Aneurysms - Dacron durability?

[jiniani]

Now that I know I need ascending aorta replaced with Dacron... What is the durability of Dacron? Is there any life style changes because of this? I know this surgery carries little bit more risk than "Plain vanilla valve replacement D ). What should I expect with "new" aortic root, "new" aortic arch, "new" ascending aorta? If I need another surgery in future... what are the risk?

 

[PJmomrunner]

Hi Jiniani! I guess we're to be members of the same "club". As I understand it, our Dacron aorta's will be in fine shape long after our need for them passes--they last forever. I actually saw one at a traveling plastination exhibit in Chicago last year and it looked like a Dacron tube! It's pretty cool too that after it's implanted our bodies assimilate it by depositing tissue in it. The operation does come with more risk than an AVR alone because we are placed under hypothermic circulatory arrest while the aorta is replaced. They do this so they can stop the circulation to the ascending aorta without the risk of damaging it by clamping. They can do that safely for about 40 minutes, so in my book that's a great reason for choosing a highly experienced surgeon. (An aortic specialist, actually.)

As for restrictions, I have been told that my current lifting/pushing/pulling restrictions will remain in place for life, but my cardio workout restrictions will be lifted. It seems some get different advice on that--I'm sure they'll chime in.

If you need another surgery it is not likely it will be because of the Dacron conduit, but rather because of the valve. If you choose a tissue valve, at your age, you can plan on at least one more replacement as the current state-of-the-art valves MAY last 25 years, but that remains to be seen and probably isn't a good bet at your age. 10 to 15 years is what my surgeon said I could expect out of a tissue valve at my age. Younger people's body chemistry causes them to go through them more quickly than the older folks. If you choose mechanical you stand a very good (excellent, perhaps) chance of never needing to replace it. (Valve choice is VERY personal, since our lives depend upon it, and I have attempted to state the odds of resurgery generally and fairly.) The risks involved in a second surgery are, statistically, about the same as the risks of a first. The risks involved in a third surgery are considerably higher and any subsequent surgery carries very high risk.

I hope that helps. Good luck.

 

[temp69]

Nip and Tuck

Nip and Tuck

I have an aortic aneurisym (sp) at 5.1 cm along with a bicuspid aortic valve with stenosis now at .9cm. I met with Dr. Laks at UCLA and he said he would shorten my aorta, attach it to the new valve (On-X) and then wrap the aorta in dacron, I think. Am nail biting like crazy, just want to get the process behind me.

I don't have symptoms, but have been advised that it's best to have the surgery right before you have symptoms, so you don't have permanent damage.

anyway, all I've heard and read is that the surgery is very, very safe and successful these days. My fingers are crossed for me, and you, and others waiting to have it done.

temp69

 

[musician2k]

hyperthermic arrest?

hyperthermic arrest?

Can I join this club too? Wish I didn't qualify but I do. 5cm aortic dilation, here, and .8 (or .6, depending on which test you choose to agree with) functional area on my AV. I'm currently trying to get surgery scheduled, and will hopefully be getting this taken care of soon. I'm relieved to hear it's more common than I thought (at first was pretty freaked out) but while it won't be a breeze, it's do-able. The part about them putting us in circulatory arrest, hyperthermic or not, IS freaking me out, however. What does this mean? Does this lengthen recovery time?

 

[Ross]

The dacron is a very durable synthetic material that should last longer than you do. When archaologists from a future civilization exhume your grave, a little piece of dacron will be left lying in your coffin, and all the tissues you were born with will have turned to dust.

Precisely!

How will it affect future surgeries? It really shouldn't. Just find a piece to fit an walla.

 

[MrP]

Here are a few things to think about...not intended to scare you but simply to share and hopefully give you better insight. Hypothermia circulatory arrest will mean more time on the pump since it takes time to cool your blood (like a couple of hours) before turning off the pump in order to resect your aneuyrsm without clamping, and then more time to rewarm your blood and air out all the debris, etc after resection. You should be aware of possible neurological damage and increased risks for stroke for this surgery. I met another patient who also had this surgery and was paralyzed on one side due to a stroke during this surgery. Definitely get the most experienced thoracic surgeon you can find and one who has performed thousands of thoracic surgeries...one with an excellent reputation and track record. Post surgery you'll also be at increased risk of stroke as a result of more prosthetic material than AVR alone. Be prepared for depression following surgery as a result of OHS and in particular this surgery...for months on and off regardless of how well balanced you are emotionally prior to surgery. Immediately after surgery and in recovery I also experienced neck pain and soreness from the Dacron graft attached in the transverse part of the aortic arch and just prior to the first artery to the head. Healing will take longer than AVR recovery. About 1 1/2 yr. post surgery I started experiencing eye spasms in the left eye and eyelid that seem to modulate with each beat of my heart. I'm not sure if this is due to to something completely unrelated or is a result of a positional change to my carotid artery or another aneurysm in my head that affects an adjacent nerve....more appointments ahead to find out. Risks associated with future surgeries? At your age, you've probably been advised to get a mechanical aortic valve to minimize the probability of another surgery and to avoid replacement of your valve again. With a connective tissue disease of the aorta, there's also some risk of future aneurysms elsewhere on your aorta. Avoid heavy lifting and manage your blood pressure after surgery to minimize these risks. Enjoying my children and some day grandchildren. And now it is much easier to truly appreciate what's really important in life and not get sidetracked by all that's not important. Be advised that if you're going through a divorce at the same time as this surgery, life can be especially difficult. I'm also able to run greater distances and now run 2 miles daily without getting out of breath...this still amazes me. You need less sleep than you ever thought possible. The positives far outweigh the negatives...."I AM ALIVE!"

