January 7, 2009
Cleveland_Clinic_Host: Welcome to our Online Health Chat with Dr. Marc Gillinov. Marc Gillinov, MD, is a staff cardiac surgeon at the Cleveland Clinic Miller Family Heart and Vascular Institute and he is board-certified by the American Board of Surgery and the American Board of Thoracic Surgery. He holds the Judith Dion Pyle Chair in Heart Valve Research at Cleveland Clinic. Dr. Gillinov has special expertise in minimally invasive mitral valve, aortic valve, and tricuspid valve surgery; robotic valve surgery; mitral valve repair; aortic valve replacement; surgical treatment and minimally invasive surgery for atrial fibrillation; off-pump coronary artery bypass surgery and high-risk mitral valve surgery. In addition, he is Surgical Director of the Center for Atrial Fibrillation at Cleveland Clinic. We are honored to have Dr. Gillinov join us today!
Speaker_-_Dr__Marc_Gillinov: Thank you - I am glad to be here.
Mitral Valve Replacement
crusher: Can porcine mitral valves be repaired when they begin to fail or are they always replaced? Is there a way to do a replacement robotically? All surgeries should be considered 'high risk'' but is a second mitral valve replacement in a higher risk category? Can second surgeries be successful and what individual patient issues should be considered before going forward that might negatively affect the outcome?
Speaker_-_Dr__Marc_Gillinov: Once porcine valves wear out, repeat surgery is currently necessary. This usually cannot be performed robotically, but some times a minimally invasive approach through the right chest is possible. The operation is usually performed at low risk and outcomes are generally excellent. Before surgery, the patient should have an echocardiogram and a cardiac catheterization.
Mitral Valve Disease
suzieq216_2: I have been diagnosed with moderate to severe regurgitation...I have been monitored for the past two years every six months. At what point should I have surgery? I don't get out of breath that easily which my doctor says to be aware of but do find I get out of breath after I have bent down. Other than that, I do not need to limit my daily activities. I also do get palpitations on and off, some days more than others. What would be the deciding factor that would require me to have the valve repaired or replaced?
Speaker_-_Dr__Marc_Gillinov:You will likely require surgery in the next 2-3 years. You should go to surgery if you develop any symptoms more than you have (shortness of breath, fatigue, reduced exercise tolerance) or if your annual echocardiogram reveals changes in your heart caused by the leaking mitral valve (reduced heart function, increased heart size, increased blood pressure in the lungs). In addition, if you develop an irregular heart beat called atrial fibrillation, you should have surgery. Finally, if the leak is severe and the valve is easy to repair, it is common to consider surgery before any of these changes. In most instances, this sort of surgery can be performed minimally invasively or robotically. The operative risk is extremely low for isolated mitral valve repair (1 in 1000) and life expectancy after successful repair is normal.
shasza: I was probably diagnosed with Mitral Valve prolapse approx 1988. I take Sectrol for controlling whatever issues I have. Is it necessary to have any surgery at all?
Speaker_-_Dr__Marc_Gillinov: Surgery for mitral valve prolapse (MVP) is only necessary if you develop severe regurgitation ( a leak) Most patients with MVP never need surgery.
nag9015: 80 yrs., 07/23/1999 coronary artery bypass X5; developed Atrial flutter 2001 & 2003 ablations not successful; use of Celebrex induced heart trama 2006; Current: treated for interstitial thickening of right middle lobe completed; severe left ventricular disfunction; EF approx. 20-25%; moderately severe to severe mitral regurgitation; unable to sleep unless laying on left side to abort painful cough and enhance breathing. Currently on diuretics and warafin among many other meds. Will mitral valve repair or replacement alleviate severe breathing problems I am living with? Until last 4 weeks have exercised 3X week both cardio and strength training since bypass in 1999; 6'00 at 155#
Speaker_-_Dr__Marc_Gillinov: You should be evaluated by a cardiologist and a pulmonologist to determine the cause of your symptoms first. Heart surgery would be a major undertaking in your case.
myheart: left vent enlarge how much before surgery is indicated?
