Jack's Guestbook

Hi Jack. Just a quick follow-up note regarding the MitraClip. On the first page of your guestbook is an entry claiming 57% vs 10% rate of badness with surgery vs MitraClip. If you read the study results you'll note that what counts as bad events is exceptionally broad. The vast majority of the adverse events in the surgical cohort were represented by blood transfusions. Not so happy since you'd rather have your own blood, but a far cry from death, re-surgery, stroke. Take transfusions away and you get a different picture. You can catch a study summary at: https://www.theheart.org/article/1054941.do Google has the article cached at the moment, so if theheart.org wants to charge you for access you can get to the article free through Google: Put the url above in the Google query box and it will be one of the first results shown. Then click on the word "Cached" to view the article. -- DVB

Hi Jack. WIth a valve repair vs replacement rate of more than 90% the current standard, you are right to balk at the locals. A replacement is an easier surgery to perform so takes less skill and more surgeons can do it. In this day and age it is pretty unusual to need replacement because the repair techniques are so good and keep getting better. But sometimes a replacement is in fact needed. So be sure to get the full scoop, not just a one-liner. Some things that can lead to needing a replacement are heavy calcification and anterior leaflet prolapse. Even with a replacement it is important that they leave as much structure intact as it provides future benefit. You can research all this online or in cardiology textbooks and then discuss with prospective surgeons. You will want to look at the American College of Cardiologists' / American Heart Association Guidelines. It is freely available at this URL: https://circ.ahajournals.org/content/118/15/e523.full With this in hand, talk to your prospective surgeons and have them walk you through the decision process regarding their recommended surgical approach. It doesn't talk about the MitraClip though. If memory serves, the mitra clip is still investigational and primarily recommended for patients that are not surgical candidates. Probably because there's no long term data on its effectiveness. The clip does not stabilize the base of the valve, doesn't restore normal flow patterns, and doesn't re-attach any ruptured tendinae. So its a prosthetic, not a repair. It has been very helpful though for a certain class of patients. Google the clinical trial: "Everest II clinical trial" for more information. You probably want to consider the lowest risk surgery that is effective and right for you. Folks that end up in the ER can't be so choosy - they're happy just to survive. But you have the time to optimize your care. Survival rates at top places are better than 99% so you shouldn't settle for less. You have to do what is right for you, but I'll tell you what I did when I learned I had severe mitral valve regurgitation when visiting my GP. First I balked. How can that be? I'm very active and healthy. Eventually I had an echo (TEE) that demonstrated the valve dysfunction pretty graphically. That motivated me to do as much research as I could, reading journal articles and cardiology textbooks and learn about prospects, therapies, surgeries, outcomes, etc. When I did that, I realized that the cardiologist my GP referred me to was not right for me. He was steering me to the local community hospital for surgery when the guidelines clearly recommended that I seek out a university hospital center-of-excellence. So that's what I did, calling up the number given on the UCLA cardiology web site for a consultation. There they seemed up to speed from what I could tell and I jumped onto their train and a month later had my mitral valve repair - open heart. My research told me that was the least risky option, the one with the best outcomes and least complications. Sure, I have a scar. But it is a battle scar from a battle I won. Other folks here on HVJ are happy with their minimally invasive repairs and they'll weigh in or already have on what that was like. Take care man, DVB