“What Percent of Heart Valve Surgeries Are Re-Operations?” Asks Marc

I just received a very interesting email from Marc about heart valve surgery re-operations. He writes, “Adam, I’m an active 47 year-old just diagnosed with severe mitral regurgitation. I can’t help but think that I’ll need a 2nd surgery if I get a repair or a tissue valve. Do you know what percent of valve surgeries are re-operations? Are they primarily from surgical error or degenerative reasons? Thanks, Marc”

Black Percent Sign WIth Question Marks

You can probably understand why I wanted to feature Marc’s email… He asks a great question. Unfortunately, I did not have a great answer. So, I contacted Dr. Kevin Accola, M.D. and Dr. Paul Stelzer, M.D. — two leading heart valve surgeons to learn more about heart valve re-operations.


Dr. Kevin Accola, M.D.

In response to Marc’s question, Dr. Accola, who practices at Florida Hospital Cardiovascular Institute, wrote:

Most institutions with significant volume do between 10% and 15% redo’s on average… Mine is about 12% in regards to patients who have had previous bypass surgery and now need a valve procedure, or a redo valve which has degenerative changes and now needs to be replaced. Sometimes these valves can calcify or the initial degenerative process continues and over time progresses to the point that the valve needs replacement.

Specific to Marc’s question about surgical error, Dr. Accola noted:

Redo’s for “surgical error” is quite low. Although it demonstrates again why a patient should seek out an institution or a surgeon who does a significant volume of valves and has obtained an “experience” with valve repair or replacement. This also demonstrates why we prefer to repair valves earlier as the tissues are typically better with less calcium and more likely repairable.

Dr. Paul Stelzer, M.D.

I then heard from Dr. Stelzer, a heart valve specialist at Mount Sinai Hospital in New York, who shared:

Valve re-operations are very rarely due to “surgical error” but there is definitely a slow degenerative process that affects tissue valves that ultimately leads to re-operation unless the patient is over 70 at initial surgery.  As for coming up with a number for what percent of valve operations are re-do cases that is a little hard to estimate.  I looked up the New York state data base for the most recent reporting period that has been published (2005-2007). It lists the percentage of valve operations that have had previous open heart surgery as 18.2%.  It should be noted that a patient who had previous bypass surgery and then gets a valve operation is included here so it’s not quite the same as a “failed valve” operation.  There are also some patients who get endocarditis on a previous aortic valve and have a complete root replacement with a homograft to fix this.  These patients are notcounted as valve surgery by the New York state system – the root replacement is considered “other” and these are counted separately with less common operations such as arch replacements, transplants, etc. That’s a bit of a long answer to the question, but the short version would say between 10-15% of operations on valves are reoperations.

For me, these responses were incredibly helpful in learning more about heart valve re-operations. It was also very interesting to see the relative consensus of Dr. Accola and Dr. Stelzer specific to Marc’s inquiry.

Thanks to Marc for his question and thanks to Dr. Accola and Dr. Stelzer for sharing their surgical expertise.

Keep on tickin!

Adam Pick
Written by Adam Pick

Adam Pick is a patient, author of The Patient's Guide To Heart Valve Surgery and the founder of HeartValveSurgery.com.

To learn how Adam has helped millions of people with heart valve disease, watch Adam's video, subscribe to his free newsletter, or visit his Facebook, or Twitter pages.

  • John Zucker

    Adam, I very much enjoy your blog. In July, at age 44, I underwent mitral valve repair at the Cleveland Clinic by robotic assist. Prior to surgery I had been living asymptomatically with severe regurgitation but then contracted endocarditis and it was time for surgery. Naturally, I did my homework and was concerned about long-term prospects as well as the likelihood of re-operation. I saw similar stats of 10-15% after repair, but figured that it was far preferable to replacement. By the way, the robotically-assisted procedure performed by Thomas Mihaljevic was amazing. Not only was I discharged in 3 days, but on that 3rd day I spent an hour and a half touring the Cleveland Art Museum. That evening I went to a friend’s bar-b-que for dinner and flew home the next day.

