Adam's Heart Valve Surgery Blog – Page 67

More news from the leading heart valve manufacturer this week…

According to Reuters, Edwards Lifesciences Corp said won U.S. regulatory approval for a device to replace diseased mitral valves, one of the most common forms of heart valve abnormalities (including mitral valve prolapse).

Edwards’ Perimount Magna mitral valve replacement will be launched in the United States immediately, making Edwards the only company to have a bovine pericardial mitral valve replacement on the U.S. market.

As you may know, mechanical valves last longer than tissue valves, but patients with mechanical replacement valves must take a blood thinner, like Coumadin. Alternatively, tissue valves are more convenient and those derived from cows are perceived by some physicians to last longer than those from pigs. For more on the pros and cons of mechanical and bioprosthetic valves, click here.

Medtronic and St. Jude Medical also compete in the mitral valve market with a mix of mechanical valves and valves made from pig / cow tissue. Edwards, an Irvine, California-based company, posted total sales of $1.1 billion in 2007.

According to industry estimates, there will be 35,000 to 40,000 surgical mitral valve replacements in the United States this year to correct defect valvular disorders like mitral valve prolapse.

Keep on tickin!
Adam

Beth just emailed me about her husband’s problematic recovery from heart surgery. She writes, “Hi Adam – My husband had heart valve replacement surgery (from mitral valve prolapse with regurgitation) two months ago. Since then, he seems to be experiencing some emotional and behavioral changes after heart surgery. Although his heart is doing great, Erik seems to be “a little down” and somewhat “out of it” since the heart surgery. Any thoughts? Thanks, Beth.”

Here are my thoughts for Beth:

As patients, we enter the operating room with two critical thoughts. The first thought is, “Please let me live!” The second thought is “Please fix my heart so that I can live longer!”

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I just clicked on an email from Esther that reads, “Hi Adam – How long does it take for patients to regain consciousness after open heart surgery? I am preparing for the replacement of my mitral valve due to my worn out and prolapsed mitral valve. I’m just curious to know how long I’ll be unconscious, under general anesthesia. Thanks. Esther.”

From my own experience, I can share with you that I went under general anesthesia at 11am – once I was brought into the operating room. According to Robyn, my wife, my open heart surgery was 3 hours long. After surgery, I was rolled into the intensive care unit (ICU) where I was actively monitored by an ICU nurse for the next several hours.

Then, around 5:30pm, I SLOOOOOOWLY (emphasis added) began to regain consciousness. At first, I only heard noises. Next, my eyes began to open slightly and close slightly. The epic moment, when I knew I had fully regained consciousness was when the very uncomfortable ventilator tube was removed from my dry throat.

So, given the above, it took me about 6.5 hours to regain consciousness after open heart surgery. However, please know that each patient case is unique. There are many variables which could impact surgery length (e.g. heart surgery complications) and the time that a patient is unconscious.

I hope that helps explains how long it takes for a patient to regain consciousness after heart surgery.

Keep on tickin!
Adam

Yes.

That is my answer to Sally’s question, “Did you lose weight after heart surgery?”

In fact, I lost A LOT of weight after heart valve replacement surgery. Robyn (my wife) just reminded me that I lost about 15 pounds during the three months after heart surgery. Before surgery, I weighed 187. Then, I dropped to 172. Ultimately, I ate like crazy to fuel my body as it healed. Now, I’m hanging around 192 pounds. I’d like to get back to my pre-surgery weight of 187 – but you probably know how tough it is to lose that final 5 pounds.

So you know, not all patients lose weight after heart surgery. I have spoken to a number of patients that have had the exact opposite occur…. They gain weight from fluid retention.

Regardless of whether you lose or gain weight, the critical element of surgery is that your heart is fixed and your surgery is successful. A few pounds here-or-there won’t kill you, but a faulty valve will.

Please scroll below to post a comment or read over 40 patient reactions below!

Keep on tickin!
Adam

Lisa was recently diagnosed with severe mitral valve regurgitation due to due to mitral valve prolapse. That said, Lisa is currently searching for a heart surgeon. She writes to me, “Hi Adam: I live in New York…. And, I am curious… Do you know the name of David Letterman’s heart surgeon?”

