Andy's Journal

Valerie Allen  Wonderful news! Did you have to ask for plates instead of wires or is that what they routinely use there?

Marie Myers  Congrats on your surgery! I, too, had upper back and shoulder pain. I would have given anything for a massage! Glad you are on the road of recovery!

Tom Everson  Well done. I also have the resilla valve ( easy decision for me since I was 77). My only pain was back pain , which was fine with me. I was told that you are opened up like a book . It came and went for about a month.  Walk and enjoy the new you

Matthew Malooly  That's great to hear.  It's so crazy how much effort and care and thought go into such a relatively quick little procedure - and how that changes the trajectory of our lives.  Congratulations on the new valve!

Rose Madura  Great to hear and welcome to recovery.  I also had back and shoulder pain. It eventually got better. Hang in there and take care.

Ana Brusso  Andy, glad that you are on the road of recovery. I also have the Resilia valve almost four years. I experienced the back and shoulder pain but eventually it went away. Congratulations on your successful recovery ❤️‍🩹 

Jeff Williams  I had my surgery at Piedmont with Dr Kauten (who is retiring this week), he is a proponent of the traditional wires to close. I really didn't have any issues with my sternum during recovery.

Other surgeons there may do it, he just had a preference for the wire method. 

Delise Becker  After I viewed a video about Rigid Sternal Fixation (on this site) and also heard Dr. Marc Gerdisch talk about how his program utilizes the plates and screws for almost all of their sternotomy patients, I asked my surgeon if he would do it, and he said yes. He explained that he individualizes each surgery based on each patient's needs, but he knows that some surgeons use Rigid Sternal Fixation routinely. I'm glad I asked him, because my understanding is that the recovery (and use of your arms, particularly) is faster. 

Andy Parker  My surgery was moved to the 7th of September, I’m walking everyday to help my strength level as I prepare, I was wondering what others have done to prepare?

Renee Leunig  My mitral valve replacement  and sternotomy was closed with sternal lock ridged fixation. I have an allergy to nickel so my surgeon decided to play it safe and I’m so glad he did. I think I had much more pain free movement early on. I still have some sternum healing discomfort but it’s only been 6 weeks. I would definitely push for the rigid Sternal fixation 

Delise Becker  Andy, my surgery will be at Heart Hospital of Austin, located in Austin, TX. I am continuing my stretching and exercise routine, and since I am now two weeks away from surgery, I am also paying much more attention to my diet. My husband and I always try to eat a healthy, balanced diet, and mostly we succeed . . . but on occasion, we do slip. I'm doing my best not to "slip" during these two weeks prior to surgery. I also think Rose's advice about deep breathing is a good idea. Continued prayers for you on the 7th. 

Andy Parker  Hello mr Jeff I hope you are healing and all is going well, I was wondering if your doctor has you on a low dose of warfarin as the f d a has approved it! Also is the ticking a bother? Sorry to bother you but my surgery is Thursday and I want to be ready👍

Jeff Williams  I am on warfarin. My INR is holding around 2.8-3 for the first 3 months then it will be down to 2. Hasn't been an issue. 

The ticking doesn't bother me at all. I'm a loud ticker that can be heard in a quiet room too. Sleep hasn't been an issue either with the tick. It is also a "nice" sound. Hard to describe other than that. 

You'll do great with the surgery and meet some great people at Piedmont. 

Andy Parker  Thank you Jeff for responding, today I talked with a brother at church and he got his machanical valve in 2005 he’s “70” or so now and he is in great shape and looking good, was working out yesterday in the gym👍On x valve and no problems, this may be encouraging to all of us!

Jeff Williams  That is encouraging. Feel free to check out my YouTube stuff in my profile. It may give you some insights on what to expect at Piedmont. 

Jeff Williams  I'm also more than happy to talk live if you have any questions about the hospital or tips we learned. Just let me know. 

Tom Everson  I had a easy choice was 78 and choose the Resilia valve . I am a calcium producer and the Resilia valve is engineered to discourage calcium build up. Had this valve for 3 years , so far  all is great. As for the TAVR. Trust the Lord and then the Doctors 

Rose Madura  If it helps I chose a tissue valve at age 59.  I have an Edwards bovine valve.  It was a difficult decision and always is.  My advice is to do your research, make a decision and then run with it. Don't look back. It will be the right decision.  God bless you. Please keep us posted.