Speaker_-_Dr__Marc_Gillinov: Any left ventricular enlargement represents damage to your heart and should prompt surgery to prevent further damage.
eugenejung: Is there a cause/effect with LV enlargement and MVR? Which happens first?
Speaker_-_Dr__Marc_Gillinov: Mitral valve dysfunction usually comes before left ventricular enlargement. In patients with a primary disease of the heart muscle such as cardiomyopathy - this relationship may be reversed.
JJAOBTS: I have severe mitral valve regurgitation awaiting surgery should I limit or eliminate: stair climbing, alcohol, caffeine?
Speaker_-_Dr__Marc_Gillinov: No. No need to limit yourself. However - always check with your doctor for specific questions about your care.
Mitral Valve Surgery
ms0901: My 82-yr-old father has had 2 previous CABGs ('85 & '98) and 2 wks ago had 2 medicated stents implanted for blockages. He also has moderate mitral valve insufficiency. At this time, would you recommend repairing the mitral valve now, or later, when it's more severe? Could this be done minimally invasively? Thank you.
Speaker_-_Dr__Marc_Gillinov: I would only recommend mitral valve surgery if the regurgitation becomes severe and he develops symptoms or a decrease in heart function. He may also be a candidate for a percutaneous (non surgical approach) at an experienced center like ours.
firsttimer_2: What process is used to determine when surgery is needed on the mitral valve?
Speaker_-_Dr__Marc_Gillinov: The surgeon will view your echocardiogram film along with medical history and results of physical exam to determine when surgery is needed on the mitral valve.
deejaykay38: Could a persons scheduled repair of the mitral valve develop into a replacement and does this happen often?
Speaker_-_Dr__Marc_Gillinov: 98 percent of leaky mitral valves can be repaired. Rarely the damage is so severe that replacement is the best option. We always discuss this option with patients before surgery.
deejaykay38: Could you explain the difference in recovery and time for a repair or replacement.
Speaker_-_Dr__Marc_Gillinov: There is generally no difference between repair and replacement. Recovery time depends in part on the approach to the heart. With minimally invasive approaches there is shortened recovery time.
kmkinan: Hello. What kind of tests are conducted before the surgery (my mother is scheduled for mitral valve repair, using the minimally invasive procedure)?
Speaker_-_Dr__Marc_Gillinov: In the first day or two after surgery, she will be tired but functional. By the time of discharge from the hospital (4-5 days) she should be almost fully functional.
Our team of health care professionals will help guide her activity and education before and during the hospital stay. We look forward to treating your mother.
fkratina: In cases of mitral valve regurgitation, moderately severe, and previous CABG in an enlarged heart with chronic atrial fibrillation.
Speaker_-_Dr__Marc_Gillinov: Usually surgery will be indicated.
fkratina: mtral regurgitation with tricuspid insufficiency, trial fib., CABG hx...Min.invasive Rx options?
Speaker_-_Dr__Marc_Gillinov: The possibility of minimally invasive surgery in a complex reoperative setting is low. The key factors are to provide the safest and most effective operation. If this can be achieved minimally invasively (unlikely in this case) we would do so.
jimslade: Under what major conditions is a mitral repair unable to be performed robotically? If the repair is not performed robotically, is it still a minimally invasive procedure?
Speaker_-_Dr__Marc_Gillinov: Robotic surgery on the mitral valve is not possible if the aortic valve is also dysfunctional, if the patient has peripheral vascular disease, or if the patient needs bypass surgery. In some instances other minimally invasive approaches can be used for patients with these conditions.
eugenejung: Can you comment on the repair vs. replacement debate? And has the 5 year survival data showing repair to be better held up?
Speaker_-_Dr__Marc_Gillinov: Mitral valve repair is generally preferable to valve replacement for a variety of reasons. These include - better heart function; reduced risk of complications; and elimination of the need for blood thinners.
data concerning the impact of valve repair on survival are conflicting - in part, because younger patients do well with repair or replacement. Still, repair is preferable.
krisirr: I had robotic mitra surgery last dec. it was the best medical experience of my life. now i have a resting heart rate of 90 so I have to take topril. is this a normal side effect?
