- Joined
- Aug 30, 2022
- Messages
- 15
Hi All,
(Posting in two parts due to character-count limit)
I’ve been lurking for the past six months, ever since I (/my cardiologist) made the decision to have my aortic valve and root replaced.
I have found tons of useful information and lived experiences on this forum, but the most valuable posts for me was reading about other member’s surgery experiences and their road to recovery. These posts helped me prepare for my upcoming surgery and went some way to reducing the anxiety I felt as I approached surgery date.
I am now five and a half weeks post-op and I would like to give back to the community and share my story for others who are facing open heart surgery.
Background
In my early teens, my family GP identified a heart murmur and recommended that I begin seeing a cardiologist once I reach 18. I was diagnosed with a bicuspid aortic valve and aortic root aneurysm. And so began 20 years of yearly echos/MRIs/check-ups with various cardiologists as I moved around. My aneurism was relatively stable at 45-47mm (depending on the sonographer) but approaching the critical limit for operation, which for me was determined to be 50mm.
I always thought that the aneurism would be the trigger for surgery, but ultimately my BAV began to get more leaky with my ejection fraction dropping to 50-55% and my left ventricle beginning to enlarge.
18 months ago, my cardiologist began discussing the need for surgical intervention and that I should begin talking to surgeons to evaluate my options.
Valve Choice and Surgeon Selection
I spent long nights agonising over my choice for mechanical valve, bioprosthetic valve or Ross procedure. I read everything I could, trawled through various forums and watched countless YouTube videos. Ultimately I spoke to four surgeons on the east coast of Australia who I would consider to be experts in their field.
I have decided to share their names and my experience as I found it difficult finding “reviews” of medical practitioners.
Dr Emily Granger (St Vincent’s Private Hospital) – Dr Granger strongly recommended a bioprosthetic valve with subsequent TAVI procedures when the original valve wore out. St Vincent’s Hospital is known for predominantly using bioprosthetic valves and Dr Granger indicated that 80-90% of her valve replacement procedures were bio valves.
We discussed the effective duration of the bioprosthetic valves and the longevity of subsequent TAVI replacements. Ultimately, I couldn’t reconcile my expected (hopeful) life expectancy of 80+ years with a valve life of 10-15 years. Assuming a best case scenario of a valve lasting 15 years, I would be having surgery at 38, 53, 68 and 83 years of age. While valve in valve is viable I just don’t think you can stack 3+ valves inside each other and I felt I would need another OHS at some point down the track. This would be further complicated by a need to replace my aortic root.
Dr Peter Skillington (Melbourne Victoria) – Dr Skillington is one of the few cardiothoracic surgeons in Australia that carries out the Ross procedure.
Given my relatively young age (for a heart patient), the Ross procedure was attractive given the lack of ongoing anti-coagulation therapy. I had a good discussion with Dr Skillington and ultimately was advised that due to the size of my aortic root, I would not be a viable candidate for a Ross procedure – decision made for me
I met one of Dr Skillington’s patients (we just happen to live equidistant from the same pub). He is about my age and had a Ross procedure carried out – he spoke highly of Dr Skillington and his team.
Dr Paul Bannon (Royal Prince Alfred Hospital) - Dr Bannon said the valve choice is ultimately up to me and he would work with me to achieve the best outcome. Asked what his choice would be in my position, Dr Bannon indicated he would select a bioprosthetic valve, as this would allow him to continue surfing in remote parts of the world without risk of a serious bleed if dragged across a coral reef (I don’t have the funds or skills to surf remote reef breaks, so this was not a real consideration for me).
We did also discuss a David procedure (valve sparing aortic root replacement) with an attempt to remodel my bicuspid aortic valve back into a tricuspid version of its former self. After further review of CT/MIR scans, he decided that the likelihood of this being successful longer term was unlikely and further surgical intervention would be required. Dr Bannon indicated that he had performed ~15 valve remodels with a reoperation rate of 25% - I know this is a small data set, but I didn’t like the odds.
@Wiles Darkwinter gives a good account of his experience with Dr Bannon here:
My Story - Valve Sparing Aortic Root Replacement – David Procedure, 16 Feb 2021.
Dr Manu Mathur (North Shore Private) – Dr Mathur was recommended by my GP as Dr Mathur was the only surgeon who was prepared to operate on a patient with severely diseased valves and my GP indicated a favourable outcome.
Dr Mathur recommended I go with a mechanical valve option given my age and certainty for further surgical intervention if I selected a bioprosthetic valve. I found Dr Mathur to have a patient demeanour and he spent a significant amount of time discussing various options, risks and likely outcomes with me.
My takeaway from the various discussions I had with these surgeons is that there is no right/best option in my situation and ultimately it is my choice with consideration of:
- comfortability with further surgeries (bioprosthetic)
- ongoing anticoagulation (mechanical)
This is a somewhat daunting position to be in, as you are making a decision about your future life with somewhat limited information.
In the end, I decided on a mechanical valve with Dr Mathur and my surgery was scheduled for 11th November 2022.