Delise Becker  Hello, Pastor Parker. Because you've been a member since last December, you may have already viewed many of the videos available on this site; however, I just joined this community last month, so I am still in the process of reading and learning all that I can in preparation for my upcoming mitral valve replacement and tricuspid repair, via sternotomy on Sept.11. Just today I viewed two videos that were excellent. One features Dr. Marc Gerdisch in a Q&A session with him answering patient questions. You can find it under the Learning Center/Videos/Adam's Updates/ Patient Webinar: Ask Dr. Gerdisch Anything! It lasts an hour, but I found it to be very informative. If you watch it in its entirety, you'll find that, in answering numerous questions, he discusses different valves and sizes and procedures, etc. In addition, I also watched a shorter video entitled "Enhanced Recovery After Heart Surgery." It can be found under the Learning Center tab/Recovery. In this one, Dr. Judson Williams shares information about the importance of the recovery process. Perhaps the info shared by these surgeons (particularly in the Q&A video) will help you with your research and decision-making. I'll be praying for you and your surgical team on Sept. 2.

Marie Myers  Valve choice was very difficult for me at age 63. I went back and forth for weeks. I did eventually choose the tissue valve, and hope to have TAVR next time around. 

Jeff Williams  I believe there is a difference between the two. I had a full sternotomy AVR last month at Piedmont (different surgeon). It is an 8 inch incision, which is about what you described with the thumb and finger. 

Brady Busch  There is median sternotomy(full) and mini sternotomy(partial,which can involve an upper or lower procedure).

J Alexander Lassally  I think the mini is more like 4 inches - places like Mt Sinai market this as a thing. Some people say the recovery is identical - some day it is easier. I suppose it depends who one asks. I read several academic articles and the mini is somewhat slower as less room to work (cross clamp and bypass times). Obviously, though, maybe a better alternative if surgeon is well skilled in both. 

Cathleen Weed  When they try to do a shorter one it prevents the scar from showing at the top. The scar will start lower. Some people care, some don't.

Pamela Gregory  I didn't care as Cathleen was pointing out, just wanted to be alive. Now that all is said and done (for now) it is kind of nice for it to start lower. The bones are still cut all the way up though.

Deena Z  Sinai told me for women almost always the surgeons will make a shorter incision, 4 or 5 inches, because of the chest being more exposed for women while in clothing.  I was told the "opening surgeon" makes the smaller incision and then stretches the skin to make the opening wider.  I did not think the incision size into the bone was any different.  Others may know more about the latter than I.

Nap Garcia  Sorry not much help on this but I didn't realize that tissue wears out. My surgeon repaired and used my own tissue because it should last the rest of my life versus having to replace a mechanical one eventually, plus using blood thinners. I prefer not to be on blood thinners but that's just my own opinion.

Rose Madura  Hi Andy, at 59, (six years ago), I chose a tissue valve and it was a hard decision. I did not want the blood thinners if I could avoid them, and I have. I was told the tissue valve would last 15-20 years (maybe longer nowadays) and then I'd have the TAVR. That was my thought process.  It's a very personal decision that only you can make. And once you make it, go with it and don't question your decision. Please keep us posted. Godspeed.

Marie Myers  Yes, I had a tough time choosing the valve also. I was 63 at the time of my surgery, and eventually chose the tissue valve, hoping to get 15 years from it, then TAVR. My decision was one primarily of avoiding Coumadin. Only time will tell if I chose well. I sympathize with you because it is a tough decision. Both choices have their advantages.

