26M 5.1cm Aortic Root Aneurysm + Bicuspid Valve Surgery

[ncw3642]

FYI,
I had a valve sparing root and ascending aneurysm repair just over 11 years ago when I was 51. The valve was well functioning so I was given the valve sparing option and not knowing much about all of this I went with "If it ain't broke, don't fix it". My valve started leaking after the surgery and progressed from mild to moderate over the course of a year, but it stabilized and hasn't gotten worse since. Knowing what I know now I would probably lean mechanical but it's a difficult choice and both options are very good. You will almost certainly have better options available in the future.

Thank you for your input as well-- that is my concern but seeing as I have moderate regurgitation already and am currently asymptomatic (likely due to young age/no other cardiac/pulmonary issues) I am okay if it last 10+ years before getting the mechanical.

Also due to likely banking on new, advanced and longer lasting mechanical or other interventions when/if I need to reintervene in the future.

Are you having any symptoms since/things you can/cannot do as a result of your moderate regurgitation? Just trying to understand where your regret stems from- just the thought of having another redo-sternotomy in the future?

Thank you for sharing!

 

[pellicle]

Also due to likely banking on new, advanced and longer lasting mechanical or other interventions when/if I need to reintervene in the future.

never conjecture or dream (pray?) on relying on this ... its basically expecting Roy to save your arse ...

I've seen posts here (and I've been reading / participating here for over 10 years) where people have done just that and had a bio on the hope ... then had another bio ... on the hope ... and had another.

Its not wise and there are (perhaps hidden from your view) cumulative outcomes for which the piper will get paid eventually.

To me, as I've said before, at your age, planning for one bio and then a move to a mechanical is not a bad choice (for the reasons I mentioned). I was being 100% honest (I usually am).

But with mech already reaching the peak of realistic performance (recall that **** has a 59 year old technology valve still ticking) there will be no "hypersonic missle" level investment in technology to reach an already diminishing return curve on an already diminishing market (because the focus is on making more money out of TAVI).

Best Wishes

 

[Deidra]

never conjecture or dream (pray?) on relying on this ... its basically expecting Roy to save your arse ...

But with mech already reaching the peak of realistic performance (recall that **** has a 59 year old technology valve still ticking) there will be no "hypersonic missle" level investment in technology to reach an already diminishing return curve on an already diminishing market (because the focus is on making more money out of TAVI).

100% seconding this. You should make decisions based on what options are available now, not what options may or may not be available in the future. The newest mechanical valve (On-X) is basically a slightly "improved" version of the St. Jude, which was created in 1977.

The only "new technology" in terms of non-biological heart valves I've heard of is polymer-based heart valves like the Foldax Tria, which are still a very long ways off from being offered by surgeons as an option to the public at large.

 

[pellicle]

The only "new technology" in terms of non-biological heart valves I've heard of is polymer-based heart valves like the Foldax Tria,

there was talk of a tricuspid mechanical ...
https://www.frontiersin.org/articles/10.3389/fcvm.2023.1220633/full

I became aware of this back in March 2014 when the guy involved made a comment on my blog post:

I am a MD-Ph-D expert in this particular field since 1978. Your opinion is absolutely right. Marketing is everything and the public is not correctly informed. I could add many clinical and scientific studies that support what you say but are ignored by most cardiac surgeons and cardiologists.​

​

DL. Switzerland​

as you see we're still not there... its just over the horizon ... like Fusion energy being the solution to our energy needs ... just 10 years away (for the last 50)

 

[ncw3642]

Thank you so much for both of your posts.

You both pose a great point that I fully agree with. I am actually fully comfortable with the current technology of mechanical valves (w/ the On-X) and if the repair isn't viable, I have told my surgeon to use one- I think it's a great device.

My comment re: advancement somewhat stems from better understanding and practice/techniques for redo-sternotomies which is my primary concern. If I get the repair done, I know I will at one point (who knows how long) need to have another procedure to have a mechanical done (total procedures of 2) and then if something fails or I need (for instance) a CABG later, later in life, you are looking at 3 procedures (2-redos).

