Steve's Guestbook

Steve Farthing  Hi Carmel, I do not have Barlow's Disease. It is good that you are pursuing several opinions regarding your mitral valve repair. Apparently some surgeons are skilled enough to repair a mitral valve in patients with Barlow's. But it sounds like you are not certain yet whether you have Barlow's? Regardless, mitral valves are almost always repairable if the surgeon is skilled. One study found that a surgeon should do at least 20 mitral valve repairs a year to be considered skilled. Some surgeons do many more than that. But the average per year across all surgeons is less than 20 so it pays to find out if surgeons you have access to perform enough mitral repairs to be skilled. A surgeon who is not very skilled will be much more likely to replace the valve since that is not as difficult to accomplish. A repair is preferable since warfarin is not necessary and a repair is often a permanent fix. If you have time, use it to explore your options!

Carmel Power  Thanks Steve. I’m in Australia and we don’t have specialist mitral valve surgeons as such. They tend to be specialists who work in many different fields. I’ve spent the last few months trying to find the best surgeon with a interest in minimally invasive/ mitral valve repair. I even went out of state to speak to someone who was involved in the 2015/17 Mitral Valve Symposiums in Sydney. He is very pro early intervention. He says if you take a wait and see approach, it will put pressure on your LV and the operation can be more difficult to perform. Currently, my LA enlargement is only mild / moderately enlarged, EF 73% and I am very fit. I am still working out whether to have this done before anything gets worse as I have had different views on when to have surgery. All surgeons say now but the cardiologist says to wait. Very pleased you are going so well.

Bill H  Steve - do you have any links or references that show mitral valve repair is often a permanent fix? I would like to read / learn more about this. Thanks.

Steve Farthing  Thanks, Kathy. That is greatly appreciated. Will walk across the street to the hospital in an hour. Hope you enjoy Crested Butte. Very pretty there in the winter. I don't believe I've ever been there in the summer though!

Steve Farthing  Great you got discharged so soon. My doc said a lot depends on whether I develop afib which can require additional time to get under control. About half of patients evidently do get afib.

Jim Stutler  Yes, that combined with my existing a fib history led us to the ablation thrown in. I had one quick episode the night of surgery, but nothing since.

Steve Farthing  Jim, Thanks. Are you home from Porter? We're now checked-in at the John Zay guest house across from Penrose Hospital. Walk across the street tomorrow at 5:30am.

Steve Farthing  In my case, since the mitral regurg is already extreme and left atrium very enlarged, cardiologist suggests fixing soon or now even though left ventricle is not yet enlarged. Their code word is that surgery now is 'reasonable'. So I am using the time to learn more, interview possible surgeons and try and discover if my pre-op anxiety can be reduced somehow which is really my biggest issue.

Steve Farthing  Hi Pam. Thanks for your insight. Probably not robotic or front entry, more likely right-side small incision with videoscopic assistance and long 'chopstick' surgical instruments. My valve needs a repair of the P2 segment which is the least technically challenging mitral repair to perform. Therefore, I am not quite as inclined to go out of state but have not made a decision yet. You may well achieve your goal of being back on the court in April!