Speaker_-_Dr__Marc_Gillinov: A resting heart rate of 90 is in the normal range. It is uncommon for a mitral valve procedure to have long term impact on heart rate. An EKG is necessary to confirm that you are in sinus rhythm.
jimslade: I am currently on bisoprolol. After a successful repair, will I be required to be on any medication?
Speaker_-_Dr__Marc_Gillinov: If you on this medication for your blood pressure - you will probably still need it. Usually patients do not need new medications after mitral valve repair.
memser_2: Post mitral valve repair, does the enlarged part of the heart return to normal?
Speaker_-_Dr__Marc_Gillinov: If the left ventricle is enlarged, it will usually return to normal. An enlarged left atrium will frequently stay somewhat enlarged.
Left ventricular enlargement is an absolute indication for mitral valve surgery as it represents damage to the heart.
thafeez: My Dad is 89 Yrs old. Had Mitral replaced and Aortic Valve repaired 10yrs ago. Mitral Valve is giving away again is he a good candidate for surgery.
Speaker_-_Dr__Marc_Gillinov: Mitral valve replacement is certainly possible. If his heart function is good and he is otherwise healthy, then he would be a good candidate for repeat surgery. He should certainly go to a center with extensive experience performing reoperative surgery.
firsttimer: What questions should be asked of the heart surgeon when facing mitral valve surgery?
Speaker_-_Dr__Marc_Gillinov: The important questions are:
- How many mitral valve operations do you do a year?
- What percentage of valves do you repair?
- Which minimally invasive options do you offer?
- What is the risk of mitral valve surgery in your hands?
fkratina: "fish-hook" surgery for mitral regurgitation, where done?
Speaker_-_Dr__Marc_Gillinov: Not sure what this means.
mollie: had mitral valve repaired in 1999 by dr cosgrove, every thing seems to be fine was wondering if there is any time limit on how long it will last.
Speaker_-_Dr__Marc_Gillinov: A mitral valve repair performed by an expert surgeon frequently lasts a lifetime.
Aortic Valve Disease
pathammond: I am a 50 year old female diagnosed with aortic stenosis about 5 years ago. They think I have a bicuspid aortic value but that has never been confirmed. I was told that I might expect to have the value replaced in 3-5 years. So far, every time I have had a check up and stress test, I have done very well and there has been little change. I've tried to read up on value replacements so that I am prepared when the time comes. Last year I mentioned minimally invasive options to my cardiologist and he told me the techniques are not perfected yet and that he would not recommend it at that time. So I want to know how quickly these new advances are being perfected with the hope that when the time comes, it will not just be an option but the preferred approach for my value replacement?
Speaker_-_Dr__Marc_Gillinov: Surgery will be indicated when you develop severe stenosis or regurgitation. We do offer minimally invasive approaches and have performed minimally invasive aortic valve surgery in thousands of patients with excellent outcomes and quicker recovery.
factotum: Please comment on the prospect of supplementing with Menaquinone-7 to delay or obviate aortic valve surgery for someone with a bicuspid valve.
Speaker_-_Dr__Marc_Gillinov: There is no strong data to support this. If you have a bicuspid aortic valve, you should obtain periodic echocardiograms (usually annually) to follow the valve function.
firsttimer_2: Is an echocardiogram the best test to check out what is happening after one is diagnosed with mitral valve prolapse?
Aortic Valve Surgery
rfcrow1: I had avr and ascending aorta replacement 8 weeks ago. I received a medtronic freestyle valve and am 61 years old and in excellent health otherwise.. Can you speak to what type of reoperation that I could have in 10 to 15 years?