(Posting in two parts due to character-count limit)
I’ve been lurking for the past six months, ever since I (/my cardiologist) made the decision to have my aortic valve and root replaced.
I have found tons of useful information and lived experiences on this forum, but the most valuable posts for me was reading about other member’s surgery experiences and their road to recovery. These posts helped me prepare for my upcoming surgery and went some way to reducing the anxiety I felt as I approached surgery date.
I am now five and a half weeks post-op and I would like to give back to the community and share my story for others who are facing open heart surgery.
Background
In my early teens, my family GP identified a heart murmur and recommended that I begin seeing a cardiologist once I reach 18. I was diagnosed with a bicuspid aortic valve and aortic root aneurysm. And so began 20 years of yearly echos/MRIs/check-ups with various cardiologists as I moved around. My aneurism was relatively stable at 45-47mm (depending on the sonographer) but approaching the critical limit for operation, which for me was determined to be 50mm.
I always thought that the aneurism would be the trigger for surgery, but ultimately my BAV began to get more leaky with my ejection fraction dropping to 50-55% and my left ventricle beginning to enlarge.
18 months ago, my cardiologist began discussing the need for surgical intervention and that I should begin talking to surgeons to evaluate my options.
Valve Choice and Surgeon Selection
I spent long nights agonising over my choice for mechanical valve, bioprosthetic valve or Ross procedure. I read everything I could, trawled through various forums and watched countless YouTube videos. Ultimately I spoke to four surgeons on the east coast of Australia who I would consider to be experts in their field.
I have decided to share their names and my experience as I found it difficult finding “reviews” of medical practitioners.
Dr Emily Granger (St Vincent’s Private Hospital) – Dr Granger strongly recommended a bioprosthetic valve with subsequent TAVI procedures when the original valve wore out. St Vincent’s Hospital is known for predominantly using bioprosthetic valves and Dr Granger indicated that 80-90% of her valve replacement procedures were bio valves.
We discussed the effective duration of the bioprosthetic valves and the longevity of subsequent TAVI replacements. Ultimately, I couldn’t reconcile my expected (hopeful) life expectancy of 80+ years with a valve life of 10-15 years. Assuming a best case scenario of a valve lasting 15 years, I would be having surgery at 38, 53, 68 and 83 years of age. While valve in valve is viable I just don’t think you can stack 3+ valves inside each other and I felt I would need another OHS at some point down the track. This would be further complicated by a need to replace my aortic root.
Dr Peter Skillington (Melbourne Victoria) – Dr Skillington is one of the few cardiothoracic surgeons in Australia that carries out the Ross procedure.
Given my relatively young age (for a heart patient), the Ross procedure was attractive given the lack of ongoing anti-coagulation therapy. I had a good discussion with Dr Skillington and ultimately was advised that due to the size of my aortic root, I would not be a viable candidate for a Ross procedure – decision made for me
I met one of Dr Skillington’s patients (we just happen to live equidistant from the same pub). He is about my age and had a Ross procedure carried out – he spoke highly of Dr Skillington and his team.
Dr Paul Bannon (Royal Prince Alfred Hospital) - Dr Bannon said the valve choice is ultimately up to me and he would work with me to achieve the best outcome. Asked what his choice would be in my position, Dr Bannon indicated he would select a bioprosthetic valve, as this would allow him to continue surfing in remote parts of the world without risk of a serious bleed if dragged across a coral reef (I don’t have the funds or skills to surf remote reef breaks, so this was not a real consideration for me).
We did also discuss a David procedure (valve sparing aortic root replacement) with an attempt to remodel my bicuspid aortic valve back into a tricuspid version of its former self. After further review of CT/MIR scans, he decided that the likelihood of this being successful longer term was unlikely and further surgical intervention would be required. Dr Bannon indicated that he had performed ~15 valve remodels with a reoperation rate of 25% - I know this is a small data set, but I didn’t like the odds.
@Wiles Darkwinter gives a good account of his experience with Dr Bannon here:
My Story - Valve Sparing Aortic Root Replacement – David Procedure, 16 Feb 2021.
Dr Manu Mathur (North Shore Private) – Dr Mathur was recommended by my GP as Dr Mathur was the only surgeon who was prepared to operate on a patient with severely diseased valves and my GP indicated a favourable outcome.
Dr Mathur recommended I go with a mechanical valve option given my age and certainty for further surgical intervention if I selected a bioprosthetic valve. I found Dr Mathur to have a patient demeanour and he spent a significant amount of time discussing various options, risks and likely outcomes with me.
My takeaway from the various discussions I had with these surgeons is that there is no right/best option in my situation and ultimately it is my choice with consideration of:
- comfortability with further surgeries (bioprosthetic)
- ongoing anticoagulation (mechanical)
This is a somewhat daunting position to be in, as you are making a decision about your future life with somewhat limited information.
In the end, I decided on a mechanical valve with Dr Mathur and my surgery was scheduled for 11th November 2022.