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I had open heart surgery for repair of an aortic aneurysm. I also inherited the same wanky bicuspid aortic valve that has contributed to the death of at least o

I had open heart surgery for repair of an aortic aneurysm. I also inherited the same wanky bicuspid aortic valve that has contributed to the death of at least one person (and usually more) in each of the last four generations of my family. For some reason, the heart surgeon decided not to replace it when he had me opened up. Maybe I'll have the joy of undergoing another $160k operation to fix the valve using this technique. By the way, in case you're wondering, open heart surgery kind of sucks. I wouldn't recommend it unless you absolutely need it.

tehlike 8y ago
Not sure what kind of insurance you have, but it might make sense to go to european countries for surgery.
- Waterluvian 8y ago
  How does this work if you're not a citizen or resident? Do you just pay cash?
  - Brakenshire 8y ago
    I don’t know, but it may well make sense. Private treatment often is quite reasonable because the alternative is free. You can get a private self-referral MRI for instance for £200-400 in the UK. I haven’t heard of people coming from the US for treatment though, only about people from the UK going to Poland for dentistry, which apparently is cheap and good quality.
    - sverige 8y ago
      I ended up paying $8k out of pocket after my pretty good insurance paid out. I'm still astonished at the overall cost, though.
      - randerson 8y ago
        $160K sounds cheap to me if you're in the US. I had a heart ablation a few years back for an irregular heart beat. Like the procedure in the article its minimally invasive where they go in through the groin to zap some electricity at a few cells in the heart. I was conscious throughout and was back at work the next day. They billed $400K for that, and insurance negotiated it down to around ~$120K. For something as complex as what you've mentioned I'd have expected 7 figures.
        tehlike 8y ago
        what did you end up paying?
        trevyn 8y ago
        Check the annual out-of-pocket maximum on your plan. It’s been capped at about $9k since Obamacare.
        randerson 8y ago
        Around $6K out of pocket.
    - tehlike 8y ago
      Dental might or might not make sense. Depends on how many surgeries you need usually. Implants here in the us costs ~5-6k. Implants where i came from is around 700$, but thing with implants is it needs a lot of time during recovery. Like 3 months after bonegraft etc. You can also det double insurance for cheap-ish and get it covered like that in the us for about 1/6th the price. For most non emergency surgeries (some heart surgeries are in that category, you can plan in advance), europe does make sense, especially insurance is not good. At some point i thought that could be oretty good way to balance out cost here.
      - yakshaving_jgt 8y ago
        I was advised to have a mole removed. The private clinic in London wanted £700 for the removal, and the initial consultation was £250. I flew to Poland instead, and had it removed at another private clinic for £80. All the staff in the top clinic in London are Polish anyway. Paying crazy amounts of money for medical procedures is just dumb. I cannot understand why Americans would pay tens or hundreds of thousands of dollars for surgery when they could fly to Europe, live the highlife, and also buy a house with the change.
        surfmike 8y ago
        Because their insurance pays.
        raverbashing 8y ago
        Yeah, but the copay sounds it could be more expensive than doing it entirely abroad
        yakshaving_jgt 8y ago
        Please see this comment: https://news.ycombinator.com/item?id=19411068 https://news.ycombinator.com/item?id=19411068
  - tehlike 8y ago
    People get eye surgeries and a pretty nice vacation for the same price in europe. Private you pay cash but it may even be cheaper than office visit there :)
jedberg 8y ago
> I wouldn't recommend it unless you absolutely need it. Ask your doctor if open heart surgery is right for you! (If your local cardiologist advertised on TV)
- carbocation 8y ago
  There was an ad for Impella (a form of mechanical circulatory support - basically advanced life support) during the Super Bowl 1-2 years back [1]. Which is basically even more absurd than advertising aortic valve replacement... 1 = https://www.ispot.tv/ad/ArZf/protected-pci-impella-25 https://www.ispot.tv/ad/ArZf/protected-pci-impella-25
- sverige 8y ago
  Well, I would say if you are given a choice of a procedure like the one described in the article or open heart surgery, choose the less invasive one. Although in my experience, they don't really consult with you about what you'd prefer so much as tell you what they are going to do.
robbiep 8y ago
Aortic valve disease is bi (Tri- for unileaflet but that usually presents at about 5-10 years) modal; trileaflets around 70-80, bileaflets at 40-50. There are quite good reasons to not replace, not least of which is that replacement valves are nowhere as good as your native, particularly if it’s still functioning. Ie if metallic, you need to be on anticoagulants for life which can be a massive pain and cause other complications. Metallic last for around 30 years. If porcine/bovine or possibly human, then they degrade much faster, 10-15 Years is the average. So, depending on your age, and depending on the repair your aorta needed, the surgeon likely decided that since you will have to undergo the knife at some point again anyway (either for graft replacement for the Dacron that now makes up the proximal part of your aorta) or eventually due to the valve, you might as well minimise the complexity by only doing one thing at a time. Plus, since we first started doing TAVIs (transcutaneous aortic valve repairs) they are getting better and better - see article - so possibly you wouldn’t need the on-pump surgery. Interesting that it costs you $160k; in the Australian public health system a valve is about $30k. Source: I did my honours thesis on cardiothoracic surgery (actually on mitral valve repair, but spent a lot of time in cardiothoracic theatres dealing with aortic valve-disease)
- sverige 8y ago
  Thank you for the very informative reply. Frankly I didn't have the energy to really quiz my very excellent surgeon on all the details. I was pretty low energy at the time. I was relatively young for the surgery, mid-50s, so I don't doubt that that was a factor. I'm not sure a valve will cost $160k. That was the cost of open heart surgery with a double bypass and aortic aneurysm repair. I ended up paying about $8k of that after the insurance did its part. I would definitely prefer a less invasive procedure. Recovery would probably take less than five months, for example.
  - Gibbon1 8y ago
    > I was relatively young for the surgery, mid-50s, so I don't doubt that that was a factor. Ex-gf's ex husband needed a valve replaced at 25 due to damage from an infection. That lasted 15 years. So at 40 he had to have it replaced again. And at 55 he died because they can only do it twice. So yes I suspect your surgeon wanted to push that as far into the future as possible. And every decade that passes is an opportunity for better treatment. > I would definitely prefer a less invasive procedure. Cross fingers. My friends brother is a young[1] cardiac surgeon that does really whack less invasive valve replacements. So this stuff is becoming available. [1] Gosh he's like in his only his late thirty's!
ludicast 8y ago
I'm not a doctor, but I have had valve-sparing aortic root replacement surgery done myself. think the reason the valve wasn't done was maybe 1) it's a big decision that the surgeon might not have felt comfortable making 2) there are safer valve replacements coming out (neither metal nor animal) that the FDA (in America) should eventually be approving. This caused one surgeon I'd spoken to to wisely delay the decision. Perhaps this article is describing the specific valve but it seemed to be metal. 3) I dont know how bad the regurgitation is on the valve, it might not have been time My 0.02 - see the absolute best surgeon you can get for this (in NYC his name is Takayama, don't know where you are). And depending on your root/valve dance, get a "gated ct-scan" rather then a run of the mill that most doctors recommend.
rscho 8y ago
From personal experience, I would say that one should generally be most thankful if the surgeon decided to not do something. Surgeons are the kind of people you generally need to restrain, not encourage. That said, I wish you the best.

