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harple's avatar

Does anyone have any experience or close-hand knowledge of heart operations?

Asked by harple (10422 points ) December 7th, 2010

They’ve just discovered a second murmur in my Dad’s heart, and that one of his valves is calcified. My Mum is so busy with him, and he’s in hospital, so I’m only getting my information second or third hand, but I have been told that they are going to operate. (We don’t know if that’s this week, this month, or at “some point in the future”, but they’ve not sent him home yet.)

Does anyone here know what the operation might be for? My brother in law thinks it might be to add a stent, but we – or at least, I – have no information as to what the operation is to achieve. (My Dad’s 84, so any sort of operation is not the best news.)

Do you know what it might be for? Or how long an operation it may be?

Thanks…

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14 Answers

Dr_Dredd's avatar

Sounds like it might be for a valve replacement. Calcified valves are often too narrow to work well and need to be replaced. Do you know which valve is involved?

Heart valves can be replaced with either mechanical valves or porcine (from a pig) valves. The type will determine whether someone needs to be on blood thinners afterwards.

Does your father have a primary (family) doctor? If so, make sure he or she is involved. Sometimes surgeons are overeager to operate and the family doctor can make sure “cooler heads prevail.”

Rarebear's avatar

Just to add on what @Dr_Dredd says, depending on the patient and the operative risk, they can sometimes do a valve dilation, although they don’t work as well as valve replacements.

Most likely it’s an aortic valve that they’re dealing with.

JLeslie's avatar

I am not a doctor, but here is my two cents. First, I am guessing you are in England possibly, because of how you spelled some words, and A gentlemen here in the states who is British and runs the brain cancer research here at St. jude’s children’s hospital mentioned to me once, that his type of research the best of the best are here at St. Jude’s, but heart disease the best work is being done in England. :). Next, as @Dr_Dredd mentioned it seems possible he might need a new valve, which is usually a very successful surgery, I believe they use pig valves as well as horse valves now. If he does need a stent PM me. My mother used to work in medical devices at our FDA and she knows the tricky things to watch for. Like if you are allergic to the metal the stint is made of (I think it has some nickel in it, that I once heard a bad story about an allergy, but I am sure that is rare, my mom would know) and some are treated with medication and have had complications, things like that. Still, I have several friends who have stents who are just fine, recently President Clinton had one put in.

Rarebear's avatar

@JLeslie They don’t put stents in for valves. They put stents in for coronary arteries which are a very different ball of wax. You actually don’t stent a valve because if you do you’ll be left with valvular insufficiency.

As @Dr_Dredd mentioned, aortic valves are generally replaced with the followin indications, taken from Dynamed
aortic valve replacement – curative treatment
indications for possible valve replacement in asymptomatic aortic stenosis
moderate to severe calcification of aortic valves
jet velocity > 4 meters/second
progression in jet velocity > 0.3 meters/second/year
abnormal exercise response – minimal change in valve area, cardiac output and blood pressure; significant decrease in stroke volume
impaired functional status
Reference – J Fam Pract 2002 Sep;51(9):739
replace valve when symptoms develop or peak systolic gradient across aortic valve > 50 mm Hg or cross-sectional area < 0.7 cm2 (severe) or < 0.5 cm2 (critical)

JLeslie's avatar

@Rarebear yes I know, but since the OP mentioned a valve and a stent, and seemed unclear on details, I figure maybe the OP is not accurate on the details in general or there might be more than one thing going on.

Kardamom's avatar

My father, aged 85, just had an aortic valve replacement (open heart surgery). His aortic valve had also calcified over the years and so was about to stop functioning. This surgery was coming down the road for about 10 years. Sometimes, especially if you don’t go to the doctor on a regular basis, will not be known until the patient has a major problem, like a heart attack. Other times, it’s discovered by the patient’s cardiologist during routine exams.

So my Dad had his surgery in August of 2009. He was scheduled for the aortic valve replacement surgery and they always assume that the patient may also need to have some by-passes as well, so they make sure that the patient has some useable veins in the legs (beforehand). If the patient needs to have any by-passes, which they will probably determine this by a test done a few days prior, or the day before the valve replacement surgery. In my Dad’s case, they only determined that he needed the by-passes when they got him opened up and could see inside. But they always assume that you might need by-passes and they make sure you have veins ready for that purpose. In my Dad’s case, they ended up making an incision in his left leg (from thigh to ankle) and then they removed one long piece of vein, which they then used to construct 3 by-passes (where he had clogged veins going to the heart).

If you are having scheduled surgery (as opposed to having this procedure done in an emergency situation) they will ask the patient whether he would prefer a mechanical heart valve (which lasts longer, but necessitates taking a blood thinner for the rest of your life, which causes it’s own complications) or an animal valve (usually pig and sometimes cow). Some patients, because of religious beliefs may not choose an animal valve. The animal valves last a long time, but not as long as the mechanical valves, but usually do not necessitate a life time of taking the powerful blood thinner called Coumadin. That is why my Dad opted for the animal valve (pig). We said a thankful little prayer for the animal that gave its life to save my Dad’s life. My Dad was on Coumadin for awhile, but then he had some major problems with bleeding, so they took him off of that and put him back on Aspirin (a less powerful blood thinner) just recently.

The typical surgery takes from 2 to 6 hours, depending upon whether there is any complications or whether the patient needs to have by-passes. My Dad was in there for about 4 and a half hours, then the patient will be in recovery for anywhere from 2 hours to overnight. Luckily, my Dad was conscious, barely, after 2 hours and we were able to go into the ICU (Intensive Care Unit) to see him. I don’t think he knew who we were, because he was still heavily sedated.

