Open Heart Surgery

My 100 hour Mitral Valve Repair

(Part 1: Events Prior to Surgery)


Diagnosis...

Around Thanksgivings, 2001, I went to my cardiologist for my annual Echocardiogram. After reviewing the tape, the cardiologist informed me that my Mitral Valve Prolapse (MVP) had gotten worse and now is classified as "Severe". He added that I should prepare myself for the possibility of having the valve repaired or replaced as soon as possible. If left untreated, permanent, irreversible heart damage was inevitable. There was still one test to go to confirm the diagnosis and to get a more detailed view of the damaged valve, but it was most likely it would simply confirm what he already suspected.

Verification...

To get a more detailed look and the interior of the heart, blood flow and regurgitation, etc., doctors use TEE (Trans Esophageal Echocardiography). It is similar principle to the conventional TTE (Trans Thoracic Echocardiography), but where TTE is noninvasive (done from outside the body), TEE is done via a small probe that is placed in the esophagus (food pipe), which provides a much clearer, more detailed pictures of the heart than is possible with TTE. While it is a somewhat unpleasant and considerably more involved procedure, it is virtually painless. (See my web page on TEE for more information). In my case, the TEE confirmed the fact that the valve was indeed in need of immediate repair. Both the cardiologist that performed the TEE and my own cardiologist agreed that surgery was my only option at this point. Certainly not what I wanted to hear, but it didn't come as much of a surprise either.

Choosing a Surgeon, Hospital, and Procedure...

One thing that became abundantly clear early on was the fact that I had as much, if not more, of a part to play in this whole ordeal than did the doctors, nurses, lab tech's, etc. taking care of me. Steps 1 and 2 were on the doctor's side of the court, but now it was my turn. I had to decide where I wanted my surgery done, who would do it, and what was to be done. My cardiologist made recommendations, but in the end, I had to make the final decisions. After all, it was my heart that was to be operated on, and I was the one that was going to have to live with the consequences. Needless to say I gave this considerable thought.

I had recently seen a video tape of a Mitral Valve Repair (MVR) performed using a telerobotic surgical system and minimally invasive laproscopic techniques. Three small half-inch incisions were all that was required and the patient was fully recovered and back on the job in just 7 days. I was sure that was the way to go until I dug a little deeper. First of all, even though it has recently been FDA approved, it hasn't much of a track record yet. Secondly, no hospitals in my area where equipped to perform this type of surgery, which would have meant considerable travel before the operation and certainly a hardship on my family during and immediately after. I soon dismissed this as a viable option... and so it went.

I did as much research as I could on the web to see what other alternatives were available. I talked to several doctors, nurses, and other health-care professionals to get their inputs. I also talked to everyone I knew about their experiences with open heart surgery, be it first hand knowledge or from having friends or family that had undergone the procedure. As I said earlier, this was to be one of the most important and long lasting decisions I would ever have to make. I owed it to myself to be as well informed as I possibly could.

As it turns out, I went full circle with this process. Without exception, every health care professional I talked to said that if they needed to have the surgery done themselves, they would choose the same surgeon my cardiologist recommended. Likewise, every patient or relative or friend of a patient that had their surgery done by this surgeon, recommended him without reservation. Good enough for me. Decision made... Actually two decisions down, since this surgeon's primary place of practice was a nearby hospital. All was left was deciding on the procedure; i.e. type of incision used, valve replacement options (if required), etc. These decisions would be made much later during my first consultation with the surgeon.


If I might climb on my soapbox for a moment...

After I had my Cardioversion done, I had to remain basically motionless for six or so hours with small sandbags applying pressure to the incision site. When discussing this with a friend who had recently undergone a similar treatment, he told me that his artery was sutured closed, effectively sealing it immediately. When I heard this I thought it was very strange that this had not been presented to me as an option. Perhaps an oversight? Perhaps a decision was being made for me based on some unknown criteria? I didn't think much more about it until the nurse called me about my upcoming Angiogram (which also involves making an incision in the femoral artery). Again, no options were offered. It wasn't until I told her what my friend had told me, that she admitted that it was an option after all, with the following caveat: Since most insurance companies won't pay for this "luxury" I had to agree in advance, in writing, that I would pay the additional cost out-of-pocket (approximately $200 as I remember)! Was this the why it was never mentioned? Whatever the reason, I learned an important lesson... You must be proactive! Don't just assume that everything is going to be laid out for you on a silver platter and all you need to do is sit back and go along for the ride.

