Adam's Heart Valve Surgery Blog – Page 69

At the age of 62, Etta’s mitral valve regurgitation has reached severe status. That said, Etta will be having mitral valve repair surgery in three weeks. In her last email to me, Etta raised an interesting question. Etta asked, “Adam – Do I really need full-time help after open heart surgery?”

This question really brings back memories from my early, early, early recovery from aortic valve replacement surgery. My family and support group was insistent that I was not home alone for the first two weeks after open heart surgery. We even created a detailed Microsoft Excel Spreadsheet that highlighted which days my mom, sister, brother, dad and Robyn (my wife) were responsible for me.

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As we have previously discussed, there are a number of symptoms related to mitral valve prolapse. However, Cindy just wrote me an interesting email about whether-or-not anxiety is a symptom of MVP.

During my own research, I did not find any clinical evidence of the relationship between mitral valve prolapse and anxiety. That said, I thought I would post a blog and see if YOU have any ideas for Cindy. Here is her story:

Hi Adam,

I have a question that I am hoping to get some feedback on. Are there other people out there who have mitral valve prolpase and an anxiety disorder. I am not talking about anxiety that may be present AFTER you find out you need a mitral valve repair or mitral valve replacement. I am talking about a “free floating” anxiety – when you get anxiety for no particular reason, not related to any psychological problem per se. I can go for months and then suddenly one morning I wake up with anxiety in my chest.

This can go one for several days in a row.

Always occurring upon waking up and often leading to depression for those days on which this happens. I am under doctor’s care for depression but this is something that is stumping even him.

It is the strangest thing. I just thought MAYBE it has something to do with having severe mitral valve prolapse. Anyone out there know what I am describing?? I am not at all worried about surgery. This has gone on for years and years. I’m just thinking maybe there is a connection.

Thanks,
Cindy

I just received an insightful email from Charlene (in Florida). First of all, her surgery was a success. YEEEAH! CONGRATS TO CHARLENE!!! Second, she raises some critical points for those of you preparing for valve surgery. Here is what she writes:

Dear Adam,

This past July, I found out that I had an aortic aneurysm and would need my aortic valve replacement as well as aorta replacement. As a 45-year old woman with small children, I have to admit this scared the hell out of me. Your book helped so much with all the information and uplifting stories. I would like to pass on some of the wisdom of what I found to you and the others reading your blog.

1. I recommend that everyone get actual copies of all their testing. You may not understand the test results but when you go for a second opinion it helps so much at least you can point out the parts you do not understand and ask the questions. My cardiologist in Florida obviously did not read my initial echocardiogram. It showed the aneurysm back in 2006 and he never said a word about it. It was not until 2008 that he sent me for a CT scan to see what was going on.

Getting Second Opinions – Patient Survey (2007)

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I recently received an interesting question from Emily about her upcoming aortic valve replacement.

Emily writes, “Hi Adam – After years of monitoring it, my aortic valve now has severe stenosis and I need a valve replacement. Yes. I’m scared. Yes. I’m confused. One thing I’m both scared and confused about is the cracking of my chestplate. Is it true that AVR can be done with smaller incisions to the sternum? If so, is that common?”

Mini Sternotomy Scar (3-inch Incision)

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If you are a patient or caregiver preparing for heart surgery, I want to make sure you don’t have a false expectation regarding overnight visiting hours in the hospital.

While many caregivers want to sleepover in the hospital (see “Ali’s 12 Night Hospital Stay“), each hospital has its own rules about whether-or-not caregiver slumber parties are allowed.

In my case, I was blessed one night… Cursed the next… And then, blessed again.

On my first night in the intensive care unit, Robyn (my wife) negotiated with the Head Nurse to stay with me. Many years later, I still can’t believe what Robyn did that night.

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I just received an email from Everitt, 65, about anemia. He writes, “Adam: I had mitral valve replacement two weeks ago. That was some experience. I’m glad to be home but I’m also concerned. I’m very pale and lethargic. By pale, I mean I’m white as Casper the Ghost. Do other patients become anemic after heart surgery?”

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Every once-and-a-while, I receive patient email that is both curious and comical. This email, from Greg (in Oregon), qualifies as one of those special emails…

Hi Adam – My name is Greg and I bought your book a couple months ago and have been reading your blogs ever since! I have never written to you with a question before, but I have one that I would really like answered for my own peace-of-mind.

I have a bicuspid aortic valve with stenosis and regurgitation that I am told will need to be replaced possibly as soon as November of this year (that is when I am scheduled for my next EKG with my cardiologist). Thanks to your book and blogs I feel I have educated myself quite a bit in regards to what I should expect during this process, but one question that I have never seen addressed is in regards to the “breaking of the sternum”.

Is the sternum really BROKEN? I just always assumed that a saw or cutting wheel of some kind was used, but all I ever hear or read is about it being broken. How do they do this? Does the surgeon and an assistant across the table make a wish first?

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I’ve learned that laughter is one of the best forms of medicine relative to heart surgery. With that noted, I offer you a truly tasteless but quite funny heart surgery cartoon:

He… He… He…

Keep on tickin!!!
Adam

Vicki (pictured below) recently sent me a question regarding her upcoming mitral valve surgery. While I have some ideas for Vicki, we thought it might be helpful for Vicki to gather feedback from other patients – especially females. That said… Do you have any thoughts for Vicki? Here is what she writes:

Hi Adam,

I’m scheduled for mitral valve surgery (hopefully repair, not mitral valve replacement) on September 26. I’m a very fit 54-year old woman that climbs mountains, bikes and generally expects a lot of her body!

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I just read this tragic story from The Telegraph in the United Kingdom. My thoughts and prayers are with Sasha, her family and her friends.

Sasha Bartin, described as a girl who never stopped smiling, was taken ill during a hockey lesson at Westfield Community School, Yeovil, Somerset, on Monday morning. According to one her friends who just emailed me, “Sasha fell over, then she tried to get back up, her eyes went fixed and she fell back down. In the ambulence she stopped breathing.”

The thirteen-year old, who was waiting for an operation to mend a faulty valve in her heart, complained of chest pains and asked for time to recuperate. She was taken to Yeovil District Hospital but later died with her parents by her bedside.

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The use of robots for minimally invasive heart valve surgery continues to rise.

If you read the patient success stories of our own Larry Larsson and Leslie Lafayette, you will quickly understand the benefits of the da Vinci Surgical Surgical Robot for heart valve disorders including prolapsed mitral valves.

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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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