I had my first meeting with the surgical team at Papworth yesterday . I’m now pencilled in for an aortic valve replacement in June. We discussed my AF , the effects of surgery on episodes after and anticoagulants . Interestingly they stated that oral anticoagulants reduce the risk of stroke by 60/70% on average for those with AF .
Additional to my valve being replaced they will exclude the Left Atrial Appendage using a clip . Apparently this area of the heart is a common place where rogue electrical short circuits can start and it’s close to the pulmonary veins. By closing this appendage off the signals eventually die off but also the risk of stroke is now reduced by 70/80% providing anticoagulants are still being taken .
Personally I always had the impression that anticoagulants prevented stroke in AF sufferers not just reduced the risk. After my two ablations my EP report showed that the PV’s had been isolated and the floor of the left atrium had been mapped and ablated . My surgeon said in layman’s terms the floor has been fixed now we deal with the roof lol
It’s very common to develop AF after this kind of surgery so I’m keeping my fingers crossed my AF doesn’t get worse as my episodes are so much less frequent and shorter since my last ablation and I’ve got used to the quality of life I’ve enjoyed
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It’s nice to have things put in perspective Bob , I’m going to speak to the arrhythmia nurse to see if I can stay on the EP list till I see how my AF performs after surgery
I see many replies on this forum from you, and it often seems to me that you might be an EP, or some medically trained authority on AF and such related matters. Is this the case, as I sometimes get confused with which advice to follow, or that which is just well intentioned?
Good luck,will follow with interest as I have a bicuspid aortic valve,and apparently an 80% chance of replacement is average.They sound very thorough. I did understand the reduction of risk,others have done calculations on the reduction of risk as against our 5 times more likely to have a stroke. I'm useless with figures but it seems that being anticoagulation balances the risk to that of a 'normal person. My GP agreed so I take comfort from that.
June will soon roll up,and hopefully you might get a bit of sun to sit out in!
I first started with AF after OHS for a bicuspid aortic valve which I was born with and I have suffered from AF since 2009 on and off till about five years ago when it became persistent. I now have a pacemaker. Anticoagulants have worked for me as I havevnever had a Stroke. I have a mechanical valve and am Warfarin.
Ive heard similar stories sadly , it seems common after surgery . I’m having a tissue valve , a pacemaker is another possibility in about 5% of patients I was told yesterday
The Pacemaker has done the job, so far! I I had it implanted last year so fingers crossed 🤞. I had the Pacemaker because medication wasn’t working for me.
Me too-after aortic valve replacement and mitral valve repair just before covid I did suffer AF but had an abalation 8 month later with no problems since. Actually did a skydive to raise funds for Stoke university hospital last year to thank them for their efforts-I understand the surgeon cut his teeth at Papworth- Good luck!!
Why did you have a pacemaker if you don’t mind me asking , instead of an ablation . I often wonder if that would be a solotuon for my husband in the future when he s recovered more from his stroke .
An ablation had been suggested some months prior to me being admitted as an emergency through A&E with Tachy / Brady Syndrome, in fact I had been taken by ambulance to A&E twice in a matter of days. On the second occasion I was admitted to CCU and the decision was taken there to go straight for a Pacemaker as I wasn’t responding to medication and I was told that the only thing they could do for me was to go for the pacemaker which they did as an emergency for which I was transferred to St. Georges, Tooting, who were absolutely brilliant.
Good luck. Search on Youtube for a video by Dr Sanjay Gupta (York Cardiology) about vitamin C and AF. There is some reasonable evidence that vitamin C beforehand reduces the incidence of post-operative AF.
He also has a couple of videos on stroke risk and AF. His point is, and I think there's good evidence, that it's one's overall stroke risk that matters and the effect of clots forming in the heart due to AF causing pooling of blood is far from the only cause of a stroke.
great to hear things are progressing and you have a good team!
I have the atriclip across my left appendage. No anticoags though whilst I remain in NSR.
I wonder if they will check your ‘floor’ that’s already been dealt with whilst they do your other surgery, often there are gaps that they’ll be able to deal with easily with the maze irons. They can check there are no rogue pulses a pulse pen. Might be worth asking, be worth getting the full fix while you can.
Best of luck! Look forward to following you and hearing a successful outcome 😍
Thanks , I did ask about any ablation that could be carried out during the surgery . They said without mapping they couldn’t and it would increase surgery time . Apparently they go in to change the valve through the aorta so don’t access the heart directly.
Apparently they go in to change the valve through the aorta so don’t access the heart directly.
Are you saying this is not going to be open heart surgery? A little beyond my pay grade, but if it's not open heart surgery, how are they going to clip the LAA which is done from the outside? And if it is open-heart surgery, why aren't they doing a full maze procedure while the heart is open --which is probably the gold standard to prevent atrial fibrillation?