Speaker_-_Dr__Marc_Gillinov: If the valve wears out you will require valve replacement at that time. This will be open heart surgery.
rlbernard: In 1981 at age 31 I had a Bjork-Shiley aortic valve implanted (not the Bjork-Shiley Convexo-Concave (BSCC) valve) . Two questions: 1) As I have no symptoms that worry myself or my GP, and I have annual checkups, should I anticipate a problem and replace the valve before obvious problems occur? (I need to note I have HepC due to some bad blood in the '81 surgery - liver fxn tests show little damage and no recent progression of damage). 2. As a previous open heart surgery pt., is the "minimally invasive" surgery a valid option?
Speaker_-_Dr__Marc_Gillinov: If your valve is still working now, it will probably continue to work for years to come. Repeat surgery is unlikely. If you did need repeat surgery, it is occasionally possible to go through the right chest to get to the mitral valve--this may be less invasive than a sternotomy for a repeat operation.
mariabrown: When you talk about surgery for a aortic valve replacement, what are you replacing the valve with?
Speaker_-_Dr__Marc_Gillinov: There are two types of aortic valve replacements. There are tissue valves (cow or pig) and mechanical valves (constructed of synthetic material).Both types of valves work very well. We try to fit the valve to the patient's needs and lifestyle. Mechanical valves require lifelong blood thinners. Tissue valves sometimes wear out.
myheart: aortic valve insufficiency 2+-3, can it be replaced w/o opening chest? also, no insurance.
Speaker_-_Dr__Marc_Gillinov: This degree of aortic insufficiency usually does not require surgery. If surgery is required, minimally invasive options are available. In addition, aortic valve repair (rather than replacement) may be possible.
rich3742_2: What would you est. is the oldest age for AVR
Speaker_-_Dr__Marc_Gillinov: We have performed aortic valve replacement for patients in their 90s. Aortic stenosis is a life threatening condition and advanced age is not a contraindication to surgery.
happyface: Can minimally invasive approach surgery be done with a bicuspid aortic valve? In September 2007 as told I had not only the bicuspid valve, but also a dilated aortic root with ascending aortic aneurysm. After CT done in August 2008 the aorta is measured in the ascending thoracic aorta just below the pulmonary artery level. MEAN 47mm ; MIN 45mm ; MAX 48mm. Is there any new cutting edge surgery that can be done to correct the aneurysm? Can the bicuspid aortic valve be fixed without putting in a new valve? Can this be corrected without major surgery?
Speaker_-_Dr__Marc_Gillinov: If you have aortic stenosis, the valve must be replaced. If you have aortic regurgitation it may be possible to repair the valve. This does require heart surgery. But - frequently we can use a minimally invasive approach.
pbelloff: Are there any minimally invasive techniques that can be employed for aortic valve replacement surgery?
Speaker_-_Dr__Marc_Gillinov: Yes. The most common approach is a 2 to 3 inch incision in the upper portion of the chest. Recovery is very quick.
Dominicanldr_2: Can aortic valve be repaired?
Speaker_-_Dr__Marc_Gillinov: Leaking or regurgitant aortic valves can frequently be repaired. This requires a high degree of surgical specialization.
joerub: Does the same hold true for an aortic repair as the mitral valve?
Speaker_-_Dr__Marc_Gillinov: Aortic valve repair can be performed minimally invasively and is associated with excellent long term outcomes.
thejane46: What are the indications for NOT doing minimally invasive surgery for aortic valve replacement?
Speaker_-_Dr__Marc_Gillinov: Need for bypass surgery at the same time is the most common.
sbenson: My father is 79 and has been diagnosed with moderate to severe aortic stenosis - it has been recommended he have the valve replaced, it hasn't been confirmed yet but are thinking his mitral valve will need to be replaced at the same time, What is the survival rate to do both and is possible to just repair rather than replace the mitral valve and could all of this be done with minimal invasive surgery?
Speaker_-_Dr__Marc_Gillinov: A minimally invasive approach may be possible depending on the preoperative tests. In most cases we can repair the mitral valve in this setting. Survival is 95 percent with this type of surgery in a 79 year old.
thejane46: As a post-polio, I have severe curvature of the spine, w/spinal fusion. Will this condition affect the possibility of minimally invasive aortic valve replacement surgery?
