I had an aortic valve replacement surgery in 2017 and till now everything has been fine with regular INR home monitoring and checkups by the Cardiologist, but one thing has been noted that the ascending aorta's size has increased steadily over the years from 3.5cm in 2017 when I was operated to 4.3cm as of now. The surgeon says he will be monitoring it closely with CT till it reaches 5cm and then will only opt for any interventional surgery, and given my growth rate it looks fairly sure that another surgery is needed in the future. So I want to know whats the surgery is like and the success rate given I am already on blood thinner.
Is an aneurysm common for people with a bicuspid valve?
- Thread starter shah4u
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Hi.
Per your question:
The answer is yes. aneurysm is very common with bicuspid valve. I am also BAV. When I had my surgery in 2021, they took care of my aneurysm at the time so that I would not have another OHS down the road. I now have a Dacron graft which has replaced my aortic root and ascending aorta.
It is too bad that they did not fix your aneurysm when they replaced your valve, but in that your aneurysm was 3.5cm at the time of your valve surgery, the guidelines do not call for valve replacement at that size.
So, mine is a little different from yours, in that both were taken care of at the same time, like many other members here. There are also many members who are in your situation, getting valve surgery initially and then needing another operation years later for an aortic aneurysm.
Your aortic aneurysm will be similar to your valve surgery, in that it is an OHS operation. They will cut out the aneurysm and replace that segment of your aorta with a dacron graft. At that time, depending on the location of your aneurysm, and other factors, they may also replace your valve with a new valve.
At a competent high volume hospital, this surgery has a very high success rate, as is also the case for valve surgery.
There are several members here who have been in your situation- valve surgery, then another OHS for their aneurysm repair. I'm sure that some of them will give you input on their experience.
Per your question:
Is an aneurysm common for people with a bicuspid valve?
The answer is yes. aneurysm is very common with bicuspid valve. I am also BAV. When I had my surgery in 2021, they took care of my aneurysm at the time so that I would not have another OHS down the road. I now have a Dacron graft which has replaced my aortic root and ascending aorta.
It is too bad that they did not fix your aneurysm when they replaced your valve, but in that your aneurysm was 3.5cm at the time of your valve surgery, the guidelines do not call for valve replacement at that size.
So, mine is a little different from yours, in that both were taken care of at the same time, like many other members here. There are also many members who are in your situation, getting valve surgery initially and then needing another operation years later for an aortic aneurysm.
Your aortic aneurysm will be similar to your valve surgery, in that it is an OHS operation. They will cut out the aneurysm and replace that segment of your aorta with a dacron graft. At that time, depending on the location of your aneurysm, and other factors, they may also replace your valve with a new valve.
At a competent high volume hospital, this surgery has a very high success rate, as is also the case for valve surgery.
There are several members here who have been in your situation- valve surgery, then another OHS for their aneurysm repair. I'm sure that some of them will give you input on their experience.
Good. It is important to closely monitor aneurysms and to get the repair when it reaches a certain threshold.
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3cm to 3.5cm is the standard size that I had and the surgeon said the same thing when I asked why he didn't do both of them together that it was not needed at that time but now it is looking more likely that it will be needed in future, so monitoring the situation is the main thing I can think of. Also, I would like to know what's the efficacy of the DACRON graft since he mentioned the same graft to me for the aneurysm. The hospital I chose for the last surgery specializes in Cardiac surgery only with high volume and success that's why I chose it, also the doctor has prior working experience in Australia which makes it easier in my mind that he knows what he is doing. hoping for the best.
As others have said, yes it is common in people with BAV. I haven't had surgery yet, but will be getting a valve replacement and aneurysm repair at the same time. I have one appointment with a surgeon next week and am waiting on my doctors network to transfer my testing records to a second surgeon so I can set up that appointment. 
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See link below to learn more about Dacron grafts:
"Dacron is so completely compatible with the body that rejection and calcification do not occur. With the passage of time the body deposits its own tissue into the Dacron graft. Today's modern Dacron grafts are strong, flexible and collagen impregnated, making them impervious to blood. The durability of these grafts exceeds that of the human life span."
https://www.cedars-sinai.org/health...rgical removal of some,of the human life span.
Do they make valves out of this material? LOL
pellicle
Professional Dingbat, Guru and Merkintologist
Good morning
for what its worth I agree with everything said above, however I'm not sure if this is already well addressed so:
Until that point awareness and monitoring is (in the main) all that's needed.
being on blood thinners makes zero difference to the experience; simply because they will cease the blood thinners for the surgery and then re-establish you back on them after healing has proceeded the correct amount.
This is normal ... yes you're on blood thinners (a stupid name that I despise mot least because its wrong) for life but that is "general life" ... as with everything there are exceptions. When needed you simply go off them. Please read this (blog post of mine) in some detail, carefully and patiently for an example of why you may be taken off blood thinners. It is centered around my experience and this article:
I hope that you find that you don't need future surgery, but my advice is to live life normally and don't regard this as a Sword of Damocles but as simply you being aware that all sorts of stuff happens in life but you just happen to know about one of them now. I'd be surprised if you didn't know anyone who:
Best Wishes
for what its worth I agree with everything said above, however I'm not sure if this is already well addressed so:
this is the usual approach.
