I’m counting the sleeps till I see the surgeon for their decision on whether surgery is an option for me (meds haven’t worked). Very excited. The thing is I full expect the answer is no! I am largely resigned to that the reasons being-
1. Research hasn’t sufficiently proved unroofing surgery relieves symptoms post surgery - it’s too early / not enough numbers / not enough surgery done especially in UK. Not in the numbers bypass / valves are done that is.
2. Two Cardiologists (the specialist and local one) say it won’t help and operating could cause more damage than good (e.g. hole in heart) and likely not relieve symptoms.
3. The surgeon is very experienced in general and complex surgery so I would respect their decision.
3. My gut is telling me to trust the cardiologists’ opinion. My gut is always better at decision making than my head or heart 😊 but always chance I’m wrong and don’t know if I should be pushing for surgery as so many with this condition are. I don’t know why I’m not on the same page 🤔
What I wanted to ask (how long is a piece of string) do cardiologists and surgeons tend to be of the same view?
Would cardiologists go out on a limb and say something contrary to their preferred surgeon or do they get to know what the surgeon is likely to say because of working with them?
Do cardiologists and surgeons usually see eye to eye?
I will actually be astounded if surgeon says yes. That will actually through me into turmoil more than the answer being no.
thanks - full expect unanswerable question but please have a go😊
"Do cardiologists and surgeons usually see eye to eye?"
In front of patients they try and present a professional, unified front. But the relationship between heart surgeons and cardiologists is famously testy.
In 2009 the number of heart operations in Britain reached an all time high at over 41,000, by 2020 that had fallen to 31,000 and it continues to drop. The reason is that "Interventional Cardiologists" are taking the work away from surgeons, via procedures like stents and TAVI valve replacements. These are done by cardiologists rather than surgeons, and technology is rapidly increasing what can be achieved via a catheter fed via the wrist or groin into a patients heart.
When TAVI was introduced into Britain in 2007 it was only used for very old and frail patients who probably wouldn't survive open heart surgery. Heart surgeons fought tooth and nail to keep it that way, arguing that TAVI was less safe for more robust patients than open heart surgery. But as the data accumulated it became clear heart surgeons were massively exaggerating the risks of TAVI procedures. Patients prefer TAVI (who wouldn't prefer a valve replacement via a catheter under local anaesthetic to full blown open heart surgery?), it's cheaper, and with much quicker recovery times.
Another source of friction is that the last twenty years has seen more quantified monitoring of cardiac surgical outcomes. This has resulted in the EuroSCORE II study, which analyses the risks of open heart surgery. Surgeons have tended to push back against this kind of data driven analysis, where as cardiologists have embraced it. Samer Nashef, a British surgeon wrote a fascinating book on how EuroSCORE II was developed, and it shows how fierce was the opposition from surgeons who did not want a spotlight shined on their own, individual results.
Thank you for explaining the tensions that can exist and I did look up the EuroScore II as I think you mentioned this to me on another post.
Interesting dynamic between the two disciplines.
The surgery for my condition is something that could not be done by cardiologist in catheter lab but is OHS as far as research tells me. So it needs surgeon opinion to be absolutely sure, I’m grateful the cardiologist still referred, he’s stated his opinion but not forcing it on me.
He makes some good points, but he also twists the facts to support his own position. For example he brushes past the fact that heart surgery has become much safer since EuroSCORE, and also that heart hospitals now pool high risk cases so that surgery continues to be available to all.
None the less, the OP may be in the front line of this struggle, between heart surgeons searching for novel and possibly contentiously risky cases, and cardiologists and administrators arguing "do no harm" with a data led policy of caution. Personally I look at how much safer heart surgery is becoming and conclude that, as a patient, I'm on the side of prudence!
I was faced with a similar decision a couple of years ago.It was pointed out to me,among other things, that if the tavi is not going wellthey will open you up there and then.No chance to say no as they will be having a big bleed or some other nasty events they have to deal with there and then. I do not know what you need to be done. Mine was a tricuspid valve clips op. sounds simple but I am quite elderly although in pretty good nick and they had not operated on very many advanced age seniors ,still haven't done so and those surgeons who are prepared to take the risk may be risking the patients life.
you’ve done it again, got me thinking about things from different perspectives - exactly what I wanted❤️
I hadn’t thought of that regards taking up a surgeon’s time for them to just say no. Only thing I’ll say is the cardiologist (and the surgeon’s secretary) did say this surgeon always prefers to see face to face - albeit the round trip will cost me near on £200 all said and done! I’m happy with face to face whatever answer as I will I hope get better understanding
On the point of new procedures and being first or one of the very few - 🥴
Yes I think and hope it is influenced by my particulars as it is “very deep” rather than blanket no. . I need an explanation specific to my case.