Speaker_-_Dr__Marc_Gillinov: Usually not. We have experience treating patients with scoliosis.
sfawbush: How often is minimally invasive surgery used for aortic valve replacement?
Speaker_-_Dr__Marc_Gillinov: For isolated aortic valve replacement minimally invasive surgery is our first choice and our standard practice.
escargome: I underwent aortic valve replacement with a bovine pericardial valve. I realize that I will most likely be in need for another surgery within the next 15 or so years. Do you believe minimally invasive surgery would be sufficiently perfected to allow me this option?
Speaker_-_Dr__Marc_Gillinov: Sure - we frequently perform minimally invasive surgery today for aortic valve reoperations.
dordavs: Can the minimally invasive surgery be used to replace an aortic valve? If so, what determines whether that will be used or the open chest surgery?
Speaker_-_Dr__Marc_Gillinov: Minimally invasive approaches can be used depending upon the need for additional procedures beyond the aortic valve. For isolated aortic valve surgery, minimally invasive approaches are our preferred approaches.
Dominicanldr_2: If aortic valve replacement is recommended but not absolute, should it be done even if patient is reluctant?
Speaker_-_Dr__Marc_Gillinov: In patients with aortic stenosis - aortic valve replacement saves lives. Delaying surgery in the face of severe aortic stenosis with symptoms can be hazardous.
pathammond: Is the Ross procedure an option for aortic valve replacement?
Speaker_-_Dr__Marc_Gillinov: The Ross procedure is uncommon today and is usually reserved for children.
Tricuspid Valve Disease
kthomas: Does moderate mitral regurgitation cause tricuspid regurgitation?
Speaker_-_Dr_Marc_Gillinov: It can. If the mitral regurgitation is worse than moderate, mitral valve surgery is indicated. At the time of mitral valve surgery, a dysfunctional tricuspid valve can be repaired, too.
Minimally Invasive and Robotic Heart Surgery Heart Surgery
joerub: What is the percentage of success of minimally invasive surgery vs the traditional procedures?
Speaker_-_Dr__Marc_Gillinov: with mitral valve surgery an experienced surgical team achieves identical repair rates and outcomes with minimally invasive and robotic approaches. The keys to the success are patient selection and surgical skill.
mariabrown: 1. What is the difference between your minimally invasive and robotic procedure and the traditional approach?
Speaker_-_Dr__Marc_Gillinov: The minimally invasive robotic procedure does not require a traditional sternotomy incision. The largest incision is less than one inch. The postoperative pain is minimal and recovery is rapid. In fact - many people return to work within one to two weeks after surgery.
cudos2you: Hello Dr. Gillinov, I had robotic mitral valve repair surgery done at Cleveland Clinic on 7-31-08 and am feeling excellent! My question is this: When can I expect my Ejection Fraction to come back to normal. Right after surgery it lowered to 40%. 4 months later (via ECHO) it was at 48%. I understand the 'normal' range is 55 - 60 %.
Speaker_-_Dr__Marc_Gillinov: Over the first year, left ventricular function will usually continue to improve. It may not reach the "normal" range, but if it is around 50% ejection fraction you should notice no limitations whatsoever.
JJAOBTS_2: What is the time difference under anesthesia when using the robot assisted method for mitral valve repair?
Speaker_-_Dr__Marc_Gillinov: In experienced hands, it is nearly the same as the time with conventional open surgery.
JJAOBTS_2: Does the surgeon select the approach to the repair i.e. minimally invasive side approach, open chest, robot assisted? What are the criteria?
Speaker_-_Dr__Marc_Gillinov: Reviewing everything with the patient, the surgeon selects the best approach based upon safety, effectiveness, and least invasive incision. For isolated mitral valve surgery, robotic approaches are our preferred approach. Additional testing (cardiac catheterization, CT scan, echocardiogram) determine the suitability of this approach.
JJAOBTS: With minimal invasive surgery using the small incision on the right side of the chest is the robot always used?
Speaker_-_Dr__Marc_Gillinov: Not always. The robot is a tool that facilitates right-sided approaches in appropriate patients. We will some times perform a right sided, minimally invasive approach without the robot. The key is to fit the operation to the patient.
