Written by: Adam Choose, Affected person Advocate, Writer & Web site FounderPublished: April 22, 2024
I’ve mentioned it earlier than and I stay up for saying it once more…
Listening to from sufferers about their coronary heart valve success tales stays my favourite a part of working this web site. For instance, here’s a improbable affected person story from Lynn Friedman who overcame a really advanced kind extreme mitral regurgitation because of Dr. Joanna Chikwe, Dr. Dominic Emerson and the whole group at Cedars-Sinai Medical Middle in Los Angeles.
Lynn Friedman With Jim, Her Husband
My Prognosis & My Signs…
I’m 73 and reside in Chicago. I used to be identified on December 19, 2023 through a Transesophageal Echocardiogram (TEE) with extreme mitral valve regurgitation as a result of extreme P3 and P2 prolapse. I used to be extraordinarily fatigued and wanting breath on very delicate exertion.
A Delayed Surgical procedure?
I’ve rheumatoid arthritis and obtain an infusion each six months to maintain it underneath management. The docs suggested me to not have surgical procedure too near one in all my infusions, so the earliest I used to be eligible for surgical procedure was mid-March. That delay turned out to be a blessing, as a result of it gave me time to do lots of analysis on mitral valve surgical procedure, the perfect surgeons, the perfect hospitals, and seek the advice of with numerous surgical groups.
A Regarding Complication… Mitral Annular Calcification
My exams revealed important Mitral Annular Calcification (MAC) across the mitral valve. Via intensive analysis my husband and I did, and suggestions we acquired from a number of coronary heart surgeons, I realized that the calcium makes it very tough to repair the mitral valve. Making an attempt to take away the calcium might be harmful, probably inflicting a stroke or worse throughout surgical procedure. We spent many sleepless nights from prognosis by way of surgical procedure not understanding whether or not my mitral valve may very well be repaired adequately, and whether or not changing the valve can be secure or not. I used to be advised that changing my mitral valve can be inherently riskier than a restore as a result of having to “mess with the calcium” so as to get the brand new valve to seat correctly, to not point out different disadvantages of a alternative vs. a restore.
Lynn’s Household
I Seek the advice of With 3 Totally different Surgeons
We despatched my take a look at outcomes to a few well-known surgeons at three famend coronary heart hospitals for an analysis. The primary one mentioned that the mitral valve may very well be repaired robotically, however it must be an “imperfect” restore because of the MAC. I used to be advised my extreme regurgitation may very well be decreased to someplace between mild-moderate, and {that a} alternative can be much more problematic than a restore.
The second seek the advice of was adamant that my mitral valve couldn’t be repaired, and {that a} alternative, at considerably extra threat because of the MAC, was the one answer. I used to be additionally advised that average regurgitation as an final result of surgical procedure can be silly to simply accept, and that I ought to contemplate an open-chest (sternotomy) operation.
The third seek the advice of was additionally from a widely known robotic surgeon at a top-rated hospital. I used to be advised the mitral valve couldn’t be repaired because of the MAC, and that they don’t do replacements robotically. Their solely suggestion was to contact a surgeon who would substitute the mitral valve through a sternotomy. My husband and I had been discouraged past phrases, and felt we didn’t have a good selection between any of the three consults.
We Discovered Our Surgical Workforce!
After my third seek the advice of, I used to be prepared to surrender on my hope for a robotic restore. Thank goodness my husband made one final name, to the workplace of Joanna Chikwe, MD, Chair of Cardiac Surgical procedure at Cedars-Sinai Medical Middle in Los Angeles. His first query to the workers: “Does Dr. Chikwe do replacements robotically, or solely repairs?” He was advised she will do both one with the robotic, however it will rely upon a evaluation of my take a look at outcomes and pictures. They setup an account for me on their on-line medical file system whereas my husband was nonetheless on the cellphone, and by that afternoon my husband had uploaded all of my exams to Cedars-Sinai. Three days later, I acquired a name asking if I might meet with Dr. Chikwe in two enterprise days for a video seek the advice of.
Dr. Joanna Chikwe
Her seek the advice of was the one one which gave us hope. She mentioned she was “moderately assured, however not sure,” {that a} robotic restore may very well be achieved, and that primarily based on my take a look at outcomes, a robotic strategy ought to be moderately secure for me. She mentioned the restore wouldn’t shut the leak fully because of the calcium, however she thought she might get it to delicate. If she couldn’t get it to delicate, or if there have been indicators that the restore wouldn’t be sturdy (long-lasting), she mentioned she would decide throughout surgical procedure to interchange the mitral valve.
Dr. Chikwe mentioned if she needed to do a alternative, she would attempt to use the robotic, however that I’d get up with a medium sternotomy. Her willingness to strive for a restore, and change to a alternative, both robotically or through sternotomy, primarily based on what she learns throughout surgical procedure, was precisely the strategy we needed, and is what set her other than the opposite surgical consults described above. She was extraordinarily compassionate and trustworthy in regards to the dangers concerned. When she expressed “cheap confidence” within the outcomes she thought she might obtain, and defined her flexibility to modify gears, if essential throughout surgical procedure, we knew instantly that we needed to be underneath her care. We’re so grateful that she was keen to take my case.