  • Cindy McGinn

    Hi Adam,
    I was 52 when I had my aorta valve replacement. I can totally relate to Marc and his concern about facing a possible second surgery if selecting a tissue valve. The fear of being older and having to do it again was the driving force behind my decision to select a St. Jude mechanical valve. It’s been about 19 months and for the most part I don’t regret my decision. I haven’t had a problem taking Coumadin, though I discovered something as minor as dental surgery to have a root removed turned into a major deal. Some future foot surgery that would be routine will also be complicated by the Coumadin. I’ve given it a lot of thought, with hind-sight being what it is, and even with the hassle I would select the mechanical valve. My surgery went well and I’m doing great, but having to go through the surgery and recovery again is still something that I never want to have to face. The only thing that gives me pause now is seeing how they are making great strides in valve replacement through a catheter. I do wonder if something would go wrong and that option is available would the mechanical valve disqualify me as a candidate.

  • Randy Heimerl

    Hi Adam,
    Cindy asks a question that I’ve been meaning to ask also. Could you have a mechanical valve replaced through a catheter? They said my mechanical valve should last the rest of my life,but you never no, something could go wrong and it would need to be replaced.
    Randy

  • Zee

    my husband had the mitral valve repaired August 3, he seem ok to be discharged, one week later he had to have his heart shocked. that was successful. during this time his eating is non existant. unable to eat. Sept 7th he had a stroke on his left side, dr said he expects a full recovery. The vomitting stop but he is still unable to eat, unable to deal with scents, he has zero feeling to eat anything. His heart is back in sinus since saturday but for 2o mins yesterday was off. He is very depressed. He could be discharged tomorrow but I am afraid for him and how care for him if he is not eating. This morning we were told the valve is still leaking. What now.

  • Jim Hilbe

    Adam and friends,

    The Cleveland Clinic website has a document available called “Outcomes 2009”, which was recently completed for the latest full year of all procedures done at the Clinic. They performed a total of 2,677 valve procedures; 1,981 or 74% were primary operations (including my wife’s AVR), while 696 or 26% of them were re-operations. This is a considerably higher redo rate than the others mentioned here. One factor is they do far more total valve operations than any other facility, and they use a lot of biological valves. I hope this sheds more light on the question.

  • Sherri Hendry

    I am glad this subject came up. I will be one of those re-op statistics in the future. After my last echo in May, I learned my MV was again a moderate leak. My MVR was in January of 2009. After surgery I had a tiny tiny leak which I was told is normal. By late last summer, the leak went to a mild-moderate. I was also told in May that a replacement will be in my future. The repair is doing what it is suppose to do, but my leak is from calcification due to years of wear/tear. However, at time of repair, the valve was still in decent shape.

    For Dee – tell your husband to hang in there! We are rooting for him and our hearts go out to both of you.

  • Don Hull

    I am a “re-op” patient. In April ’09 I went in to have a mitral valve repair. For a day or two, they said everything looked ok. Then my heart didn’t have sinus rhythm. After it did get into sinus rhythm, I then developed hemolytic anemia. It seems the valve was leaking in a different place than before surgery and it was physically damaging red blood cells. So I then was told it was time for a valve replacement. I chose tissue over mechanical, and they placed an Edwards Bovine tissue valve. After surgery, recovery went slow but sure, and I was finally discharged. After getting home, I got stronger and stronger, mainly due to a terrific rehab program. It took a while but now I’m back to work and feeling great.

    Note to Zee- As others have said, we are pulling for you and your husband. Don’t be afraid to ask for a second or even a third opinion. Don’t give up.

  • Kathy Cooper

    I recently had triple bypass, I only had 20% of my heart working before surgery and 20% working after surgery. But my last echo showed that I had about 40 to 45% working now.I also have a leak
    at the top of my heart.My doctor said,that it would be ok that most people have one and never know it. I am concerned about this because
    I have heard that the longer it is leaking the worse it gets and cannot be fixed. Should I get another opinon?