Until that point awareness and monitoring is (in the main) all that's needed.
its a probability ... there are situations where after the valve is replaced it does not require surgery in the future. Some people explain it as being "supported and strengthened by the scar tissue in the area" (remember scar tissue is not just something on the surface of your skin, its all the way down and encompasses everything that was cut or injured inside (even the very stitching holes). I'm not sure if this "explanation" (of the scar tissue support) is correct or not.
being on blood thinners makes zero difference to the experience; simply because they will cease the blood thinners for the surgery and then re-establish you back on them after healing has proceeded the correct amount.
This is normal ... yes you're on blood thinners (a stupid name that I despise mot least because its wrong) for life but that is "general life" ... as with everything there are exceptions. When needed you simply go off them. Please read this (blog post of mine) in some detail, carefully and patiently for an example of why you may be taken off blood thinners. It is centered around my experience and this article:
I hope that you find that you don't need future surgery, but my advice is to live life normally and don't regard this as a Sword of Damocles but as simply you being aware that all sorts of stuff happens in life but you just happen to know about one of them now. I'd be surprised if you didn't know anyone who:
- had a serious accident
- contracted cancer
- became diabetic
- ...
Best Wishes
Thanks for the reply and as usual a very detailed one, but what I would like to know how to proceed with the surgery if in case it is needed. Will the ACT be stopped before surgery and Is heparin needed post surgery or can a halt of ACT for few days not going to matter much? I need answer related to Acecunamarol management (which is my current ACT meds) for the duration of surgery.
pellicle
Professional Dingbat, Guru and Merkintologist
Good morning
Hope that helps
Best Wishes
welcome
I would expect the doctors and system around you knows this, but as you suggest its is generally like this
- you cease ACT
- you have the surgery
- you resume ACT
they may decide to give you a shot or two until your INR comes back up, but aince you are on Acenocoumarol they may just simply resume your dose ... but they may choose to administer a bolus (fancy name for a bigger dose first) to get you on track to your correct INR. However as Acenocoumarol has such a short half life (and therefore is faster to resume) they may not bother.
Hope that helps
Best Wishes
It's my understanding (not that I know much) that there's a genetic relationship between bicuspid valves and aortic weakness - incidence of aortic aneurysms is higher in people with bicuspid valves than it is in the general population.
The doctors probably look for this either at surgery or at pre-op (or both) and decide on the correct course of action.
The doctors probably look for this either at surgery or at pre-op (or both) and decide on the correct course of action.
pellicle
Professional Dingbat, Guru and Merkintologist
they go one better ... its called Pyrolytic Carbon and that's what mechanical valves are made out of (these last 20 or so years)
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ChuckM
Active member
I'm ChuckM, and I'm right there with Chuck C. A routine calcium score discovered my aneurysm, and the testing began. When it was all said and done, I'd had a 5.0cm aorta and a bicuspid aortic valve.. both replaced at the same time. Now I have a mechanical valve and a dacron ascending aortic root replacement.
Re: the genetic predisposition. My father died of an ruptured aortic aneurysm (why I was on the radar), my sister had a dissecting aneurysm repaired before she caught the bus, and my mom passed from a brain aneurysm. So yea, it sorta runs in the family. Twin brother and sister had imaging done, no symptoms at all, they're the lucky ones.
Even lacking a genetic link, I have none of the genetic markers that are quoted in the many papers on aortic aneurysm or bicuspid valve, the abnormal functioning causes the heart to work harder, creating a higher pressure which impacts the aorta, which seems to be my case. Or not, I'm not a doctor, just what I have deduced from reading.
And here I thought they would last a life time. Silly me.they go one better ... its called Pyrolytic Carbon and that's what mechanical valves are made out of (these last 20 or so years)
pellicle
Professional Dingbat, Guru and Merkintologist
I was being conservative.
See my recent post on that.
Will edit a link in shortly
https://www.valvereplacement.org/threads/anyone-had-3-valve-replacement-surgeries.887870/post-936521
If I understand nobog properly "no sign of wear after 3billion actuations"
Well how do they conclude whether the valve is tearing or deteriorating with passage of time.
pellicle
Professional Dingbat, Guru and Merkintologist
Mechanical valves don't tear. Bio valves do, and you can read of cases posted here.
There is "in vitro" testing done where a valve is connected up and operated at high speed for extended durations. They are periodically examined microscopically and measured. St Jude for instance has been testing theirs for decades now
Does a mechanical valve change comes into question during aneurysm surgery?
pellicle
Professional Dingbat, Guru and Merkintologist
pellicle
Professional Dingbat, Guru and Merkintologist
If there is no reason to disturb the valve they are left in place. However as I understand it, there are situations where it's faster (surgically) to repair the aneurysm by replacing the whole valve with one that has a factory pre attached aortic graft. Every minute of reduction of bypass pump time is important.
Eg
