Surgeon Q&A: What Should You Know About Heart Valve Re-operations?

The good news about heart valve surgery is… It will save your life. The other piece of good news about heart valve surgery is that most patients only need surgery once in their lifetime. For a small group of patients, however, the need for a second surgery may occur. While the thought of going through two cardiac procedures can be quite daunting, the good news is… The second procedure may also save your life.

The more I learn about the complexity of valve re-operations, the more inspired I am to educate our community about this very important topic. For that reason, I just met with Dr. Anelechi Anyanwu, a complex valvular specialist, at Mount Sinai Hospital in New York. As you will learn in this video, the differences and risks between a first and second surgery — for the patient — are significant.

I hoped this video helped you learn more about the complexities of a heart valve re-operation. I know it helped me.

That said, I want to thank Dr. Anyanwu for taking the time to meet with me. His advice and insights about complex heart valve re-operations were excellent. I also want to thank Dr. Anyanwu for helping several patients in our community – like Bob DeVos (shown below).

bob-devos-crop-smallerBob DeVos – A Mitral Valve Re-Repair Patient of Dr. Anyanwu

So you know, Bob traveled all the way from California to New York to be operated on by Dr. Anyanwu. After surgery, Bob is doing great!

Keep on tickin!

P.S. I have provided a written transcript about this video about complex mitral valve re-operations below:

Dr. Anyanwu: I’m a cardiac surgeon at Mount. Sinai Medical Center in New York. I perform about 200 operations a year of which about half of these are valve operations and complex re-operations.

I think what I enjoy the most is actually making a difference to people’s lives. I think it’s very rewarding because heart surgery is very taxing. Some of our operations take hours. I did an operation last weekend, the surgery took 12 hours. But, when you see the same patient a year or 2 years down the line, giving you a hug in the hallway then, it makes it worthwhile.

At Mount Sinai, we have a very busy program for mitral valve repair. And our focus is on achieving repair rates that are close to 100% of patients — if the valve is repairable. My other main interest in complex valve reoperations. Valve re-operations require a different approach compared to primary operations.

What makes a re-operation complex is 2 main factors. One is that when you’ve had surgery – it all heals as a scar – and the more surgeries you’ve had within your chest, there’s more scar tissue within the chest. So it makes it more difficult to for the surgeon to get back into the chest because he has to divide all the scar tissue. In the process of dividing that scar tissue, there’s a risk the surgeon could injure the heart, leading to massive bleeding or sometimes complications like a heart attack during the surgery. The surgeon has to take special precautions to try and prevent that from happening. The second factor is that, if your heart valve itself has been operated on before, and the valve is leaking again, then dealing with that is more complicated than dealing with the first surgery. We focus on trying to re-repair these valves, even if they’ve been repaired before, we try and repair them again. That’s very complicated.

Dr. Anelechi Anyanwu
Dr. Anelechi Anyanwu – Heart Surgeon

I think the thing to do for patients is to seek opinion from more than one surgeon or cardiologist because sometimes it might not necessarily be that you need to have another operation. That your valve is leaking again doesn’t necessarily mean that you need to have another operation. If it is established that you do need another operation, we tend to favor valve repair the second time — if it’s possible.

Every complex case is very different. Every valve re-repair is different. And I think you have to trust your cardiologist and trust that he will only send you to a surgeon that will act in your best interest.

For the valve re-repairs, we tend to have a team-based approach, so myself and Dr. David Adams.  I think having two surgeons on a complex operation is good because you have 2 brains thinking at the same time. You have two pairs of hands. You have 2 sets of eyes. I think the days of single physician practice are gone. I think to deliver healthcare you need a group of professionals or multidisciplinary group as opposed to single professionals.

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.

  • Janie Lou Greenlee

    I am facing my 4th aortic valve replace or repair. So I have had three open heart surgeries. I want to see what else is out there for me. Thanks

  • Zafar Mahmood

    Dr. Anyanwu is an expert cardiac surgeon for the re-operations of Mitral valve. May we know who is expert for aortic valve re-operations.

  • Harold Spriesterbach

    This topic has suddenly become of great interest to me as I just learned via a TEE test that my porcine mitral valve replacement of 5 years ago has developed a leak from the edge of the valve. I assume this is where it was stitched in to my heart.

    It is almost certain I will require another surgery before too long. I have had thoracic surgery on my right lung in the past and don’t know at this time if that would prevent me from a minimally invasive procedure even if I were a candidate.

