Monday, December 17, 2018

Consult with Surgeon #1

I had my consult with Surgeon #1 this morning. This is the surgeon that my cardiologist would like for me to use for surgery. We had to wait for over an hour to talk to him. Walls were thin, so we could hear him talking to the patients in the room next door, and they were getting some very difficult news and had lots of questions. He took his time with them, and I respect that.

When he finally did come in to meet with us (because of COURSE Jim was there to hold my hand), he also took his time, and I thought that spoke well for him.

He told me that it appears that the best fix would be to put rings around the perimeter of the two valves, and that I was an excellent candidate for repair, as opposed to replacement.

There are two primary ways to access the heart for the repairs I need: thoracotomy approach vs the sternotomy approach. The thoractomy is where they make a small incision between the ribs, and a couple of keyholes. Some find that this is less invasive and an easier recovery than the sternotomy approach, which is where they cut the sternum and open the chest up in the traditional way.

This surgeon doesn't like the thoractotomy approach because the surgery takes 25% longer, is more damaging to muscles, and he doesn't get as good of a view of the heart. In addition, he says it's not a good approach if the tricuspid valve also needs repair because you can't get a good angle to work on it from that way.

So, if I go with Surgeon #1, I'll definitely end up with the traditional scar down the chest.

Surgeon #1 said that the approach to these repairs has changed quite a bit in the 20+ years he's been doing it. He said when he first started in the field, the approach was to wait until the patient was seeing major symptoms and the heart was showing major damage. He feels that the more proactive approach gives the patient a much higher chance of living a long life and reversing any heart damage, so he's pleased that we're addressing this now, before my heart is irreversibly damaged.

My priorities when it comes to this surgery are:

1- A good repair that will let me lead the active life I want to live and minimize future surgeries.
2- A recovery that is as quick as possible
3- Less visible scarring

I'll be interested to see what Surgeon #2 says.

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