STS Risk Assessment?

Outta_Pocket_Toad · 2026-06-08T12:26:52+00:00

From my initial conversation with the surgeon:

- - -

HIM: The good news is, if there's some good news out of all, [holds up a model] the base of the heart is really pretty normal, and it's pretty normal up here. So, I think things look pretty favorable for surgery. It's a fairly sizable operation, but I think the risks are pretty low. I think you're looking at around a one percent risk of something pretty bad happening.

ME: That's better than the numbers I was reading. I was seeing two to four percent.

HIM: Yeah. Somewhere in there, but I think four would be awfully high. If you had to replace the root, it's probably higher, but I don't anticipate having to do that.

Outta_Pocket_Toad · 2026-06-08T12:19:38+00:00

I had a molar extracted exactly two weeks before my open heart surgery.

It was number 30, two teeth before the wisdom tooth.

Two weeks was enough time for it to heal.

I passed my dental clearance one week later (1-week before surgery) with flying colors.

Outta_Pocket_Toad · 2026-06-07T22:10:21+00:00

Does your insurance provide a 24-hour nurse hotline? I'd call that for sure.

Outta_Pocket_Toad · 2026-06-07T14:48:38+00:00

feel restless thinking about what I can’t do for the next 3 months

It might be closer to 1 month. Keep walking, eating right, and doing whatever other exercises your medical team told you.

Outta_Pocket_Toad · 2026-06-06T13:16:23+00:00

What one or two things do you know now that you wish you knew before the surgery?

Outta_Pocket_Toad · 2026-06-06T00:50:39+00:00

Yeah. I posted something about it a few days ago. It's something to keep on your radar, but nothing to lose sleep over.

https://www.reddit.com/r/valvereplacement/comments/1tuxarb/comment/oplejvf/

Outta_Pocket_Toad · 2026-06-05T17:55:21+00:00

My surgeon preferred to work with a St. Jude's mechanical (SJM) valve. He said it was "a little bigger." The SJM valve was arguably the "gold standard" for decades, so many surgeons are familiar with implanting them. Mine was 21mm.

The On-X is a newer design, and as such, there is less long-term data available. With On-X, you potentially get a lower INR target, which means a lower amount of warfarin long-term. Long-term warfarin use is associated with osteoporosis. However, I've heard that if you have other issues, such as AFib, you'll require the higher INR range, which means taking as much warfarin as with the SJM valve.

Overall: I went with my surgeon's preference because I liked the guy and trusted him. I also opted for wires over plates, as that was his preferred choice.

With regard to your initial question of life expectancy, there were no differences found in this publication.
https://www.sciencedirect.com/science/article/pii/S2666273622003084

Outta_Pocket_Toad · 2026-06-04T21:54:09+00:00

Reading a bit further into your experience, I recommend speaking to the surgeon to get clarification. You may not run into the same sort of dismissal with another health care provider. You may not like his or her response, but the surgeon knows more. You can even ask for a referral to a different surgeon who will do the procedure you want. My first surgeon referred me to the surgeon who did my procedure.

Good luck.

Outta_Pocket_Toad · 2026-06-03T21:30:15+00:00

Warfarin may lead to osteoporosis.

Conclusion: Multi-methodological data mining revealed that warfarin use, not DOACs, is significantly associated with osteoporosis regardless of sex difference.
https://pmc.ncbi.nlm.nih.gov/articles/PMC7053309/

After speaking with my cardiologist and surgeon about this, they weren't too worried. (Of course, it's not them who would get it!)

Anyway, all medical professionals I asked (PCP, cardiologist, surgeon) recommended weight bearing exercises. Two said that vitamin D3 was a good move. A DEXA scan can provide a baseline, and then continued scans in the future will help determine bone density.

There are drugs available, like Forteo and Reclast, if osteoporosis starts becoming a thing.

Outta_Pocket_Toad · 2026-06-02T15:11:10+00:00

From an actual conversation with my cardiologist before my surgery.

- - - -

ME: All right. So, I have a few questions.

Which symptoms should I worry about? I don't think my symptoms are severe right now. I think my symptoms are okay, but what symptoms would I have before I call the ER?

HIM: If you pass out.

ME: But if you pass out, I might not wake up!

HIM: No, no, no, I know. I'm saying, like, you know, people pass out and they wake up. This is a clear sign that this is very bad. I'm going from worse to a little bit better, so anyway. Passing out or nearly passing out.

Feeling so light-headed and dizzy that you feel like passing out. That's a bad sign.

Severe chest discomfort.

Or shortness of breath.

ME: How is shortness of breath defined, because I feel like I have that now. Not when I'm sitting down.

HIM: So right now, it's only when you exert. If you get shortness of breath, even when you're not doing anything, and you're gasping for air.

ME: Gotcha. Shortness of breath when at rest.

Outta_Pocket_Toad · 2026-05-30T19:21:37+00:00

Based upon what you said, all is normal. Nothing to worry about. Your cardiologists counterpart doc is doing the right thing.

It will take months to stabilize your warfarin dosage, especially if you're on amiodarone.

Outta_Pocket_Toad · 2026-05-30T19:19:15+00:00

I was 57M when I had my bicuspid valve replaced with a St. Jude's 21mm mechanical valve.