  • Ann Green

    My husband had a four-way bypass and a valve replacement on September 3, 2010. He then contracted bilateral pneumonia. We are home as of last Friday – so 2 weeks in hospital. He is also a severe and very brittle (4 shots a day) diabetic. He is somewhat depressed but will feel much better when his voice returns. They had him on the vent three times, as well as a bronchial procedure to remove fluid from the lungs and a test called an EET, which also involves a tube, so tubed at least 5 times that I know of. Thank you for this blog – reading that this hoarseness is not too unusual helps me a lot and will also encourage him some.

    For Zee, our thoughts and prayers are with you.

  • Graeme

    Hi Adam,
    to Marc.I know its hard getting your head around the operation but you should be thinking about the first one before worring about the second. I am 8 weeks out from my secound and it went very well, in fact the pain was minimal, my only regret is not having a tissue valve so I don’t have to take this rat poison and i could go and have a few beers with my mates,(like more than 2)
    Jokes aside I think once you are over that 10 year mark (I was 12 years)you forget the scarey bits and the pain and at the end of the day you want to be better rather than not.

    Graeme

  • alissha

    I’m thankful to have found this site and anxiously await your book which I just ordered. My 82 year old father just learned that he needs a valve replacement. Within the past week, he had been having trouble breathing and there is now an accumulation of fluid in his lungs and the heart echo revealed the need for a valve replacement….still not sure if it is an aortic or mitral valve. My guess is a mitral valve since I have mitral valve prolapse and I’m thinking it might be inherited. In any event, does anyone know of the top one or two cardiac surgeons at Mayo in Rochester. I’m having a difficult time locating any information on the top valve replacement/repair surgeons there. Our family physician is fine with the idea of having a local surgeon (town of 80,000 with a pretty good heart unit), but I’m now rethinking the idea. Mayo sounds better to me considering he now is having kidney problems, too, because of the excess fluids/diabetes. Thanks for any info anyone might have.

  • Michael Ingiosi

    Hi Adam,

    Thank you for bringing up re-ops, as I am going to be experiencing one very soon. I am 37 years old. I had aortic valve replacement surgery in June of 09, after which I needed a permanent pacemaker implanted two days later. I now need to have another surgery due to a paravalvular leak around the mechanical valve, and a ventricular septal defect caused by the surgery. I have recently been diagnosed with severe pulmonary hypertension, which was caused by these heart problems. I am not sharing this to scare anyone, although I am in fact really scared. I am sharing this to inspire people to please do their research and choose their surgeon and hospital very wisely. If you have to travel far to get the help you need and deserve, then go as far as you need to. In hindsight, I firmly believe that I did not do enough research before my initial surgery and that I made a very poor choice in the surgeon and hospital. This time around I have done a lot of research, in large part thanks to your book and site, and have chosen a world renowned surgeon in one of the top heart hospitals in the country. He and his hospital specialize in complex re-operations. As my insurance would not allow me to go out of state, I had to look a bit deeper than the Cleveland Clinic, who would have been my first choice for obvious reasons. I believe I will in much better hands next time around. Thanks again.

  • Richard Erickson

    Adam,
    I read with great interest this blog about Marc’s question on re-operation. I am 60 and have had three aortic valve replacement surgeries (27, 32, 42 yrs). The current valve I have in is a human allograft, which I’ve had in since 1993. This valve has functioned exceptionally, but is now starting to degenerate. I will be facing number four probably summer of 2011. I want to tell Marc that each time I had my valve replaced it healed with no complications and I went on to live a normal active life with no resrictions. The Surgeons today and the technology they have to replace valves are exceptional and I don’t have any anxiety or fear that my forth valve surgery will have any complications and will allow me to get back to a normal active life.

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