While you are sitting in the waiting room at the hospital, it is likely that you will be in a special waiting room that is devoted just to critical care heart patients. They isolate you like this so that you don’t have to listen to people laughing and talking and carrying on, like you would in the regular waiting room. There were 4 other families in this waiting room with us, and by the end of the 9 day stay, we were all like one big huge real family. It’s because you are all going through almost exactly the same thing, it was much better than being in a waiting room with the general population.

During your stay in the waiting room, while the surgery is taking place, they will usually send someone out at the half way point of the surgery to let you know how they are progressing. Then they will send someone out when they start to close the patient up, and then again when the patient has been sent to recovery and then one more time when you are allowed to go visit the patient in the ICU.

While you are in the waiting room, make sure to bring a bag with you with a book and magazines, a soft pillow, a bottle of water, a thermos of coffee and some snacks like nuts and energy/breakfast bars. I even brought a small cooler with sandwiches. At some point, you may want to go down to the cafeteria to eat, but in the meantime, make sure you have something to eat and drink if you feel like you can’t leave the waiting room. The seats can get hard so make sure you have a soft pillow and a light blanket and a sweater. It gets cold and that will make you feel more anxious.

Before the surgery, designate a family member or a friend to be the contact. Don’t let friends and relatives call or visit the hospital until the patient is out of the ICU and decides that he wants (or doesn’t want calls or visitors). The designated person ONLY will give everybody (friends, relatives, neighbors and co-workers) his cell or home phone number or e-mail address and everybody will be instructed not to call the hospital or come to the hospital until they are given the go ahead. While you are in the waiting room, you won’t want to be bothered with the phone calls and explanations. Let the designated person do all of that. A friend of ours put together a blog for me, that could be accessed by anyone we chose, and I updated it every single night after I got home from the hospital. That way, everybody stayed informed and I didn’t have to make any phone calls or repeat any information. And the loved ones could leave messages for me and for the patient, to be read after he came home.

If you need any more info or just moral support, please don’t hesitate to PM me. Six months after my Dad had his surgery, my brother who is 30 years younger was diagnosed with a congenital heart defect (which had no relation to my Dad’s problem at all) so he just had open heart surgery for a completely different kind of open heart surgery at the same hospital with the same surgeon in July of this year. So now my Mom and I have gone through this same thing twice in less than a year. Both patients are doing just fine.

YARNLADY's avatar

A good friend of mine had quadruple heart surgery a few years ago. He and his wife just returned from a world wide cruise.

My Mother In Law has had heart surgery twice over the last 5 years. She has a pace maker now, and they make sure it is working correctly over the telephone!

FireMadeFlesh's avatar

Just to add to @Dr_Dredd‘s great answer, a murmur is basically when blood flows back a little when the valve is closed, meaning the valve is not closing properly. I know someone who has had two mechanical valves and now a porcine valve. Mechanical valves can make you a little more out of breath, because they slightly lower your red blood cell count. Patients with mechanical valves also need to take blood thinning drugs to stop blood clotting around the valve. I think they generally last about 10–15 years depending on the design. Porcine valves are nearly as good as human, and do not need any blood thinners.

Valve replacements are one of the more simple heart surgeries, not that any are particularly simple, and have a high success rate. However considering your father’s age, the risk is somewhat higher depending on his health. At 84 they would not usually operate unless he was healthy or the condition was life threatening.

harple's avatar

Thank you all so much for your helpful advice – I feel so much better informed now!

@JLeslie I am in England, yes, thank you for your supportive words. The Stent comment was just something my brother in law had wondered, and I now see it is irelelevant, but it goes to show how uninformed we all are. That’s not a comment on the health service, more on the fact that the two people who are regularly at the hospital – my parents – are rather preoccupied to be passing on information.

@Rarebear Thank you for your very detailed answer – I’m afraid its all dutch to me, but I aprreciate it none the less!

@Kardamom Your answer is amazing, thank you. I have a better idea of what to expect now…

@FireMadeFlesh Thank you – I appreciate the explanation, I really have felt very much in the dark about the whole thing, and didn’t fancy confusing myself with contradicting advice from google searches.

@Dr_Dredd @YARNLADY Thank you, thank you.

Dr_Dredd's avatar

Good luck, @harple!

harple's avatar

UPDATE – My Dad came out of hospital last week… They’ve decided to try him on meds for a couple of months to see if they can control his heart that way. I spoke to him just yesterday though, and he said that he was getting worn out doing the most menial of tasks (he had a friend come over to do something, and all my Dad had to do was hand him the screwdriver etc, and he had to go have a lie down after that) so he feels like he really would benefit from surgery. For the holidays, at least, he’s home and we’re all delighted. (I’m particularly delighted as I’m away for the holidays, and was so worried about being so far away while he was in hospital still.)

JLeslie's avatar

@harple Thanks for updating us. It does sound extreme if he is winded or exhausted after such little effort. In my non expert opinion it does sounds like surgery could really help. Pf course there are risks with surgery, but if everything went well, he would be like a new person. Heart surgery has incredible impact, life changing from what I have observed, if there is no damage to the heart muscle already. My dad was short of breath, that was his symptom. All of a sudden he could not walk from his car in the parking lot to his work building without feeling winded. He never had a heart attack, so his heart is strong. After his bipass and healing, he was able to do everything again. I think people with valve replacements have similar recoveries.

Happy Holiday to you and your family,

harple's avatar

@JLeslie Thank you, I really appreciate hearing that! Happy holidays to you too :)

Kardamom's avatar

@harple I’m so glad your dad is out of the hospital, but because of the extreme fatigue, it sounds like he would benefit from the surgery. When the valve isn’t functioning properly, the heart and everything else is not getting enough blood flow, and oxygen, at the correct rate.

Keep us updated. I’ll be thinking about you and your family at Christmas : )

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