Michele Miller  I am 54 and I have chosen a tissue valve as well, hoping to get 15 or so years from it then TAVR. It was a tough choice but not taking blood thinners for the rest of my life was important to me.  I should have AVR before the end of the year. My surgeon said I was a 'size 27' which was good for future prospects

STEPHEN MORRIS  It's a very tough decision...I went with my gut and said I wanted tissue...the surgeon said that's all he does is tissue. (I am in Canada)

Rita Savelis  I have 2 mechanical valves implanted when I was 53 (8 years ago). This was my surgeon's recommendation as I have radiation induced heart disease and re-surgery was not recommended. I rarely think about my valves anymore, I take an anticoagulant and have a blood test whenever I feel like it (about once a month) to make sure my anticoagulant dose is okay. Whatever valve you choose is the right valve for you. There are no perfect valve choices, alas. Each one has its pluses and minuses. And younger (under 65) patients have a much harder choice as they have to live longer with replacement valves. I remember being jealous of older patients when I had surgery. Take care.

kevin comras  go with mechanical. they last forever. and big deal you take a pill once a day. as you get older you probably have to take something anyway. the blood tests dont hurt. once you find a good place where they can take blood.

Andy Parker  Thank y’all for your “heart” felt opinions my doctor called me yesterday and said I could choose either valve the day I check into the hospital, he said he uses sapion resilla tissue or onyx mechanical, I’m really active outdoors and I was wondering about bruising or if I bump my head will I need to go to the ER if I’m on thinners? Also the expense of having blood checked every 6 weeks! I believe I’ll stick with tissue, does anybody regret their choice and why? Does TAVR in TAVR really work well?

Pam Walker Lucier  Hi Andy, I am 56 and 3.5 years ago I had my bicuspid aortic valve replaced  with an Onx valve .  My Dr recommended this because of my age.  I take warfarin daily and keep my inr in range, monitoring it with a home tester weekly (or sometimes a little longer  longer...oops!).  I have had no issues, and honestly feel better than ever, working out at the gym daily. I'm in the best shape in probably my life and I have not had a single issue or complaint since my surgery.   I know its a hard decision and very personal, of course, but I am happy with my choice.  Best wishes to you! 

Rose Madura  Andy, if you are on the fence, why not get a 2nd opinion?  TAVR does work. my aunt had one and it lasted about 10 years and her tissue valve lasted close to 12 prior to that.  She did get a 2nd TAVR in the first TAVR at age 82.  

Robert Miller  I am about a decade younger than you and my second heart surgeon (a very experienced one) suggested I get a tissue valve rather than a mechanical valve. In average you get about 10 years with a tissue valve. A replacement after the replacement doesn't require OHS (Open Hear Surgery). That gives you another 7 years or so. That's 17 years. By that time medicine might have made advances that can further delay another OHS. Going with a tissue valve allows you to avoid warfarin, having the clicking, etc. So if I were in your shoes I would go for the tissue valve. Btw, I think I was told the bovine valve tends to last longer than the porcine valve. 
Btw, please research about recovering from OHS. Being prepared for it make a big difference. 

Rita Savelis  There are no right answers as you can see so everyone struggles over this question. I'm sorry that you have to make it. Whatever decision you make will be the right one for you. Every person's heart problems and lifestyle are singular and personal. As far as the cost of tests, I should think that they are covered by insurance as are doctors visits. Here in France INR tests are free and I have a standing prescription to take tests whenever I like. I then decide my own dose. You may bruise more easily being on an anticoagulant but this does not mean you have to go to an ER. In any case, getting used to anticoagulants takes some time and one can feel very nervous at the beginning. But then you get used to them and go on with life. My surgeon made my decision for me during surgery as well. I had 2 radiation damaged valves and when he saw them more closely during surgery he decided to go with mechanical.  Take care. 

Barry Brasseaux  I have been on Warfarin for 35 years and I am 61 years old.  Opted to have my aortic value replaced when I was 26 years old with a St. Jude Mechanical Valve.  No issues with Warfarin or Valve and I am active as well.  Difficult decision and I wish you all the best in doing what is right for you.

Tom Everson  Hi I am not a Doctor. My interruption of the numbers you provided is that you have severe aortic stenosis( narrow opening. Like a build up in a pipe ). MG ( to me ) is a mean transvalvular gradient when above 40 means
Your aortic valve is getting too narrow. A AVA below 1 cm (peak  aortic velocity) is usually associated with stenosis.   When I had a aortic valve replacement my MG went fro 41to 55
     You can always get a second opinion and verify all the results .In my case I had to be assured I had a problem, then had to find a Heart Team that I was comfortable with ,then put it in the hands of the Lord.  The whole process takes time but IT WORKS.  STAY CONFIDENT AND TRUST YOUR TEAM AND ASK FOR SUPPORT from your family and friends.