As you may know, David Letterman had emergency heart surgery on January 14, 2000 at New York Presbyterian Hospital in New York. David Letterman’s surgeon was Doctor O. Wayne Isom, the Chief of Cardiothoracic Surgery. Due to a blocked artery, Letterman had quintuple heart bypass surgery.

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I really appreciate patients that actively prepare their caregivers and their support group for heart surgery.

Earlier today, I opened an email from Shirley that reads, “Adam – At 62, my prolapsed mitral valve is worn out. I’m going in for surgery to replace my mitral valve next week. I want my husband and children to know how long they may be in the waiting room… So, how long does heart valve surgery take usually?”

The really tough part about answering Shirley’s question is that there are many variables to each, particular heart valve surgery. For that reason, my standard response to this question is, “It depends.”

For example, my double heart valve surgery lasted 3.5 hours from the time I entered the operating room to the time I “checked-in” to the intensive care unit (ICU). Alternatively, I know of several patients that had surgeries well over 10 hours due to heart surgery complications.

That is why I hesitate to give a specific answer to the question, “How Long Does Heart Valve Surgery Take?”. However, if I was really pressed to answer this question, I would estimate between 3 and 5 hours.

Keep on tickin!
Adam

Angie just made a big decision. After researching her options and talking with several patients and surgeons, Angie has selected a mechanical aortic valve replacement for her diseased, bicuspid valve that suffers from severe stenosis. (To learn more about bicuspid valves, click here.)

She writes, “Hi Adam – I never thought it would be so hard to pick between a mechanical or bioprosthetic valve replacement, but it was. Considering my age and fear of another heart surgery, I’m going for the mechanical! Now, the question becomes, which is the best mechanical aortic valve replacement for me. Any thoughts? Thanks, Angie.”

This is a tough question. In fact, it is a question I try not to answer considering that many surgeons have “valve replacement favorites” after several years of clinical work. However, this blog is about educating patients and caregivers about heart valve surgery. That said, I will reference a number of different mechanical aortic valve replacement operation devices below.

Here is a picture and link to Medtronic’s Hall Easy-Fit Mechanical Prosthesis:

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Josie just wrote me an interesting email about sternum wires. She asks, “Adam – I’m eight-weeks post-op and, like you, suffering from on-going chest pain. Plus, my skin is sensitive. By chance, have you ever heard of a patient experiencing an allergic reaction to the sternal wires after heart surgery?”

My immediate answer to Josie’s question was a simple no. However, after doing some research there are a few instances in which patients have suffered from allergic reactions to the wires that hold the sternum in place after cardiac surgery.

Dr. Takazawa from Juntendo University in Japan states, “To our knowledge, this is the first reported case of a manganese metal allergy to stainless steel wire. A 51-year-old man suffered from a refractory pruritic erythematous wheal after the insertion of a stainless steel wire. The patch test showed strong reactions to manganese, one of the constituents of stainless steel wire. After the removal of all stainless steel wires, the symptoms were much improved, except for mild pruritus on his face.”

Interesting right?

Keep on tickin!
Adam

According to reports, aortic valve stenosis is relatively common problem effecting 2% of people over the age of 65, 3% of people over the age of 75, and 4% of people over the age of 85. One of the major causes of stenosis is the calcification of the aortic heart valve. This is especially likely to occur in people with a bicuspid aortic valve, but also occurs as a result of age-induced ‘wear and tear’.

Typically, aortic stenosis due to calcification of a bicuspid valve occurs in the fourth or fifth decade of life. Whereas, aortic stenosis — due to calcification — of a normal valve tends to occur in the seventh or eighth decade of life. To learn more about aortic stenosis, click here.

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Jerry just wrote me asking, “Did you have a cat scan after your open heart surgery?”

Hmmm. I have to admit, I don’t remember having a cat scan after my aortic valve replacement surgery. However, I did have a bunch of x-rays taken after the operation. In fact, I was taken to Radiology every morning following my aortic valve surgery.

If you are interested to learn more about cat scans, here is some good information from RadiologyInfo.org.