  • Eileen J. Hawkins

    Hi again Adam,
    My son Jon drove me down to Cleveland Clinic on Monday, Jan. 27th where we were to arrive on the 28th through the 30th for three days of testing for heart surgery.
    Dr. Eric Roselli by my primary cardiologist as the dr. for the aortic root work. As I researched the surgeons online, he was my choice also, so I was glad we concurred in our opinions.
    However, when meeting with Dr. Roselli we were told that I am high risk for the second surgery re: kidney function which may require temporary dialysis and factors such as my age, 78. Although he said I did not look my age. (Nice of him) I told him some people tell me that.
    I had written here before our trip down there. Dr. Roselli’s nurse Sharleen called last Thursday to set the date of Apr. 9 for surgery.
    For the testing we arrived after an eight hour drive on Monday, Jan. 27th to our motel about 15 miles north of CC for easy access to US90 down to the heart/vascular Miller Center J bldg. Then visited the CC the 28th -30th.
    For the surgery we will have to drive down on Apr. 7. Apr. 8 will undergo pre-op testing and some other things, I think we meet the team too. Apr. 9, surgery, next two days in ICU, then to MedSurg week to 10 days.
    Have to talk with Sharlene, one of Dr. Roselli’s nurses today to reconfirm my place on the surgical list for Apr. 9 and hope she can answer some of my ongoing questions re: the procedure. I have to know what’s going on.
    During the time we were at CC for the testing we met some lovely people, but also had somewhat disconcerting time with two of the tests, the TEE and the hrt. cath lab.
    We went over my concerns and special things that involved previous testing at the hospital where my first surgery was done in 2011. But when I tried to tell the TEE people I needed more meds to keep me comfortable as I have a small airway, they didn’t listen and it was painful and very stressful. I felt like I was smothering and was having pain due to the manipulation of the scope even with what meds they gave and the bite block. My cardiologist has done a number of these (seven total now) and knows that it takes more meds for me and accommodates me accordingly.
    In the cath lab, the dr. was coaching another dr. in the groin procedure to check the three bypasses done in 2011 to make sure they were open and in good shape. Two were but one needs some work. I was supposed to be awake during this procedure and had it done twice before. I tried to tell them I was feeling a picking sensation when the primary cardiologist overseeing the cath told me to keep quiet so they could do their work. He said you can’t be feeling any pain as we have you numbed up. You can only feel pressure. Wrong!! I know the difference, but had to shut up. They finished and applied pressure for 20 minutes then sent me to the aftercare cubicle to lay flat for four hours to avoid bleeding. We were then released back to our motel with a large bandage across my lower abdomen with pressure.
    The next day, 30th, we had pulmonary testing, then met with Dr. Roselli for our evaluation and decision of what would be done.
    During the conversation with Dr. Roselli, he informed us that the cath lab drs had neglected to read his instructions completely and had left off part of the cath testing which was the pulmonary right heart cath through the arm. Since this was an important piece of my puzzle for surgery it was important. He called down to the cath lab and they said they could take me immediately and do it. We said NO, we can’t. There is a huge storm moving into the area and the roads are bad going back home. He said he accepted responsibility for the oversight but was sure he had written the orders correctly.
    I asked him if we could not contact my primary cardiologist the following morning and see if she could set up the pulmonary rt. hrt. cath at the hospital 65 miles north of us. He said that would work if they could do it the following week and get the report to him.
    I did call Friday morning and Dr. Hepner told me they had two cardiologists who could do this procedure on staff and she would set it up for the following Tuesday, Feb. 4. Of course this subjected me to another dose of Predisone to protect my system during the procedure, more fasting and traveling due to the oversight of this dr. in the cath lab who did not impress me.
    Dr. Roselli wondered if the new test would show that the pulmonary hypertension that showed in previous testing was not valid. However, I received a copy of the nine pages Dr. Recchia dictated of the test that had been sent and confirmed as received by Dr. Roselli’s office. The test showed that indeed I did have high numbers. As to what they can do about it, I haven’t talked with Sharleen yet this morning but will ask her.
    There was also a glitch in the info from the CC re: a fax number. The drs here sent the report the same day, but it did not go through as the rack card with all of Dr. Rosellie’s info had an old fax number on it from the many at the physicians registration desk. So I question who is dropping the ball here.
    I am only one patient and try to be an informed one. If I have so many problems with medical situations I have to wonder what happens to those who do not understand much or ask questions about their conditions. Throughout my life I have dealt with the death of our oldest son at age 11 after an illness of eight years and my husband’s 12 year fight with cancer as well has being the oldest of four children I had to grow up quickly and take charge when needed of my mother’s health and care during and leading up to her death from heart problems. So I am not a novice. It makes me concerned that so many things are driven by the insurance companies, the hospital bottom lines and now our Federal Gov’t without much oversight. Even the new electronic record keeping causing ongoing problems and will not be what it should be for several years before everyone is on the same software for communication. Communication is my strong suit and I have a need from those whom I have to deal with to be honest with me to help me make informed decisions.
    It has been on the news re: some larger hospitals not participating in Medicaid, or Obamacare because they are constantly facing adjustments to their budgeting to keep afloat. I know with our small local hospital facing Medicare shortages to their ER bottom line they are struggling to keep patient care as it should be while facing economic problems with cuts to many things. As I see it, rather than making it easier for lower income persons to access quality health care, Obamacare is causing more problems with all the rules and regulations they are imposing without even meeting with people in the medical communities for their input. The same with writing the software for the record keeping. My dr. also told me the software people do not confer with anyone from the medical field. Therefore some of the time that is wasted is due to the filling out of forms that are not pertinent to the patient’s care or problems thus causing a lot of confusion and mistakes. She said she tries to type in many things to assist in this which requires more time to do also.
    Bottom line is that I need: 1.New aortic valve, hopefully a larger one from 21 mm to 25 mm to ease my oxygen levels; 2.Restructuring of the aortic root to achieve this; 3. New mitral valve; 4.Repair or replacement of the tricuspid valve; 5.Possibly something done with the pulmonary situation according to the latest hrt cath findings; 6.Some clean out of calcification of the ventricles due to overwork by the heart; 7.Repair of one of the three bypasses from 2011. Plus kidneys will take another hit with the hrt/lung machine length of time. In my favor is the fact that I never smoked, I have not had a heart attack and my heart muscle is still working well.
    Dr. Roselli told Jon and I that in my age range, people are presenting surgeons with multiple problems rather than just one or two. Therefore, even though they had a lot of the surgical procedures down pretty well, addressing more aggressively multiple problems in individuals presents them with challenges. Even if my drs had sent me to CC three years ago, I may not have gotten any different help than Dr. Drake did due to the fact that technology and research has moved so fast in certain areas.
    I have read your book. It was done well and was written in clear language for the layperson. Congratulations on all you’ve accomplished to help others with your blog, book and continuing inquiries of drs and medical personnel. Thanx. E. Hawkins

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