approach. Please share your feedback.
Today I took my dad for a consultation with the surgeon who did CABG on him three years back. He explained the problem with the aorta thoroughly, and he too suggested a risk of 4 to 5%. He prescribed some more medications till the surgery is done.
He is the best available cardiac surgeon in Bangalore (India) currently, and I'm inclined to get the surgery done from him.
The only issue is the 4-5% risk factor quoted by this surgeon too. But then there is no other option.
He is the best available cardiac surgeon in Bangalore (India) currently, and I'm inclined to get the surgery done from him.
The only issue is the 4-5% risk factor quoted by this surgeon too. But then there is no other option.
Hi there,
Definitely go with the most experienced Surgeon! At the age of 68, your Dad is at risk of getting post-op complications, i.e. Pneumonia, DVT's or Lung emboli. That is maybe why the first Surgeon suggested that your Dad's age counts against him.
In the past year, I've lost 2 relatives due to post-op complications from open-heart surgery.
All the best. It is not an easy decision for your Dad or you or the Doctors to make.
Definitely go with the most experienced Surgeon! At the age of 68, your Dad is at risk of getting post-op complications, i.e. Pneumonia, DVT's or Lung emboli. That is maybe why the first Surgeon suggested that your Dad's age counts against him.
In the past year, I've lost 2 relatives due to post-op complications from open-heart surgery.
All the best. It is not an easy decision for your Dad or you or the Doctors to make.
Let me clarify. Your father's survival is going to be much more dependent on the success of the actual valve implantation inside his chest than it is on whether the incision was done in the middle of his sternum or between his ribs. Aortic valve surgery is technically challenging. The surgeon is working with his hands down inside a bloody hole. The valve is located deep inside other structures, such that it is hard to see and hard to feel.
Your father's aortic valve is encrusted in a thick layer of calcium that will want both to cling to the surrounding tissues and to break into little crumbs or particles that can get into the bloodstream. The aortic root where the valve is located may be diseased, and it may need surgical modification -- or it may not -- and the surgeon will need to be able to handle that, as well. In some cases, the ascending aorta is abnormally enlarged and has to be replaced with a dacron sleeve. Infection must be guarded against, all the way. It's a complex surgery, in regard to both the hands-on skill and the decision-making.
The surgeon has to be allowed to choose the kind of incision that he is professionally comfortable with. Any decent heart surgeon should be able to handle the dissection to get to the heart, either way. What you want is to make sure your father has a surgeon who can handle the rest of it, once he gets in. An open-chest incision allows the surgeon to get a better look at what he is doing than a minimally invasive incision does. If my surgeon feels he needs to do open-chest, I'm going to let him. It's his call. But I'm going to find the most experienced aortic valve surgeon I can.
Your father's aortic valve is encrusted in a thick layer of calcium that will want both to cling to the surrounding tissues and to break into little crumbs or particles that can get into the bloodstream. The aortic root where the valve is located may be diseased, and it may need surgical modification -- or it may not -- and the surgeon will need to be able to handle that, as well. In some cases, the ascending aorta is abnormally enlarged and has to be replaced with a dacron sleeve. Infection must be guarded against, all the way. It's a complex surgery, in regard to both the hands-on skill and the decision-making.
The surgeon has to be allowed to choose the kind of incision that he is professionally comfortable with. Any decent heart surgeon should be able to handle the dissection to get to the heart, either way. What you want is to make sure your father has a surgeon who can handle the rest of it, once he gets in. An open-chest incision allows the surgeon to get a better look at what he is doing than a minimally invasive incision does. If my surgeon feels he needs to do open-chest, I'm going to let him. It's his call. But I'm going to find the most experienced aortic valve surgeon I can.
The most important part of the decision is not whether your dad should have an open-chest procedure or a minimally invasive procedure. That is for the surgeon to decide. The decision for the patient and his family to make is to choose who performs the operation. The outcome of aortic valve replacement is very highly dependent on the surgeon's level of experience with that particular procedure -- not just how many heart surgeries he has done, but how many aortic valve replacements. I would find the most experienced aortic valve replacement surgeon that I could find, and let him choose how to do the procedure. Good luck.
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