• CT scanning—sometimes called CAT scanning—is a noninvasive, painless medical test that helps physicians diagnose and treat medical conditions.
• CT imaging uses special x-ray equipment to produce multiple images or pictures of the inside of the body and a computer to join them together in cross-sectional views of the area being studied. The images can then be examined on a computer monitor or printed.
• CT scans of internal organs, bone, soft tissue and blood vessels provide greater clarity than conventional x-ray exams.
• Using specialized equipment and expertise to create and interpret CT scans of the body, radiologists can more easily diagnose problems such as cancers, cardiovascular disease, infectious disease, trauma and musculoskeletal disorders.

I hope that helps explain more about cats scans after heart surgery.

Keep on tickin!
Adam

On the topic of cognitive decline after heart valve surgery, Dan and I just had the following email exchange:

Dear Adam,

I recently purchased your book and have been reading your newsletter. I find both very helpful and encouraging. I thank you for your efforts and concern for others who are going through experiences similar to yours.

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I just received an email from Ken – a fellow patient who had aortic valve replacement surgery earlier this year. Like many heart surgery patients, Ken experienced a complication after heart surgery. Specifically, Ken had an issue with Dressler’s Syndrome. If you are unfamiliar with Dressler’s Syndrome, I have provided some information below from the Mayo Clinic:

• Dressler’s syndrome is a complication that can occur following a heart attack or heart surgery. It occurs when the sac that surrounds your heart (pericardium) becomes inflamed. An immune system reaction is thought to be responsible for Dressler’s syndrome, which can develop several days or weeks after heart injury.

• Dressler’s syndrome causes fever and chest pain, which can feel like a heart attack. Also referred to as postpericardiotomy and postmyocardial infarction syndrome, Dressler’s syndrome is easily treated with medications that reduce inflammation.

• With recent improvements in the medical treatment of heart attack, Dressler’s syndrome is far less common than it used to be. However, once you’ve had the condition, it’s likely to recur, so it’s important to be on the lookout for any symptoms of Dressler’s syndrome if you’ve had a heart attack, heart surgery or other heart injury.

• Your doctor can diagnose Dressler’s syndrome from the classic signs and symptoms, listening to your heart and sometimes using blood tests. Other diagnostic tests may also include an echocardiogram or EKG.

• Complications of Dressler’s syndrome are cardiac tamponade, constrictive pericarditis, pleurisy and pleural effusion.

• Mild cases of Dressler’s syndrome may get better on their own without treatment. Your doctor may recommend bed rest until you’re feeling better. More severe cases require medications to reduce the inflammation around your heart. Sometimes hospitalization is necessary.

I hope this helps you learn more about the post-operative complication known as Dressler’s Syndrome.

Keep on tickin!
Adam

Following his recent mitral valve repair, Larry just sent me a glowing report about his minimally invasive procedure in which Doctor Richard Shemin (UCLA) used the Da Vinci robot. Here are the details from Larry…

Hi Adam,

I had mitral valve repair surgery along with replacing the two cords that hold the mitral valve in place with Gore-Tex cords. The operation was six hours long. Your readers should know that I had this procedure done by the da Vinci robot manufactured by Intuitive Surgical. The surgeons did not have to open up my chest, but only three little incisions on my side. From the moment I woke up from surgery, I have had zero pain and have taken no painkillers. If the patient is a candidate for robotic mitral valve repair surgery, the procedure is as good as the normal surgery of opening up your chest, and the recovery makes it 100% better.

Da Vinci Surgical System

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As you can read below, Charlotte is dealing with a unique patient condition. In her email, Charlotte asks me whether or not I know of any patients with a similar diagnosis. Unfortunately, I don’t. That said, I thought it would be a good idea to post her email in my blog to see if anyone out there can help Charlotte. Here is what she wrote to me:

Adam,

I have a question because even my doctor’s can’t answer some of my questions.

I had lung cancer 13 years ago (hooray for overcoming lung cancer). I had the left lung completely removed, which is probably what save my life. I had surgery and radiation. I had one lymph node in the pulmonary artery area that had cancer so they gave me radiation directly on the heart.