Percutaneous (Non-Surgical) Valve Therapy
Cleveland_Clinic_Host: Dr. Gillinov, we've received a lot of questions about percutaneous (non-surgical) valves. Can you tell us more about this?
Speaker_-_Dr__Marc_Gillinov: Percutaneous or catheter based valve repair and replacement are in clinical trials. They are not yet FDA approved. In selected patients who are candidates for the clinical trial they provide an excellent option. Currently they are reserved primarily for people who would be at high risk even with our most advanced minimally valve surgery. Trials currently enroll patients with aortic stenosis or mitral regurgitation. A limited number of US centers offer these therapies. We are one of the centers who are offering these trials.
eugenejung: Are you participating in any of the aortic stenosis or mitral regurgitation trials you speak of?
Speaker_-_Dr__Marc_Gillinov: Yes - we are participating in both of those trials. You may contact the Cleveland Clinic Resource Center for more information - 866-289-6911 or chat with a nurse from our website.
bermgersh_2: Is there a medical reason as to why patients with congenital bicuspid valves are being excluded from the current aortic transcatheter valve replacement clinical trials?
Speaker_-_Dr__Marc_Gillinov: Yes. The current transcatheter valves are more difficult to place in the setting of a bicuspid valve. Future developments will probably enable us to treat these patients.
mgspeer: I have heard that trials are being conducted on heart valve replacement by starting through the groin, which is less invasive. Is Cleveland Clinic conducting any trials with this procedure?
Speaker_-_Dr__Marc_Gillinov: We are conducting clinical trials of valve repair and replacement with catheters. These procedures are currently not FDA-approved.
witter123: When is minimally invasive surgery done vs catheter ablation to treat afib/flutter?
Speaker_-_Dr__Marc_Gillinov: Minimally invasive surgery for atrial fibrillation is indicated when the left atrium is enlarged, there is a blood clot in the heart, or catheter ablation is failed.
Rsallade: I am interested in the minimally invasive approaches. When after examination do I know if I have to get a replacement or repair? I have been in atrial fib for 6 years. Do you think the new procedure MAZE along with a repair would help eliminate the use of blood thinners?
Speaker_-_Dr__Marc_Gillinov: Minimally invasive approaches can be used to treat mitral valve problems and atrial fibrillation at the same time. The success of the ablation for atrial fibrillation ranges from 70 percent to 90 percent depending upon the individual patient.
jackfcoffey: I am 80 years old with atrial fibrillation on coumadin. Have mitral valve leakage. Would surgery be advisable?
Speaker_-_Dr__Marc_Gillinov: If the mitral leakage is moderately severe or severe - surgery is indicated.
Valve Surgery combined with Breast Implant Surgery
kmkinan: How long is the procedure (if conducting a valve repair, minimally invasive, plus, a breast implant removal and replacement)?
Speaker_-_Dr__Marc_Gillinov: Actually we have done a large number of procedures like this - we team with a plastic surgeon - and first remove the breast implant through a very small incision under the breast. We then repair the mitral valve through the same incision. The cosmetic result is excellent.
Diagnosis of Valve Disease
Rsallade: Can you tell from my examines if I would need 1 or more valve repairs or replacements?
Speaker_-_Dr__Marc_Gillinov: The best way to determine what procedure you need is to review your echocardiogram and medical records. Patients forward these items to us before coming to the Cleveland Clinic and we are able to provide a great deal of information and guidance in advance. If you would like to send your records, you can contact our resource center for more information - 866-289-6911 or chat online with a nurse from our website.
mianola: Prior to mitral valve repair surgery, what information will a cardio cath test tell you, other than the state of the coronary arteries?
Speaker_-_Dr__Marc_Gillinov: That is the main reason for getting a cardiac catheterization. This determines whether or not you need bypass surgery at the time of valve repair.
Combination of Medical Problems with Heart Surgery
memser_2: I have Wegeners Granulomatosis Vasculitis. Will any complications ensue as a result?