tehlike 8y ago

Not sure what kind of insurance you have, but it might make sense to go to european countries for surgery.

Waterluvian 8y ago
How does this work if you're not a citizen or resident? Do you just pay cash?
- Brakenshire 8y ago
  I don’t know, but it may well make sense. Private treatment often is quite reasonable because the alternative is free. You can get a private self-referral MRI for instance for £200-400 in the UK. I haven’t heard of people coming from the US for treatment though, only about people from the UK going to Poland for dentistry, which apparently is cheap and good quality.
  - sverige 8y ago
    I ended up paying $8k out of pocket after my pretty good insurance paid out. I'm still astonished at the overall cost, though.
    - randerson 8y ago
      $160K sounds cheap to me if you're in the US. I had a heart ablation a few years back for an irregular heart beat. Like the procedure in the article its minimally invasive where they go in through the groin to zap some electricity at a few cells in the heart. I was conscious throughout and was back at work the next day. They billed $400K for that, and insurance negotiated it down to around ~$120K. For something as complex as what you've mentioned I'd have expected 7 figures.
      - tehlike 8y ago
        what did you end up paying?
        trevyn 8y ago
        Check the annual out-of-pocket maximum on your plan. It’s been capped at about $9k since Obamacare.
        randerson 8y ago
        Around $6K out of pocket.
  - tehlike 8y ago
    Dental might or might not make sense. Depends on how many surgeries you need usually. Implants here in the us costs ~5-6k. Implants where i came from is around 700$, but thing with implants is it needs a lot of time during recovery. Like 3 months after bonegraft etc. You can also det double insurance for cheap-ish and get it covered like that in the us for about 1/6th the price. For most non emergency surgeries (some heart surgeries are in that category, you can plan in advance), europe does make sense, especially insurance is not good. At some point i thought that could be oretty good way to balance out cost here.
    - yakshaving_jgt 8y ago
      I was advised to have a mole removed. The private clinic in London wanted £700 for the removal, and the initial consultation was £250. I flew to Poland instead, and had it removed at another private clinic for £80. All the staff in the top clinic in London are Polish anyway. Paying crazy amounts of money for medical procedures is just dumb. I cannot understand why Americans would pay tens or hundreds of thousands of dollars for surgery when they could fly to Europe, live the highlife, and also buy a house with the change.
      - surfmike 8y ago
        Because their insurance pays.
        raverbashing 8y ago
        Yeah, but the copay sounds it could be more expensive than doing it entirely abroad
        yakshaving_jgt 8y ago
        Please see this comment: https://news.ycombinator.com/item?id=19411068 https://news.ycombinator.com/item?id=19411068
- tehlike 8y ago
  People get eye surgeries and a pretty nice vacation for the same price in europe. Private you pay cash but it may even be cheaper than office visit there :)

