Hubby is soon to have surgery to repair/replace the mitral valve because of regurgitation due to a
flailing valve flap (cords have snapped and some are wrapped around the flap). There is some
enlargement to the left atrium at this point from the backflow.
He is 67 years old and strong and healthy (great bp/pulse/cholesterol, had superficial bladder
cancer but just rechecked clear, has enlarged prostrate, no other known problems) aside from the
mitral valve regurgitation. Last 6-8 months has been getting tired easily, a few times out of breath
with exertion, and slight discomfort in chest on occasion. MVP, as evidenced by heart murmur, has
been from childhood (probably from scarlet fever rather than congenital, but not sure).
We see the surgeon next week and surgery will be scheduled within two weeks. Of course, if repair
can be done, that's the best. However, if that is not possible (this surgeon specializes in repair),
we need to know something about the alternatives. Prior to this appointment, I need some info to
help me ask the right questions.
Regarding mechanical replacement valves: Is there a type that works better (longevity, less clots)
than others? Also, I understand that the waferin is not "foolproof." How, aside from the blood
tests, can we tell whether there's a problem?
Regarding biological replacement valves: I thought I had seen some references to the necessity of
anti-rejection medications, however my subsequent search didn't find any sites that mentioned them.
Are they necessary if a biological (porcine or other) value is used for replacement? Do they make
him more susceptible to bacterial or viral illnesses? At his age, what timeframe is a biological
valve expected to last? (Many of his family live to the 90s and beyond. I don't want him to need
another operation at 80+.)
Where we live, there is only one "local" hospital that does heart surgery. The DC/Baltimore area is
2-3 hours away, so there are more choices if necessary. The cardiologist mentioned breaking the
sternum, so I assume that the local hosp don't cut under the left ribs. I doubt, but have not yet
inquired, whether this hospital does robotic surgery.
I understand that healing is much quicker with the left chest cut. Is access to the heart/valve as
good? Should we be looking for somewhere that does that?
What about robotic surgery? Is it that widespread? Is it more likely to be successful? Is it more
likely to enable repair? Is the recovery time better?
Is going to a distant hospital going to be risky for him in terms of traveling home afterwards?
I have seen some figures regarding the relative mortality rates of repair and replacement
operations. Is it that the repair operations are "safer" because if it can't be repaired there must
have been more damage? Or is it that the surgery takes longer for replacement, which puts the
patient at greater risk? Or is it that the replacement valves sometimes just don't work? Or
something else?
Naturally, we're both a little scared of the procedure and want to make sure he's in the best
hands possible. My apologies for asking so many questions at one time. I am trying to figure out
how to evaluate this surgeon and what questions to ask at our appointment (other than how many
have you done, what's your repair/replacement rate, and can you tell now whether he's a candidate
for repair).
Thanks in advance for your answers and for anything else you can think of that we need to know to
get the best treatment for him. Rose