 

[TomS]

Based on all the posts about total circulatory arrest, I'd say pick your surgeon wisely. I was given as low as 95% odds by some of the best surgeons in the country, because they did a lot of good things, but did not specialize in aortic root and valve replacement (the both together). I spoke with many of them from NY to the Cleveland Clinic and everyone in between.
When I found Len Girardi at Columbia in NYC he told me that he did 200 a year with a 0.7% mortality rate. He did mine last August. He also did use a clamp, and did not do a total circulatory arrest. He told me going in that he would only do that if he couldn't clamp it in a way that he was comfortable. Therefore, total surgery was only three or four hours.
Tom

 

[Troy]

I had AVR May 11, 2006. They were not aware that I had an aortic anuerysm until they opened me up. (Which I still don't understand.) I had chosen the ON-X valve, however, the doctor and my family opted to repair the anuerysm with a sleve and they used a Casrbomedics valve because it had a sleve. The surgery was 7 hours long and I am doing well now. Unsure of the details of how it was repaired, but they did a good job.

 

[JeanneImp]

They did not find Matt's aneurysm until the cath last week. It never showed up on echo's or x-rays. Something else showed up that was unidentifiable....
Waiting for opinions.

 

[xbxb]

Dacron will outlast you

Dacron will outlast you

At age 42 - last August I had my own Bi-cuspid Aortic Valve repaired - then was placed in my new Dacron Aortic Root.
Had to make a decision before surgery in case they could not repair my own valve. In the words of my surgeon, (hopefully) I will never need another surgery, but if I do it will be "due to the valve and NOT the Dacron".
I can hear my repaired valve, DR's say due to turbulance created by Dacron Repair - it is fairly loud - most nights I listen to my Ipod as I fall asleep - but this is a small concession considering I am back to playing basketball and working out at least 4-5 times a week.
I was told the risk factor is 2% 1st surgery and 5% Second surgery due to scar tissue on the high side - some Dr's quoted a little lower. Also not a lot of recent data on a repaired Bicuspid valve because most are replaced. As many people say on this board experience counts! The Dr. I chose had done only 14-15 of my specific surgey, but has been doing difficult Aorta and Valve replacement surgeries for many, many, years. Personally I recognized quickly it is the Aorta specialist that counts most. Many, many Dr's are experienced valve replacers - but their are far less Aorta surgeries per year, and thus far fewer specialists that have the experience repairing Aortas.
FYI - 50% of the Bicuspid valves will have a dilated Aorta. The thinking now is that a Bicuspid valve is a disease of the valve AND aorta tissue.

 

[aussigal]

I am another member of this elite club...

I got my Dacron Aorta and StJudes' valve in April 2006 to replace my BAV and 5.0cm aneurysm in the ascending aorta.

At almost 8 weeks post OP I am practically back to normal.

When you have surgery you can ask that your surgeon have a look around and assess your other "bits" while he's in there.(thats what I did )

My surgeon told me my Dacron Aorta and new valve will outlast me and that if/when my other aneurysms grow to operable size they will probably be fixed via a catheter with a device like a stent ( he thinks this will be 20 yrs away)...this pleases me greatly as I had a rather hard time with my OHS and dont fancy going back in for another big surgery to fix the descending aorta.

One of he problems with a second surgery is the scar-tissue that they have to work around not the fact you have a new valve and aorta.


I too am to keep my blood pressure under control and live a healthy life, both of which will keep me going strong for a very long time.

The only restriction I have come across so-far was the recovery time and that it didnt happen quickly enough for me...other than that I have no intention of ever going sky-diving or bungee-jumping so I doubt if I will notice any restrictions. . The warfarin is even a breeze, its just a little pill to take and you soon get over being scared of the blood-tests...they only take a few minutes anyway.

I can honestly say that once I was educated about all this I didnt have any worries and couldnt wait to get my OP behind me. Even being under "ice" didnt worry me as much as I thought it would, the nurse gave me drugs to put me to sleep the night before my OP.

Keep asking questions...thats what wer'e here for...

