Heart Surgery

[murf]

After my heart stress test and angiogram, the doctors found I had two small blockages inn the heart valves. Not a life threating effect but enough to take me off the transplant list. Surgeon stated that he has seen this type of problem quite often in dialysis patients. I have been given two choices. Have a stent put in and wait twelve months before I can go back on the list (something to do with the medication given with a stent) or have open heart surgery and hopefully (as long as I survive) and go back on the list in six months. I have never feared surgery so opting for the surgery.

[phyl1215]

I had the heart surgery years ago before I found out I was on the transplant list.  Having a stent put in is not that bad but waiting another year I know is hard.  I had a single bypass and my Dr. said it was better in the long run for me.  Best of luck. 

[Jean]

Good luck Murf and I hope they get it done for you soon.

[Nephrologista]

Murf, the one-year delay suggests that the doctor would be using drug-eluting stents.  Those secrete tiny amounts of a drug to prevent scar tissue from filling up the stent.  However, the drug also really slows down the process where the metal of the stent is covered up by the wall of the blood vessel.  As long as there's metal exposed to the blood flow, there's a clotting risk, so you have to take Plavix.  Plavis is a super-aspirin and it takes about seven days to get out of your system, so it makes a transplant surgery impossible.  That's why you'd be off the transplant list.  Even if you had a live donor, it wouldn't be safe for you to come off the Plavix long enough to get the surgery.  A clot in the stent would block the blood flow to that section of the heart - that's by definition a heart attack.

HOWEVER - drug eluting stents aren't the only stents out there.  Before we had those, there were bare metal stents.  You have to take Plavix for about six weeks, to let the blood vessel slowly grow over the metal.  But then you're good to go.  We upgraded to drug-eluting stents to prevent "in-stent restenosis."  That's when the blood vessel wall overgrowth goes too far, slowing closing off the stent.  It doesn't happen suddenly, like a heart attack.  Instead, you get the same angina symptoms you get when a blockage of your own is slowly developing.  In-stent restenosis is why drug-eluting stents took off in a big way.

THERE IS NOW VERY GOOD EVIDENCE that the drug-eluting stents offer NO BENEFIT in dialysis patients over the bare metal stents.  There is no reason to knock you off the transplant list for a year, just so you can take Plavix.  Your cardiologist (likely not a surgeon, they don't put in stents) may not be aware of this literature, it was published in the nephrology journals.  Have him or your neph research it and see if you can get the bare metal stent instead.

[Cordelia]

I hope you can get on that list soon! 
Good luck and take care!

[Jie]

When I did the angiogram, the doctor told me that there are two kinds of stents, one requiring 90 days of medicines another for one year. So there is a choice here.   

[RichardMEL]

Wow Murf that's a kick in the pants for you either way. I think I probably would have gone for the surgery also.

Hang in there mate and good luck with it!!!

[galvo]

Bummer, Murf. Good luck with whatever decision you make.

[phyl1215]

Well, I just had to have 3 stents put in about a week ago.  What a shock, was doing the cath to start doing treatments to lower my antibodies and this was just a check up!!!  One artery was 99%, one 90 and one 75, Doc said I was hanging on by a thread!!!!  I'm still in shock.  I am now on hold for 6 mths. on the transplant list, I hate that but I guess better than the other choice.  On hold because of the Plavix as you have to be on it for 1 yr. but my Dr. said I could be back active on the list in 6 mths. as they could stop the med. during the TX time.  Drama continues!

[huldafolk]

I live in Canada.  I have been on and off the list for ~ 7 years.  I just finished having a bare metal stent reworked with a drug-eluting one due to restenosis of 70% in 3 months.  They also had to stent the entire length of the LAD coronary artery (66mm) with drug eluting.  The transplant doctor came to see me and stated that he would place me back on the active/ready transplant list after4 weeks from the stent placement.  They seem to want to get me off dialysis due to multitude of complications over the years.  I an on Plavix/ASA/coumadin, as well as sometimes require Fragmin injection to bridge during operations.

[KICKSTART]

Go for the safest option not the quickest , time will pass soon enough.

[rocker]

Plavis is a super-aspirin and it takes about seven days to get out of your system, so it makes a transplant surgery impossible.

It does not make transplant impossible, in fact, the only effect seems to be a somewhat higher risk of needing a transfusion after the surgery.

http://www.pslgroup.com/dg/2231f6.htm is a study from 2008.

[murf]

Got the word from the cardio. Lot more work than what I had first thought. I have to have a triple by pass using the vein from the leg as a graft. Three days in ICU, 9 days in the ward. and then 2 weeks in rehab (I live alone so they won't send me home)/ Good news is that I stay at the Mount hospital which is like a hotel/ Op is in June. As always, I will take things as they come but must admit this is the biggest operation I will have to face. No driving, lifting for two months after the op. Start physio the day after the op. Doctor reckons the main pain will come from the leg.

[Des]

Oh my, when are you going in?

 

[rsudock]

thinking of you Murf. Stay strong!!

[phyl1215]

Well, I guess if it doesn't kill us it makes us stronger, as the saying goes.  We do what we have to do and hopefully all will turn out well for you Murf, sending prayers and good vibes your way.  Huldafolk, that is a lot of work but getting back on the list in 4 wks. is great, I also wish you the best and let us know how you do.  Now I have to do 3 mths. of cardaic rehab 3 x's a week to build my strength up in the hospital.....never a dull moment!!!

[murf]

never a dull moment!!!

Thanks for your kind thoughts. Henry S. will probably down my throat when I say this: The heart surgery is an Interesting diversion away from the every day hum drum of daily dialysis. BTW, I will be off the transplant list for another 6 months so, fingers crossed, back by Xmas.

[galvo]

Good luck to you, Murf!

[MooseMom]

This time that you are off the list...are you losing this accrued time?  I'm not sure how this sort of things work.

I wish you all the very best.  Make sure they get you into tip top shape!

[Henry P Snicklesnorter]

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[Jean]

Best of luck to you Murf.