That was my point too Jim. It’s easy to do a full maze if open heart but if not then that would explain it. A clip can only be done from the outside of the heart though otherwise they use a plug (like watchman). So I’m a bit confused 🤔
Perhaps open heart surgery is the wrong term for my kind of operation in that case . I’d always been led to believe it was as the term was used by my cardiologist while referring me to the hospital
The other point is how are they going to clip/suture your LAA if they are going through the aorta and not from the outside of the heart? You might call the office to clarify exactly what the procedure they will be doing.
I’m sure they know what they are doing even if I don’t fully understand Jim The LAA clip is an added procedure I was only told about yesterday and as I said a five minute job
Open heart is where they crack your breast bone in half to access the heart and it’s a major bit if surgery, if it can be avoided and done another way all the better. Makes sense if a watchman that you’d stay on blood thinners. Best of luck with it all, looking forward to hearing you are on the road to recovery
They are going to crack me open as you say so it’s a big operation, not looking forward to it but it has to be done so best get it over with . It’s mainly the recovery and possible complications I’m not looking forward to but hopefully it will all go smoothly , thank you
I’m told around June . As all the surgeons have differing waiting times it could be up to 8 months but the surgeon I’m under said she’s around 3 months . I’ll get a letter within 2 weeks to give me a confirmed date she said
They can clip the LAA using a procedure similar to ablation is my understanding. I saw Dr Tim Betts explaining it on a YouTube video. Maybe that's what they were talking about. It's only offered in the UK if people are unsuitable for anticoagulants. Hammerboy this might be what they're doing for that part of the procedure?
That's the one I meant. There seemed to be question mark over whether this procedure was open heart or not. But I guess we shouldn't muddy the waters for the OP. He's got a lot to take on. Papworth is a good hospital though
are you sure you’re not having a TAVI I think it’s called, it’s where they insert the new valve in a similar way to how they insert a cardiac stent and a new valve is inserted inside the existing valve rather than full open heart surgery. I had my Aortic valve replaced in 2017 for aortic bicuspid vale malformation where they removed the existing malformed valve and I can assure you it was open heart surgery. The TAVI procedure was just being bought in, in the UK then and I think it’s become more popular in the US as an alternative to the open heart procedure.
We talked about 3 options going forward. Medication , Tavi or as he put it open heart surgery . He didn’t recommend medication , said Tavi was for patients who were generally older and poorly so left me with one option . I’m comfortable with the operation and know it’s necessary so just want to get it done . I know I will be in good hands
You will be in good hands and as you say they know what they are doing for you and as an individual. They know all your medical history- we are all unique. All good wishes to you for the op. and speedy recovery.
My girlfriend whom I lost in January due to fall and had a changed test to negative, had MS she was so tired.
16 years ago she had an Aortia replacement - Pig's valve which lasted 13 yrs. They said 10. Then she had a her human tissue one made up at Auckland Hospital as well.
But at that time they found the pig tissue infected but had to leave it there. From that day took antibiotics for the rest of her life.
Her MS had progressed immensely and walking was out but she could transfer from sitting chair to walker. Now a wheel chair was better.
She bought a mobile scooter 4 wheels and enjoyed getting out to the local shops.
My friend has just had that operation she is now recovering st home . If you’ve read my previous posts my husband hd a stroke caused by AF . His ablation had obviously undone itself from five years previous . He is on anti coagulants and is in persistent AF . I’m worried now as our doctor said edoxoban would prevent him from having another stroke not 60/70 per cent . Hopefully he won’t have another stroke . Good luck with your op .
But this is fundamentally good news isn't it? I had thought that when the atrial appendage was occluded there'd be no need for anticoagulants at all. But maybe your case is different? Sounds like you've got a good team on your side though.
Best of luck with it all. I think the appendage op is well worthwhile from what I have read. I thought it reduced the need for anticoagulants completely (I recall reading from an American doctor who promotes his method on the internet - but that, I see having searched, is with a "Watchman" device)?
Regarding stroke risk on DOACs, there are a few studies I have read and my conclusion is that the DOAC works very well but that some individuals have excessive risks, for example, high Chads scores, or occluded arteries and such like.
Sounds similar to me - 14 months ago I had a replacement tissue aortic valve due to severe stenosis of a bicuspid valve, LAA clip (Atriclip) and surgical ablation (previously had catheter ablation).I cannot maintain a stable INR on warfarin, hence I had a tissue valve although borderline age for mechanical. I remain on apixaban, candersartan, digoxin, tildiem 300, atorvastatin & omeprazole. My catheter ablation in 2018 for PAF held until 2022 when I went into persistant atypical atrial flutter. Since my OHS I have not noticed any arrthymias 🤞I was discharged from cardiac surgery back to my cardiologist/EP for follow up. I also have LVH, dilated left atrium and ascending aorta so waiting to see how the latter 3 have fared since my OHS.You are in good hands and very best wishes for June - a lovely time for recover from your op.
