Robert's Journal

Just as a reminder, there is A LOT of information in the learning center. I am guilty of not consulting it enough myself. I wish as people compose message it would show links to the articles in the learning center. And maybe people can contribute/add information to those sites, kind of like a Wikipedia.

https://www.heart-valve-surgery.com/learning-center.php

Website Improvement: "got a new guestbook post" & "posted an update".

So many messages on this forum have no context because they are a result of updating ones history or responding to some other message on another platform (Facebook?). I am a member of a bunch of forums and all of them start with an initial question with answers listed below. It would be great to have this forum structured in the same way those other forums work, i.e. there is one initial thread and then "below" are all the responses to that original post. Just my 2 cents...

For my first mitral valve repair the surgeon used an annuloplasty ring from Medtronic. Yesterday I got a letter and apparently for my second mitral valve repair the (other) surgeon used an annuloplasty ring from Abbott. I know sizing of the ring is the most critical part but I have never heard or read anything about the difference/performance from the different manufacturers (unlike for the valves where the bileaflet valve from St Jude seems to be a favorite). Are there any differences between the manufacturers that at least in certain situations can make a difference? Not that it matters to me anymore at this point but I am just curious and maybe it might help others.

Do most people these days do the INR test at home? If so what is your experience? How often do you test at home? How often do you get the INR tested in a lab? What is your cost? It seems like around $700 for the device and about $6/test.

PS: I read the basic info here: https://www.heart-valve-surgery.com/learning/mechanical-replacement-inr-home-testing/

There are multiple companies creating mechanical valves. Are there any mechanical valves preferred over others and if so why? As for the type of mechanical valves, I think the caged ball valves are not used anymore. So that leaves the monoleaflet valves and bileaflet valves. It seems everyone is using the bileaflet version probably due to blood flow. As for companies, I am most familiar with Medtronic as we work with them. Any input is appreciated.

https://www.heart-valve-surgery.com/heart-surgery-blog/2007/11/05/heart-valve-manufacturers-who-are-they/

Pacemaker after surgery.
When I had my mitral valve repair and maze procedure I apparently was on a pacemaker for 5 days. I only learned about this when the surgeon came and turned off the pacemaker after the 3rd day and had to turn it right back on. The next day the same thing happened. Only the day after that I could go off the pacemaker (they left it on as a backup and it kept zapping me every 10 minutes or so until they made several adjustments).
I will have another surgery next month and supposedly my heart is "tired" (low ejection rate). So I am a bit worried about having the same issue again. The PA of the last surgeon I talked to said I might require a permanent pacemaker. Has anyone had to go on a permanent pacemaker after surgery and how did that go, affect your life afterwards, etc. I am not doing crazy things but I am a fairly active person (almost daily strenuous exercise, walking the dog for an hour, occasionally hiking, skiing in the winter, etc).

Blood Measurement Device Cost.
With a mechanical valve you are supposed to check your blood to adjust the medicine/Coumadin (blood thinner/anticoagulant). You can do this at home with some instrument. I assume it is cheaper and a lot easier than going to a doctor's office. But how much does such a device cost? Are you purchasing it and then pay for the "test strips"? Or are you paying for each measurement? From your experience how much do you pay per year? Obviously, it depends a lot on insurance so if you can include some information about this that would be appreciated.

Mechanical Valve Or Pork/Cow Valve?

I will have my second open heart surgery next month. My surgeon tells me I have approx. a 70% chance that the valve can be reparied. If not, I have to decide between a mechanical valve or a pork/cow valve. I understand the differences. With a mechanical valve I need to be on warfarin for the rest of my life, poke my finger to get measurements and adjust medicine, Warfarin supposedly kills rats by damaging their liver (not sure if that is a concern if your liver and/or kidney is already bad), etc. My cardiologist calls it rat poison for a reason... On the positive side a mechanical valve probably will last you for the rest of your life.

With a cow/pork valve you probably have to "fix" it after 10-15 years. For younger patients this time range is on the shorter end due to the immune response. For older patients it might go beyond 15 years. A new valve can possible be inserted through a vain rather than doing open heart surgery again. But FDA might deny that based on long-term results. A second valve (which would be put over the first one) will also reduce blood flow. On the positive side it doesn't require Warfarin.

I am pretty much at the age (50) where there is no clear decision. I mostly have a desk job (engineering) so no risks there in regards to blood thinner. I do ski and go down double black diamond runs without helmet. But I only do this under good snow condition and because I ski without a helmet I am actually extra careful. I don't do crazy jumps or anything like that. I am also on a latter quite a bit for decorations (x-mas, Halloween, repairs, etc). I also use circular saws, drills, etc to create things. While I do hurt/hit myself once in a while (bruises and such) I never had any major incident. That includes the time since my last surgery and when I am still on blood thinner. So I feel like I can handle a mechanical valve but I would like to get some input from people who had to make the same decision.

Can you rate surgeons? I can only find "recommend me" and only for some surgeons. Is there no option to rate the surgeon, rate the preop service, rate the postop service, rate the success, type of surgery done, etc? Then people can search for something like a search for average x stars, location within x miles, number of reviews, type of procedures, how many surgeries done per procedure (maybe I am pushing it here), etc.

How do you subscribe to this community either a) for all new posts b) for answers to my posts, c) any posts where I was mentioned and/or d) any posts that I responded to? I searched but couldn't find anything about subscriptions. I do think during sign up there were some options and I believe I clicked on getting immediate updates.

How does this forum work? Going through a bunch of posts it seems the posts with white background are original posts and the posts with a blue background are responses. However, I see a lot of white/initial posts that seem to refer to some other posts.

Antibiotics after heart surgery:
I went to Stanford yesterday for a consultation for my second mitral valve surgery. They told me that when you have any artificial part in your heart they recommend taking antibiotics. They told me in my case I should be on antibiotics because I have an artificial ring (and artificial/Cortex cords). If for my second surgery I will get a mechanical valve I definitely (my words) need to take antibiotics. Is this really true? I get this argument if you do some dental procedure, etc. but being on antibiotics all the time sound strange. There are issue with people getting resistant to antibiotics indirectly (meat consumption from animals treated with antibiotics, etc) so should I really take antibiotics, especially if I chose to do a mechanical valve?

I had a mitral valve repair earlier this year which was done with open heart surgery. I need another repair or replacement soon. The recovery is not something I look forward to (using a commode and people walking in on you, sleeping on your back, getting in/out of bed, not driving a car, not lifting more than 5lbs/arm, etc). So I was looking into minimal invasive surgery or robotic surgery (I excluded this the first time because it would have required long travel to get to the surgeon I wanted). I just saw a surgeon yesterday and he said for a second surgery only open surgery is an option because of the scars from the first surgery. Is this the common understanding? If so, I would assume that if you had a minimal invasive surgery before you still would need open heart surgery because you still have the scars on your heart. Or would the scars have been smaller allowing another minimal invasive surgery?