Speaker_-_Dr__Marc_Gillinov: Usually not - but we would have you evaluated by a specialist prior to surgery.
EvelynF: My husband, age 54 and 5'6", had his aortic valve replaced with a mechanical one 14 yrs ago. He now has a 4.8 centimeter ascending aortic aneurysm. When he has to have surgery, can this be done with the minimally invasive technique and does the graft get attached to the mechanical valve? How much additional risk is there in the aneurysm surgery since he already has the mechanical valve? At about what size of aneurysm should he have the surgery?
Speaker_-_Dr__Marc_Gillinov: Surgery will be recommended when the aneurysm exceeds 5.5 cm. Usually this operation requires a standard sternotomy. The attachment point of the graft depends upon the extent of the aneurysm. The surgery is somewhat complicated and should be performed in an experienced center.
General Heart Surgery Questions
mariabrown: Is it true that when a tissue valve wears out, that it is almost impossible to replace or repair it again?
Speaker_-_Dr__Marc_Gillinov: No - replacement of degenerated tissue valves is standard and can be accomplished at very low risk.
rich3742_2: You indicate that Tissue Valves wear out - What is the general time period? and what age would you decide which route to go.
Speaker_-_Dr__Marc_Gillinov: They usually last 10 - 20 years. The choice of a tissue valve is easy in patients over the age of 70 but many younger patients who wish to avoid blood thinners also choose tissue valves and do very well.
Evaluation for Heart Surgery
Rsallade: How soon after evaluation can I have surgery?
Speaker_-_Dr__Marc_Gillinov: We are happy to accommodate patients according to their schedule and needs.
pathammond: Do insurance companies typically cover patients for these procedures when they are not in close proximity to the Cleveland Clinic.
Speaker_-_Dr__Marc_Gillinov: Sure - more than 50 percent of our patients come from outside Ohio. Our team is adept at coordinating your care with your insurance company. Always speak to your insurance company first - but the Cleveland Clinic accepts most insurance companies.
Cardiac Rehabilitation/Physical therapy
Rsallade: Do I need to go through physical therapy after valve repair?
Speaker_-_Dr__Marc_Gillinov: Generally not - the recovery involves standard aerobic activity such as walking. Some people find cardiac rehab helpful to return to an active lifestyle.
benlomondeast: Should I be proactive with my radiation induced valvular disease, or wait for catastrophic failure i.e. CHF?
Speaker_-_Dr__Marc_Gillinov: Do not wait for catastrophic failure. When you have severe valve dysfunction but still have good heart function, have your valves fixed in a center with experience. Radiation heart disease requires special expertise for its successful treatment.
kmkinan: Is there anything that we, as a family and patient, should research in advance of the surgery, so that we can make the RIGHT decisions during surgery, if a different process or procedure is required (for example, right now, we expect a valve repair — if, however, we need to replace the valve, what should we study in advance of the appointment so that we are informed?)
Speaker_-_Dr__Marc_Gillinov: There are many resources on the our website describing the different options in valve surgery. Your most important source of information is your surgeon. With your surgeon you should choose the best procedure for you.
Cleveland_Clinic_Host: I'm sorry to say that our time with Dr. Gillinov is now over. Thank you again Dr. Gillinov, for taking the time to answer our questions today and for staying a few minutes late for us!
Speaker_-_Dr__Marc_Gillinov: Thanks for having me - I have to run to surgery now. Bye.
Technology for web chats paid in part by an educational grant from AT&T Ohio and the AT&T Foundation (formerly SBC).
This information is provided by Cleveland Clinic as a convenience service only and is not intended to replace the medical advice of your doctor or health care provider. Please consult your health care provider for advice about a specific medical condition. Please remember that this information, in the absence of a visit with a health care professional, must be considered as an educational service only and is not designed to replace a physician's independent judgment about the appropriateness or risks of a procedure for a given patient. The views and opinions expressed by an individual in this forum are not necessarily the views of the Cleveland Clinic institution or other Cleveland Clinic physicians.