Wow you have been through the mill but seem to have come through albeit on necessary medication . Thanks for your good wishes , I’m a little nervous understandably but more for the recovery than the actual operation 👍
Hi, I had open heart for valve repair they also did an ablation while in there, don't know if that's possible with your op, but it seemed to make sense for them to do it at the same time. You can still have a stroke even though on anti coags, disappointing bit was stroke consultant saying that as I was on anti coags there was nothing else they could do and I'd just have to wait and see, fingers crossed etc
Yes I've heard others say they have had ablation at the same time . I did ask as it made sense to me to do it at the time the heart is accessible but I was told it was not possible. I don’t have a reason as to why other than you have to be mapped at the same time and the operation would be while longer .
interesting; my understanding about the LAA and why clipping is carried out is that it is a potential site of blood pooling and clotting, which can subsequently lead to a clot being expelled, causing stroke.
That's the first I've heard about it being a primary source of rogue electrical signals.
From what understand from what the surgeon was saying both clotting and signals emanating from that site are the reason they do it . I’m sure I’ll get another opportunity to talk before surgery
Hi. I'm on the list for a mitral valve repair (hopefully they won't need to have a replacement as they said I'm too young for a tissue valve 😫) and they intend doing a Cox IV Maze at the same time, whilst they are in there to hopefully sort the AF once and for all.There has been mention of clipping the LAA buy I'm not keen on that idea. If I'm still hoping to have to take anticoagulants, I don't see the point, mainly because the medics don't fully understand what role it plays in your body, other than clipping it can raise your blood pressure. Other than that they are sure about the long term implications of clipping or abating it......... hence my reluctance.
I googled the clipping of the appendage just out of curiosity as it had bit been discussed prior to referral . I then asked the question and was told why , I did ask wether it was safe or caused future possible complications but he said it was a common add on procedure and was recommended to reduce blood clots
It's something I've long thought about too. They didn't know what my tonsils were for when they cut them out on my eighth birthday; turns out they have a role in dealing with infections. However I've got to 63 without noticing their absence!
From what I've read this is my unqualified understanding:-
They think the atrial appendages have a role in regulating your thirst and dealing with water retention, although as you say there is uncertainty.
Rather like the kidneys, (in this respect), there is one on each side and it is held that we can function perfectly well with one, which takes on the function of both.
Hope that helps; perhaps confirmation of this from a Cardiology practitioner might put your mind at rest about LAA Occlusion.
"LAA is not just an embryologic remnant, but it seems to play an important role in the regulation of heart rate and fluid balance [3].
On the other hand, LAA has a key role in the thromboembolic risk [4] associated with atrial fibrillation (AF) and it could also have a possible triggering effect of atrial tachyarrhythmias [5]."
My hubby had open heart surgery to replace his aortic valve with a tissue valve (pig valve) in 2013. He was also told that he could have an arrhythmia and he did for about a month. As you can imagine he was worried that it might be permanent but I'm glad to say that it went away and he has not had any type of arrhythmia since then. Good luck to you.
I had an aortic valve replacement (pig valve) several years ago, and did develop AFib after. Before surgery, I had a butt-load of ectopics, including very short runs of aFib. The ectopics seemed better after the surgery, but I got 12-16 hour runs of AFib. (Now, as I've written ad-nauseum, I'm on a vegan diet and haven't gotten aFib in at least a year and feel quite healthy at 71.)
I had two valve repairs, closure of left atrial appendage and the maze procedure during open heart surgery in 2021. Other than some pacs,pvcs, I have not had any afib since. I wish you well with your surgery!
Hi, I first got AF in 2016 at 62. I’ve had PVI that didn’t work, medication was also unsuccessful, had a pacemaker and AV node ablation in 2017. I have been on Apixiban since it began. Last May I had OHS, Annunoplasty on my mitral and tricuspid valves and closure of my left atrial apendage. After the AV node ablation I was still in AF but am not aware of it anymore. I also had high pulmonary hypertension and the cardiologist I was seeing didn’t advise open heart surgery and wanted me to have the Triclip.
Fortunately I wasn’t suitable for the Triclip and found a surgeon who operated on me and did an excellent job. I’m still on the blood thinner but after the appendage closure I may be able to get of them in the future.
Good luck with the surgery, it’s very worrying but was definitely worth it for me.
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