jedberg 8y ago

> I wouldn't recommend it unless you absolutely need it. Ask your doctor if open heart surgery is right for you! (If your local cardiologist advertised on TV)

carbocation 8y ago
There was an ad for Impella (a form of mechanical circulatory support - basically advanced life support) during the Super Bowl 1-2 years back [1]. Which is basically even more absurd than advertising aortic valve replacement... 1 = https://www.ispot.tv/ad/ArZf/protected-pci-impella-25 https://www.ispot.tv/ad/ArZf/protected-pci-impella-25
sverige 8y ago
Well, I would say if you are given a choice of a procedure like the one described in the article or open heart surgery, choose the less invasive one. Although in my experience, they don't really consult with you about what you'd prefer so much as tell you what they are going to do.

robbiep 8y ago

Aortic valve disease is bi (Tri- for unileaflet but that usually presents at about 5-10 years) modal; trileaflets around 70-80, bileaflets at 40-50. There are quite good reasons to not replace, not least of which is that replacement valves are nowhere as good as your native, particularly if it’s still functioning. Ie if metallic, you need to be on anticoagulants for life which can be a massive pain and cause other complications. Metallic last for around 30 years. If porcine/bovine or possibly human, then they degrade much faster, 10-15 Years is the average. So, depending on your age, and depending on the repair your aorta needed, the surgeon likely decided that since you will have to undergo the knife at some point again anyway (either for graft replacement for the Dacron that now makes up the proximal part of your aorta) or eventually due to the valve, you might as well minimise the complexity by only doing one thing at a time. Plus, since we first started doing TAVIs (transcutaneous aortic valve repairs) they are getting better and better - see article - so possibly you wouldn’t need the on-pump surgery. Interesting that it costs you $160k; in the Australian public health system a valve is about $30k. Source: I did my honours thesis on cardiothoracic surgery (actually on mitral valve repair, but spent a lot of time in cardiothoracic theatres dealing with aortic valve-disease)

sverige 8y ago
Thank you for the very informative reply. Frankly I didn't have the energy to really quiz my very excellent surgeon on all the details. I was pretty low energy at the time. I was relatively young for the surgery, mid-50s, so I don't doubt that that was a factor. I'm not sure a valve will cost $160k. That was the cost of open heart surgery with a double bypass and aortic aneurysm repair. I ended up paying about $8k of that after the insurance did its part. I would definitely prefer a less invasive procedure. Recovery would probably take less than five months, for example.
- Gibbon1 8y ago
  > I was relatively young for the surgery, mid-50s, so I don't doubt that that was a factor. Ex-gf's ex husband needed a valve replaced at 25 due to damage from an infection. That lasted 15 years. So at 40 he had to have it replaced again. And at 55 he died because they can only do it twice. So yes I suspect your surgeon wanted to push that as far into the future as possible. And every decade that passes is an opportunity for better treatment. > I would definitely prefer a less invasive procedure. Cross fingers. My friends brother is a young[1] cardiac surgeon that does really whack less invasive valve replacements. So this stuff is becoming available. [1] Gosh he's like in his only his late thirty's!

ludicast 8y ago

I'm not a doctor, but I have had valve-sparing aortic root replacement surgery done myself. think the reason the valve wasn't done was maybe 1) it's a big decision that the surgeon might not have felt comfortable making 2) there are safer valve replacements coming out (neither metal nor animal) that the FDA (in America) should eventually be approving. This caused one surgeon I'd spoken to to wisely delay the decision. Perhaps this article is describing the specific valve but it seemed to be metal. 3) I dont know how bad the regurgitation is on the valve, it might not have been time My 0.02 - see the absolute best surgeon you can get for this (in NYC his name is Takayama, don't know where you are). And depending on your root/valve dance, get a "gated ct-scan" rather then a run of the mill that most doctors recommend.

rscho 8y ago

From personal experience, I would say that one should generally be most thankful if the surgeon decided to not do something. Surgeons are the kind of people you generally need to restrain, not encourage. That said, I wish you the best.