   

 

Andy Parker  Thanks mr Tom for your view point on the matter, we’re you asymptomatic and did your surgery go well?

Tom Everson  Yes I was asymptomatic. My bicuspid valve was full of calcium ( should be the size of a dime)  but the surgeon said it was smaller than a pencil point. I was 77 at surgery ( now almost 81). Every thing went smooth . I had low blood pressure ( barley 90) after the surgery now am averaging 101 and are pretty active ( my view point)  Only take a low dose aspirin every day.  Good luck and lean on your support team and the LORD

Andy Parker  Thanks everybody for sharing your helpful comments! Here are my numbers, vmax 4.63 / MG 48 / AVA 0.8 /  DI .24  this is what my Dr. wrote down for me,  if anyone can help me understand this I would appreciate it👍

Rose Madura  Andy, if the numbers are severe, you have to do it!  You don't want to end up in an emergency situation or worse.  I had same surgery plus ascending aorta and root repair and arch repair. I was 59 at the time and also chose a tissue valve.  Your surgeon will place a valve large enough to accept TAVR next time around if you even need it.  The valves get better and better all the time.  This is very doable and the odds are in your favor.  To make you feel better, maybe you should get a second opinion to confirm your decision.  Godspeed.

Marie Myers  When my cardiologist said, “ Surgery is inevitable for you” in fall of 2016, I was pretty freaked out. It took months to accept what needed to happen, and to surrender to the experience and technology . I listened to many “acceptance” and “surrender” videos  on UTube to help me in the process. It was hard for me, since I didn’t have symptoms and had been very active ! Like Rose said, another opinion might make you feel more comfortable. I had SAVR for an AVR and resection of ascending aneurysm and root aneurysm.  Godspeed!

Pamela Gregory  Hi Andy, I am 55 and choose the tissue valve also. That is a very personal choice but for me it felt right. Once you have a date for surgery it seems to happens very fast. I don't think you are ever truly ready but it is a life saving operation

Allen Carkner  Do your best to embrace it and except that this is the next step to the rest of your life. Surgery is consistently safe these days and the alternative is very high risk once you have severe stenosis with any symptoms at all. I was certainly scared after my Cardiologist referred me to surgery but I'm better now than I was before and still getting better. Good luck!

Grace Mason   I found seeking additional opinions helped greatly in coming to terms with having surgery and made me also feel more confident about moving forward. 
In Adam's recent ebook "Lifetime Management of Heart Disease" there is a very helpful section about seeking second opinions. 
Under Patient Case-Bicuspid Aortic valve. Adam asks the question about awkwardness in asking to seek a second opinion: Answered by Dr. Doug Johnston: That is a great question. Number 1, you should never be concerned about asking for a second opinion. If you ever get a difficult time 
about that, you’re in the wrong place. That’s even more reason to get a second 
opinion. The way I would say it to your cardiologist, your PCP, your surgeon, 
whatever it is, I really want to feel comfortable with my decision to go forward 
with surgery or watchful waiting, whatever the recommendation is. I found out 
XYZ place that can give me some more information. I’d like to ask you for my 
records so that I can send them there and then I’d like to discuss it with you 
after I’ve talked with this other physician or this other institution. That’s a very 
straightforward thing. Every physician should be used to that.
Like I said, if they’re not, if they try to make you feel uncomfortable, you’re in the 
wrong place. Then it’s even more reason to get a second opinion. Many places 
like Northwestern offer virtual second opinions. I do it for patients all over the 
world. They send the records in, my nurse will gather everything together, and 
we do a telehealth visit. We can look at the imaging together online. Sometimes 
it’s like, hey, your tests look pretty good. Here’s what I would recommend down 
the road for you if you need surgery and we’ll see you in a few years.
That peace of mind for having had somebody else go through it with you, 
and many patients will get a second opinion with me and stay at home for 
their surgery. That’s fine, too. It doesn’t mean that you’re committing to go 
somewhere else. I would absolutely encourage you to do that, even if it’s just 
to get some quick questions answered. You want to go into, especially surgery, 
with a peace of mind.