Lynn & Jim Mountain climbing
There’s lots of data and plenty of movies about Dr. Chikwe and Cedars-Sinai Medical Middle on-line, like those at HeartValveSurgery.com. One particularly that gave us nice confidence in her and her group is a speech she gave on the 2023 Cardiothoracic Surgical procedure Symposium. Though it’s supposed for an viewers of cardiac surgeons, it conveys a deep understanding of the vital components which might be important for secure surgical procedures and contribute to profitable outcomes.
My Surgical procedure
Dr. Chikwe had a top-notch group along with her within the working room. She was assisted by Dr. Dominic Emerson, Director of Robotic Surgical procedure, pursuant to their coverage of getting two attending surgeons scrubbed for robotic circumstances. Six or seven others had been additionally within the working group as a part of their group. In my case, Dr. Chikwe was the lead surgeon, however I imagine Dr. Emerson was eminently certified to have been the lead as effectively.
I knew my case was advanced and would current an enormous problem to the surgical group. After surgical procedure, I woke as much as be taught that the primary try to restore my mitral valve was suboptimal, leading to larger than delicate regurgitation. There was a dialogue amongst the group within the working room about changing the valve, and a choice was finally made to strive yet one more time to boost the restore.
Thank goodness for the redundancy on my surgical group. With out a number of certified surgeons within the working room, such a dialogue wouldn’t have been attainable, and a choice to strive for a second try at a restore might not have been made. The second try was profitable, leading to higher than delicate regurgitation (some mentioned it was “little or no leak,” or “trace-mild”), which is healthier than what I had hoped for. My surgical procedure was carried out robotically, with out the necessity for a sternotomy. They gave me a profitable restore with out touching the calcium, preserving security foremost of their minds.
Gratitude for Wonderful Publish-Op Care
I spent sooner or later in ICU and was then transferred to an everyday room.
I used to be discharged from the hospital after a complete of 4 nights. The care I acquired in ICU and in my common room was completely excellent in each respect. Dr. Chikwe got here to see me in ICU and day by day after that. I used to be additionally in a position to converse with Dr. Emerson and a few of the different individuals who had been on the group within the working room.
Everybody, surgeons, nurses, nursing aids, and so on. had been so compassionate, caring, and respectful. There aren’t any phrases to explain the depth of my gratitude for Dr. Chikwe and the group of individuals she has at Cedars- Sinai.
5 Classes Realized
There are various vital classes my husband and I realized from this ordeal:
Lesson #1: You probably have a posh case, or even when your case is straight-forward, take the time to analysis the perfect surgeons and the perfect surgical facilities. Get multiple opinion. In my case, it took consults with 4 completely different surgeons to lastly get to Dr. Chikwe – the one group I used to be keen to belief my life with.Lesson #2: You probably have MAC, your final result is probably not the identical as mine. Each case is completely different. MAC will increase the complexity of any mitral valve restore or alternative. It’s vital to have your case evaluated by a middle of excellence, like Dr. Chikwe’s group at Cedars-Sinai, that has important expertise with mitral valve surgical procedure within the presence of calcium. You’ll want an skilled group with the technical data of what to do, easy methods to preserve you as secure as attainable, and the pliability & willingness to alter course primarily based on what they be taught throughout surgical procedure.Lesson #3: If you’d like robotic-assisted surgical procedure, make sure you focus on your case with a surgical middle with important expertise doing robotic surgical procedures. Discover out if they’ve a coverage of redundancy within the working room, the place multiple individual is certified to carry out the identical operate. Not everybody qualifies for robotic surgical procedure, and all coronary heart surgeons will not be skilled sufficient to carry out it safely.Lesson #4: Robotic surgical procedure avoids slicing by way of the sternum, however it’s nonetheless open-heart surgical procedure. It’s no stroll within the park and isn’t risk-free. In my case, the place the surgeon needed to delicately work round a major quantity of calcium, I needed my surgeon to have the perfect magnified view attainable of my coronary heart, and the robotic gave her an unparalleled view. Different benefits of the robotic had been a barely quicker total restoration, much less likelihood for issues as a result of not slicing by way of the sternum, and fewer scarring. However to me, the first benefit was the surgeon’s superior view of my coronary heart that I believed would possibly result in a greater surgical final result.Lesson #5: There is no such thing as a substitute for an skilled group, the place every particular person has important expertise, and so they even have expertise working collectively as a group. It was price it to me to journey 2,000 miles to have my surgical procedure carried out by top-of-the-line surgeons, with an impressive group, at top-of-the-line facilities of excellence within the nation. It could have been extra handy and cheaper to have my surgical procedure carried out in my house metropolis of Chicago, however I’ll by no means remorse the additional effort and cash spent to get really excellent care.
That is my story, however each case is exclusive to every individual.
I hope this encourages you to do the analysis and get a number of opinions from skilled surgeons at facilities of excellence.
Lynn FriedmanMitral valve restore affected person