Three years ago doctors found a leaking aortic valve. So I had aortic valve replacement surgery. Since I was only 51, my husband and I decided to go with the mechanical heart valve surgery because the mechanical valve is suppose to last longer than a bioprosthetic valve. I was in surgery 6 hours. At that time, there was a concern about getting me off of the ventilator because I only have one lung and they did have a little trouble getting me off of it.

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We’ve talked about “It” before…

It invades our brains before surgery. It clouds our thoughts during recovery. It manifests worry.

“It” is fear. Or, as I have suggested before F.E.A.R. – an acronym for Fantasized Experiences Appearing Real.

The funny thing about F.E.A.R., in relation to heart surgery, is that most people incorrectly assume that patient fear culminates and terminates on the operating table. As I, or most patients will share with you, that is completely inaccurate.

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After evaluating the pros and cons of mechanical and bioprosthetic heart valve replacements, it appears that Stephanie has opted for an artificial heart valve replacement.

Stephanie writes, “Hi Adam – Given my age, health, love for exercise and desire not to repeat open heart surgery, I believe I am going to request an artificial heart valve replacement when I have surgery next month. However, I have one lingering question for you. Does exercising wear out an artificial heart valve faster over the patient’s lifetime?”

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Some patients want to know EVERYTHING before their operation – the valve anatomy, the surgical process, the recovery details. Other patients want to know absolutely NOTHING about their upcoming surgery. Many say to me, “Honestly Adam, I don’t want to know a thing. The more I know, the more I will worry.”

I can understand both positions. That said, this blog is for those who want to know everything – especially about the anatomy of the mitral valve. Dana just wrote to me, “Adam – Can you help me understand what the mitral valve annulus is? My sister needs mitral valve replacement surgery due to regurgitation and that term – mitral valve annulus – came up in our last discussion.”

No problem Dana. To start, please look at the two figures below. You can see a top- and side-view of the mitral valve. The posterior and anterior annulus is labeled on both diagrams.
 

 
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I just received an email from Bob about cardiac care centers. He writes, “Adam – Do you happen to know what is the number one hospital in heart valve replacements? I have a mitral valve prolapse and I need a mitral valve replacement. I would like to know which are the best hospitals in the United States.”

Unfortunately, I don’t know which hospital is number 1 for heart valve replacement surgery. However, I do have one reference point for Bob regarding the top ten hospitals for heart surgery. Each year, U.S. News And World Report issues a “top 10 ranking” of the best hospitals for heart surgery. While this ranking does not indicate the quantity of heart valve replacements performed each year, it does (in some sense) indicate the quality of heart surgery which I believe is most important.

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Here’s an inspiring email from Melissa, a recovering patient from Sydney, Australia. With her approval, I thought you might like to read it:

Hi Adam,

I’m emailing from Australia, I’m 34 and I had my open heart surgery 4 months ago (on 14 April to be exact).

I had a quirky congenital condition that needed to be fixed – the membrane just under my aortic valve was not functioning properly. Plus, my aortic valve is bicuspid and a bit leaky. But, the major concern was the membrane. My cardiologist and surgeon – Doctor Alan Farnsworth, St Vincent’s Hospital in Sydney – decided to wait on the aortic valve replacement for now. (To learn more about bicuspid valves, click here.)

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I just received an email from Jenny, a 57-year old mother of two, who was recently diagnosed with severe aortic stenosis.

According to her cardiologist, Jenny needs aortic valve replacement surgery in the next 3-6 months. That said, Jenny asked me, “Adam – What do you consider to be the latest technology in aortic valve surgery? I have heard that the new, minimally invasive procedures are less invasive and help the patient recovery faster. Is that true?”

As you may know, I am high technology consultant specializing in electronics manufacturing. That said, I spend my workdays examining the manufacturing technologies and processes for many different types of electronic products. My clients are in all areas of technology – computing, industrial, consumer, wireless and medical.

One technology category that I am always learning more about is (as you might guessed) heart valve replacement technology for the aortic, mitral, tricuspid and pulmonary valves. Recently, I went on a great manufacturing tour at Edwards Lifesciences in Irvine, California.

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