Of course this is a small, inconsequential example, but it is easy to extrapolate to the bigger picture. The choices you make for your open heart surgery can and probably will affect the quality, even quantity of the rest of your life. Like everything else in life there are compromises and tradeoffs. What's right for one person isn't necessarily right for another. For example, there are surgical procedures that result in less visible scaring, but take longer to heal. A young woman would probably opt for the more aesthetic approach with the smaller, hidden incision, where as an old guy like me just wants to get it over with as quick as possible and has little concern about the size and location of the scar.

A more serious example would be in your choice of a replacement valve, should one be required. A mechanical valve would probably last you the rest of your life, but also mandates taking anticoagulant medication; medication that has risks of its own. On the other hand, if you opt for an organic valve, you won't need the medication, but it will only last for ten years or so, at which time you'd have to undergo the surgery again.

As you can see, the decisions you make will have a lasting influence on your life. You owe it to yourself to be as well informed as possible. Ask your cardiologist and surgeon to explain what options are available to you and the advantages and disadvantages of each. Make it clear to everyone you talk to that you want to know what all of your options are, regardless of cost or what the insurance company will or won't pay for. See if your local hospitals hold seminars on cardiac surgery. Call your local chapter of the American Heart Association and request whatever literature they have available. See if there is a local support group for and by bypass and open heart surgery patients. Keep in mind that the person with the greatest vested interest in your health and well being, and the person that must live with the consequences of the decisions you make, is YOU!


Stress EKG, Blood Tests, Angiogram...

My cardiologist ordered several tests to be done prior to my valve surgery. The purpose of these tests was to determine if there were any other problems with my heart that should be addressed during the surgery. For example, if it was determined that one or more of my coronary arteries was constricted or blocked, the surgeon would consider doing a coronary bypass at the same time as the valve repair.

The first test was a Stress-EKG; running (walking in my case) on a treadmill while your heart's electrical activity is monitored. If there was insufficient blood flow to the heart while under stress, it should show up as an abnormal waveform in the EKG.

The cardiologist also ordered an Angiogram so he could see the actual blood flow through the coronary arteries as-well-as through the heart itself. The surgeon would later use this same information to help plan his surgical strategy. (For more information on this test, see my Angiogram web page).

A blood test is required, prior to having the Angiogram. It is my understanding that the dye used for the Angiogram (some form of Iodine I believe) puts a strain on the kidneys as it is filtered from the blood stream, and the blood test is required to determine if the kidneys are functioning properly.


Autologous Blood Donation...

The surgeon's office informed me that two units of blood are required for open heart surgery. My choices were either to use blood from the hospital's blood stores, or donate my own blood prior to surgery; a process called Autologous Blood Donation. While I was sure that the hospital's blood supply was well screened and probably very safe, my preference was to use my own blood. Two reasons for this decisions: (1) Blood is always in short supply and since I was physically able to donate and use my own blood, it didn't seem right to use blood that others may need in an emergency, and (2) It seemed to be the safest possible transfusion; i.e. what could be more compatible than my own blood?

If you decide this is the way to go, you'll need to check with your doctor to make sure that it is safe for you to donate blood; i.e. that you have the physical stamina required to tolerate the donation. Scheduling is also quite critical. I was told that blood can only be stored for 35 days, so your first donation should not be more than a month in advance of your surgery. There is also a limit on how frequently you can donate blood. I was told it was best to wait 7 to 9 days between donations to give your body a chance to replace the lost hemoglobin. A hemoglobin test (via a finger-stick) will be given prior to each donation to insure it is safe for you to donate blood. Remember you will also need to leave a similar period of time between your last (2nd unit) donation, and your surgery for the same reason. As you can see, there is very little leeway in the scheduling. Be sure to contact your blood bank at least six weeks before you surgery to work out the details, and setup the donation schedule


Just to be on the safe side...

A few weeks prior to my first blood donation, I came down with a severe cold, sore throat, and cough. I wasn't sure what the possibilities were of a viral or bacterial infection being carried in my stored blood and reintroduced at the time of the surgery, but I wasn't going to take any chances. I made an appointment with an ENT (Ear, Nose, Throat) specialist and explained my situation. I was given a 10 day course of antibiotics, and a throat culture was taken to check for strep, etc. Fortunately the culture was negative, and the antibiotics cleared up my other symptoms. Since I didn't suffer a recurrence of my symptoms after the surgery, it appears it was the right thing to do.

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Page Updated: 25-Apr-2005