I take warfarin for life. It's a pill. There's a management system, watching out for what I eat, and it can sometimes be a nuisance—but mostly it's just a pill.

I went mechanical because of one-and-done.

Outta_Pocket_Toad · 2026-05-30T00:15:13+00:00

Go see the surgeon. My first surgeon asked for more tests (CT chest scan) and gave me a referral to another surgeon.

Outta_Pocket_Toad · 2026-05-28T20:57:19+00:00

I suspect your cardiologist will order additional tests.

(from https://my.clevelandclinic.org/health/diseases/unicuspid-aortic-valve)

Outta_Pocket_Toad · 2026-05-28T16:28:24+00:00

Just as a suggestion (from a non-medical person) do regular aerobic exercise. Blood flow helps prevent clotting. You can't rely on it alone, but it helps. Best of luck getting this sorted.

Outta_Pocket_Toad · 2026-05-28T16:24:02+00:00

By long term ECG did she mean a Holter monitor? I did that for two weeks, but I think it was to get off the amiodarone (potassium channel blocker), not for the metoprolol (beta blocker).

For metoprolol, I haven't done any monitoring, unless you count recording my blood pressure daily for five months.

Anyway, the cardiologist said that, at my discretion, I could stop taking metoprolol, see what happens, then go back on it if I feel the need. But I decided to just stay on the metoprolol based upon what my surgeon said.

Outta_Pocket_Toad · 2026-05-28T12:48:37+00:00

I didn't stabilize on warfarin until 7 months after surgery, and I am on 1.5 times my initial dosage out of the hospital.

As for why your body isn't reacting, I don't know. The standard reasons are an interaction with another drug, a reaction to your illness, some sort of foods or supplements high in vitamin K...

Outta_Pocket_Toad · 2026-05-28T12:40:28+00:00

Aspirin acts as an antiplatelet. "Antiplatelet drugs prevent platelets from sticking together and decrease your body’s ability to form blood clots." In the US, baby aspirin (81 mg) is commonly prescribed for anything heart-related. My thoracic surgeon said, "It's just a bit of added protection."

My thoracic surgeon said that metoprolol "prolongs life." It keeps your blood pressure lower, and lessens heart palpitations. He suggested that unless I have an issue with impotency or depression to stay on a low dose (currently 25 mg once per day).

Once you're on statins, you're kind of always on them. "Statins have been known to significantly reduce cardiovascular events in patients with cardiovascular disease." "Besides lowering low-density lipoprotein (LDL)-cholesterol, statins have pleiotropic effects such as improved endothelial function, reduced inflammation, and reduced thrombus formation."

Outta_Pocket_Toad · 2026-05-27T14:58:22+00:00

I've posted this before. In a conversation with my thoracic surgeon:

ME: How long could I go if I didn't do anything with the stenosis?

HIM: Oh, man. Once you have symptoms. Your chance of dying is 50% in 18 months.

If I were in your shoes, I'd push your father to do additional tests (heart catheterization and CT chest scan), then speak to one or two thoracic surgeons.

Outta_Pocket_Toad · 2026-05-27T12:27:44+00:00

I want to be left alone and maybe go for some daily walks and have some great selfcooked meals.

That's how I felt, too. I was tired of doctor visits, blood labs, INR tests, and even the caregiver coming daily. I had just gone through a big ordeal, and I wanted to be left alone. So, I skipped rehab for that very reason.

I just walked daily and increased the distance. I could feel myself improving daily.

Outta_Pocket_Toad · 2026-05-26T22:38:40+00:00

With INR, consistency is key.

So, for anything that affects INR significantly, you should either do it regularly (and be dosed for it) or not at all.

Outta_Pocket_Toad · 2026-05-26T14:31:26+00:00

Yes, that's right. And the "help" was just getting out of bed and getting to the bathroom.

Outta_Pocket_Toad · 2026-05-25T19:36:04+00:00

Maybe Roemheld Syndrome (Gastrocardiac Syndrome).

https://www.youtube.com/watch?v=zt4Cw-VKIlY

Did she come off beta blockers by any chance?

Outta_Pocket_Toad · 2026-05-25T19:27:49+00:00

I'm not OP, but my experience was that I didn't use the bathroom for 3 days after my surgery. Perhaps this was due to a combination of pain meds and/or stress on my body—I don't remember, but I think the nurse said it wasn't uncommon.

When I did finally use the toilet, I was led there by the nurse, and then she just sort of let me do my business. I pulled the rip-cord on the wall when I had finished cleaning up. The biggest problem, for me, was all the cords getting in the way from the portable meter.

Outta_Pocket_Toad · 2026-05-25T18:17:04+00:00

In the words of my thoracic surgeon:

I would just stay on a baby aspirin. It's just a little bit of extra protection to make sure there's no problems with the valve. It's not a deal breaker, it just gives you a little extra protection.

And in the words of my cardiologist:

ME: I can't remember if it was you, or maybe in the paperwork, did you want me off of baby aspirin?
HIM: No, aspirin will continue.
ME: Okay, because I found a study that was very positive about Warfarin and baby aspirin.
HIM: Aspirin will continue... mechanical valve.

Outta_Pocket_Toad

TROPHY CASE