I’m not sure about the cases they don’t often give depths and lengths, but that could be the results section of research articles goes over my head - I skip to the discussion and conclusion. But latest research says very deep should be bypass only not unroofing but with caveat bypass can fail due to competitive flow.
So I’m conflicted as a result.
I know of one case (not per research though) where a very deep one was said to be unroofed and included cutting into the ventricle and then repairing the hole deliberately made. 😟
I’ll be looking for a very clear explanation/ justification from the surgeon whether yay or nay.
Usually a multidisciplinary team meeting is arranged which includes Cardiologists, Cardiothoracic surgeons, Anaethetists and other relevant healthcare professionals to discuss open heart surgery without a straightforward outcome.
Perhaps ask that this can take place for you, along with you expressing how your quality of life is affected at present.
I hope all goes well for your appointment.
Ask if you can record the consultation and prepare your questions beforehand.
I was supposed to be having OHS today and it was the surgeon who called me last Thursday to say he'd spoken to the cardiologist and she got him thinking that maybe it'd be better to let my heart recover a bit more before putting it through surgery.
I first spoke to the surgeon 5 days after my heart attack and said 'when will I be recovered enough, do you think?' and he said 'oh, I think we could still aim for April'.
I think what's happened since is that the cardiologist at his hospital (referred from my local one which doesn't do this surgery) has looked at my case, as has the consultant hematologist and they feel that more information is needed to reduce risks in the op.
My sense is (and this is very reductionist) that the surgeon gets paid for the cutty choppy procedure whereas the cardiologist is looking at a more holistic, long term view of the patient.
I was also seen by an interventional cardiologist who was looking to see whether I could be fixed without OHS (catheter treatment) and he said no, unlikely to work, too risky. And that was at my local hospital (Papworth) where they have long-term responsibility for my care. Whereas my surgeon in London will probably (hopefully!) never see me again once the surgery is complete.
So, in conclusion, my sense in my own case is that surgeon thinks about the surgery and the cadiologists think about the patient.
They've presented a united front, but I doubt the delay to surgery would have happened without the cardiologist's intervention.
Maybe (and I hope) my London cardiologist and London Surgeon have a united front, I think they may have discussed already or at least the cardiologist has expressed his views to surgeon when referred. The London surgeon is this cardiologist’s go to surgeon for consideration of cases like mine.
My local cardiologist (they didn’t think they could help me to extent I needed and made the referral) and London cardiologist have always been on same page / same view and I am really comfortable with trusting them.
a joined up approach certainly makes it a lot easier for us as patients.
Not mine. After my HA the cardiologist referred me to the surgeon for mitral valve replacement. Surgeon said “no, let’s wait 6 months and see if the meds pull your valve back into shape.” 6 months later my regurgitation had gone from moderate/severe to mild, my EF had gone from around 30 to 45, and the surgeon said “well, you certainly don’t need surgery now!” Phew!
oh fishface I have been reading this with real interest after my heart attack in January they found cancer in my kidney!! They too are saying they can’t take it away yet and have scheduled the partial nephrectomy for August but lots of testing for for heart in July to heart to see if can stand the four hour op. I have to come off tigachrelor for at least 10 days before hand as it is quite a bloody operation. I am very scared about coming off the tablets as still getting my head around what has happened .
that’s a very intense situation, only way can describe, hope it all works out for you seems very complex with conflicting health issues. Fingers crossed. Will read with interest too when you update us all. ❤️
In my (limited) experience, the two surgeons I have dealt with have been cautious and risk-averse in their approach - not surprisingly, as they are of course the people who will be blamed if something goes wrong! I may have been particularly lucky, but they both took time to explain my particular situation to me and the benefits and dangers of the procedures they recommended, so I could make an informed decision as to whether I wanted to go ahead. If your surgeon disagrees with your cardiologist, I would expect them to put up a good argument as to why they think surgery will benefit you, but ultimately, the decision will be yours. BTW, I became very frustrated waiting for an appointment with one surgeon, thinking nothing was going on, but as Milkfairy says above, he was in turn waiting to discuss my case at the weekly multidisciplinary meeting with cardiologists, anaesthetists and everyone else involved in my care to determine the best way forward - so they do talk to each other! Good luck!
thank you it would be reassuring they have collectively discussed and are on the same page. unless a no to surgery is a given so maybe they just don’t discuss collectively? My stomach is in knots today, starting to get very nervous but it will be good to know one way or another ❤️
I think most people on here would agree, it’s the waiting that’s the worst! I hope you get the best possible result for you tomorrow. Let us know how you get on. x
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