I just don't want adhesions to be that big of a factor in future operations- though I know they pose a risk and add complexity. My surgeon seems to think, in my case of replacing the repair with a mechanical one day, it won't be an issue worth worrying about, but that's where my concern is- not necessarily with repair vs. mech.

 

[pellicle]

I just don't want adhesions to be that big of a factor in future operations- though I know they pose a risk and add complexity

people by and large totally misunderstand scar tissue. Scar tissue is not just a keloid formation on your skin. The scar goes right to the heart and includes everything around the surgical wound. Of course that includes the pericardium and indeed the endocardium. Every place that is cut has scar tissue.

most people don't hunt and then butcher (say a deer or a moose) anymore and so have fully and utterly no clue what's inside a body.

That "slimy stuff" you see coating everything (should you butcher an animal or watch a youtube video about surgery) isn't just slime, its tissue. That tissue also gets scar tissue which is what leads to adhesions.

Think about it, what keeps all your organs from just falling to the bottom of the box? Diagrams are drawings, they are artists impressions; while accurate in some ways, are misleading in others.

what is it that allows the lungs to move around as you breath in and out ... they must move against the inside of the rib cage. If you did a rat dissection at school (we still did that) you'd have seen that (if you weren't being grossed out or flirting with the chicks).

There really is a lot in this that 99% of patients know nothing about and takes years to actually learn about (especially in this woke modern world).

I can't say how old I was when I was first involved with butchering a sheep (and we took home meat and organs to eat, skins to get tanned and used) at my uncles sheep property, but I was about 10 when I was first involved with doing the things.

:-D

 

[pellicle]

a read on the nature of scar tissue
https://www.ncbi.nlm.nih.gov/pmc/articles/PMC4737999/

Best Wishes

 

[minpin]

oops posted in the wrong thread

 

[AZ Don]

Are you having any symptoms since/things you can/cannot do as a result of your moderate regurgitation? Just trying to understand where your regret stems from- just the thought of having another redo-sternotomy in the future?

Thought I answered this but now I don't see it. No symptoms. I limit the weights I lift to a weight that I can lift at least 15 times. I workout, swim, bicycle and it's all good. I would lean mechanical now because I am less leery of warfarin than I was, and although my heart surgery was easier than my knee surgery, each repeat surgery can be a little more complicated due to scar tissue. TAVR may be changing that but I haven't seen long term data on it yet.

 

[SatoriFound]

a read on the nature of scar tissue
https://www.ncbi.nlm.nih.gov/pmc/articles/PMC4737999/

Best Wishes

But, what about NON heart scar tissue. I had lots of stuff excised and disected inside my rib cage, not sure of the actual extent as surgeries change quickly, but my surgery was a Ravitch, before they modified it. Lots of cutting...

 

[pellicle]

But, what about NON heart scar tissue

Read my post above that one.

 

[SatoriFound]

Read my post above that one.

I did read it. It just doesn't answer my question. I will ask the doctor when I finally get to talk to him, someday... LOL

 

[pellicle]

It just doesn't answer my question.

What exactly was your question

 

[pellicle]

Lots of cutting...

if this was the question, then that is just scar tissue as:

Every place that is cut has scar tissue.

 

[SatoriFound]

if this was the question, then that is just scar tissue as:

Oh, OK. LOL I wish I had access to my childhood medical records. I want to know exactly what was told to my parents about my condition. I will be asking my dad a ton of questions on our family vacation this week.

 

[carolinemc]

Oh, OK. LOL I wish I had access to my childhood medical records. I want to know exactly what was told to my parents about my condition. I will be asking my dad a ton of questions on our family vacation this week.

And be sure to have plenty of paper and pencils, you might be writing a huge novel. LOL!

 

[SatoriFound]

if this was the question, then that is just scar tissue as:

Yes that's about it. Thank you.