Patrick's Guestbook

Hi Patrick. I do not know anything about the hospital you are going to, so these are generic comments from someone who is not a doctor. Surgery risk-wise, there is a significant range between the best ranked (where they do many, many surgeries) to the lowest rank (where they do very few). Experience is a key differentiator, as is patient health on surgery day. Numerically the surgical risk out to 30 days ranges from about 0% to about 4% for AVR. Your surgeon should be able to give you his team's statistics: number of surgeries over the last year (and five years), and the outcomes at 30 days. Essentially what is their win/loss record. The best teams do hundreds of successful surgeries a year with zero or near-zero losses. The poorest ranked teams do 5 or fewer surgeries a year. Even if such a team lost only one person in 5 years, they'd still have a 4% loss rate, so be careful in assessing. Because your surgery is not emergency surgery, you have the opportunity to find the best available team. A second consideration is wait time. There is a 1%-plus per month or so mortality risk between time of diagnosis of severe AS and surgery. So you ought to balance this risk against the surgical risk if it would take you months to work a Plan B. If you are highly symptomatic, then you might want to weight immediate surgery more, if you are not symptomatic then you might want to weight a more experienced team more. You have every right to be comfortable with your surgeon/hospital. Maybe an option is to reschedule for a few weeks down the line and in the meantime work Plan B full time. Then you can choose the best option you have at that time. If you do decide to delay surgery, explore pre-surgical risk reduction options to minimize your exposure; that 1%+ per month risk is nasty. Your doubts resonate. My original cardiologist was tracking me into a community hospital for MV repair when the guidelines call for considering a center of excellence for asymptomatic patients (like I was) because of the better outcomes. At that point I changed cardiologists and switched over to one of the top-ranked heart surgery centers (UCLA). This delayed my surgery by about a month, but I followed some pre-surgery risk reduction strategies to mitigate. My best advice is to call your personal physician and explore these issues. -- DVB

One more thing I forgot. Some hospitals tie your hands so you can't remove the tube. I told my surgeon that I would not permit being tied. I cannot tolerate being held or tied I told him I have and I would fight the nurses and possibly cause harm to myself. No tying of my hands. I do not recall being tied or the tube it was all removed before I woke up. Again, talk to your surgeon and make your feelings well known to him.