Andy Parker  Thanks everybody for your response to my comments and yes the SAVR would be covered but not TAVR, I just was praying for TAVR, all my dr’s say I’m a perfect candidate but insurance says NO and they will only pay for SAVR my wife is disabled and it will be hard to navigate 6-8 weeks downtime! 

Rose Madura  Hi Andy, I'd definitely get a second opinion.  If it is severe, I'm not sure why they say it's not necessary.  You have to be your own advocate.  Maybe the TAVR is what is being denied and not SAVR.  Do some checking...and keep us posted. Godspeed,

Marie Myers  I bet theTAVR is what is being denied, not SAVR. I would ask that question specifically to your surgeon. The insurance company may think you are “too young and healthy” for TAVR…

Allen Carkner  May be age, and I believe you need to be symptomatic in many cases based on the surgery guidelines. 

Tom Everson  Hi You are in charge of your health. Get actual  numbers ( not terms like severe)  and after you talk to your heart team  and you feel you need a heart operation sooner than later , protest the insurance company decision.  Send it by registered mail. Be a Georgia Bulldog 

Ana Brusso  Agree with everyone get the facts in writing. Appeal the decision made by your insurance and show them your numbers. Good luck and keep us posted. 

Andy Parker  Thank you for all the helpful advice and yes the insurance will pay for SAVR but not TAVR my heart valve team says I’m perfect for TAVR but insurance “blue cross” says my heart anatomy “bicuspid” is the problem! My wife is disabled and for me to have 6-8 weeks of recovery will be tough on our family dynamic,,, dr,s have appealed but denied, I have made a personal appeal and I’m waiting on the answer, if anyone can think of a blind spot in my approach please let me know🙏

Ana Brusso  Hi Andy, you have a great smile. When is your surgery? You will do well. We will be here to welcome you into recovery. God bless you 

Brady Busch  Hi Andy,
The moderate to severe stage is about when doctors are looking more closely and planning for surgery.I was near 60 when being told about a heart murmur and had the first echo-cardiogram.
Even though valve replacement is a major event,having TAVR,reduces some procedures and from reading,less recuperation.Mine involved also repairing the mitral,so a sternotomy was done.
It does seem a bit surreal,finding out about what's happening,but there are many people that are going through a similar thing.

Marie Myers  Yes, I felt the same shock at age 63, when I was diagnosed with ascending and root aneurysm, along with my bicuspid valve. I did not have any symptoms either, but knew I had to do the surgery due to the aneurysms.  You might want to Get another opinion to ease your mind. Brady is right that surgeons are more inclined to operate at the moderate to severe stage than waiting till physical changes occur in the heart during the later stages of stenosis. 

Danielle Elizabeth  I would ask what are the risks if you wait and also what your surgeon feels is the optimal decision/ outcome of both options. I know it’s scary and we always wish there is more time to push it back, but in this realm, I’d find a surgeon who can answer these questions and that you trust. BAV is the most common heart defect and these surgeons perform a TON of TAVR. My surgery was a huge success and 6 months post I’ve forgotten most of the bad parts of recovery. 

Shelly Hubbard  Hi Andy I am 60 and have bicuspid. Looking to have surgery this spring. I have no symptoms but severe stenosis. I was told they cannot do tavr as not fda approved? I am curious as you can have tavr?

Deena Z  Being asymptomatic is fairly common, so dont let that drive your decision.  You want to mend your valve, before there is permanent damage. You might want to get a second opinion to avoid hindsight.  I got three opinions! Also helped my nerves to talk to more than one cardiologist.  Hang in there. We are here to help you along the way.

Greg Lewis  Shelly, and Andy.. .Adam did an article on how FDA has now approved TAVR for low risk patients. It was very interesting. Might want to take a look. 😶‍🌫️

Greg Lewis  I had symptoms, but the thing is, I didnt know it was from my bicuspid valve problem. I just thought i was getting more out of shape! This happens to lots of people. When i got the call, after my yearly check, and echo, it was that i needed to stop everything, and they would get me in, ASAP! I basically had to stop anything that could cause stress on my heart. So i agree to get some more opinions. Can only help. If you decide to wait, then possibly keep a real close eye on it, and watch for symptoms. But, make sure you dicuss it with a surgeon or two or three. Cheers!