 

[HarleyM]

I have a 25mm ON-X valve and 5" of dacron tube that replaced the aortic root. I have the neck pain mentioned above. At only 7 weeks post op I'm doing very well. Back to normal and feel better than before surg.

 

[Ross]

If you want to worry about something, worry about what will happen if you DON'T have your own rotten (literally) ascending aortic tissue cut out and replaced with some nice dacron. I've never heard of anyone having their dacron rupture, but plenty of people die every year from ruptured aortic aneurysms.

Umm no thanks, been there and done that already. Wouldn't wish it on my worst enemy.

 

[jax3172]

Neck Pain???

Neck Pain???

So I am a member of this club also: AV replaced with tissue valve and ascending aorta replaced by dacron tube. A few of you mentioned neck pain. I am blown away by this. I have had neck pain since surgery. I can sense that the pain is in my neck plumbing (veins and/or arteries). No doctor has told me to expect this as a result of the dacron graft. I even got a bunch of tests done to check my neck plumbing. PLEASE tell me more about the relationship between the neck pain and the ascending aorta replacement???? Is it common? Expected? Normal? What is it from??? Answers appreciated.

 

[BDMc]

Dacron Aorta

Dacron Aorta

I had my surgery 10/26/84 and the Dacron seems to be doing a fine job. Had an echo last week, and it appears the valve is still doing very well too! I did suffer some with "pump head", and my memory has never been as good as it was before OHS. On the other hand, as dim as my little gray cells are, I find I measure up pretty well against most of those I come in contact with. I don't play "contact sports", (except for a little soccer with the kids) or hang glide, rock climb, or sky dive. I am active in my job, and enjoy sailing my Hobie Cat,(often a very athaletic activity) Kayaking, and walking. In the past I've also done a fair amount of recreational cycling, downhill skiing, and some ice skating. As one of my best friends so often says, "Life is good!" I hope this is reassuring to you. Welcome to the club, and welcome to this wonderful place. I wish it was around when I had my surgery! All the best, Brian

 

[RCB]

Whew Brian...

Whew Brian...

I find I measure up pretty well against most of those I come in contact with. I don't play "contact sports", (except for a little soccer with the kids) or hang glide, rock climb, or sky dive. I am active in my job, and enjoy sailing my Hobie Cat,(often a very athaletic activity) Kayaking, and walking. In the past I've also done a fair amount of recreational cycling, downhill skiing, and some ice skating.

I had to take a nap after reading this list just to get my energy back- your a
lucky man!

 

[Ross]

So I am a member of this club also: AV replaced with tissue valve and ascending aorta replaced by dacron tube. A few of you mentioned neck pain. I am blown away by this. I have had neck pain since surgery. I can sense that the pain is in my neck plumbing (veins and/or arteries). No doctor has told me to expect this as a result of the dacron graft. I even got a bunch of tests done to check my neck plumbing. PLEASE tell me more about the relationship between the neck pain and the ascending aorta replacement???? Is it common? Expected? Normal? What is it from??? Answers appreciated.

I honestly don't think it has a thing to do with the dacron. I'm more inclined to think pinched nerves from surgery. I have a couple of pieces of dacron now and no neck pain.

 

[MrP]

neck pain

neck pain

With respect to neck pain/soreness after AVR and aneurysm resection, my neck pain was constant in recovery during the hospital stay and for several weeks afterward. This was unlike pain in my shoulders resulting from nerve damage and laying on my back for a long time during surgery. This nerve damage pain was intermittent, unlike the neck pain/soreness. Now over 2 years later, I still experience the neck pain every now and then after positional changes, mainly after doing situp exercises. In my case, my ascending aneurysm extended into the transverse part of my aortic arch, and in addition to a composite valve/Dacron graft, my surgeon extended the Dacron graft by attaching more to just before the first artery to my brain. I think my soreness in the neck was initially due to swelling associated with attaching the Dacron graft in the arch and possible repositioning of the inominate or carotid artery. It would be interesting to hear from others who have experienced this neck pain.

 

[jax3172]

Neck pain - MrP

Neck pain - MrP

MrP:

As I stated in a previous post, since surgery in 7/05 I have had mild discomfort in my neck - both sides. It is definitely vascular. My pulse also seems very strong in my neck and collar bone area. It annoyed me to the point that I had it checked out and they said they didn't see anything. Until you, I've never heard anyone relate it to the aorta repair. Mine goes all the way to and under the arch. It's now on that list of cardiovascular stuff that I ignore (like the rogue chest pains that I know are not "pinched nerves" from surgery). I have lots wrong post-op that I never had before but I'm learning to live with (like mild PH). I had been one of those that thought they'd be superman after surgery. It didn't work out that way for me. Except for the life saving surgery (and that's a big "except"), I feel worse after surgery, not better. Things are definitely not right and no doctor I've seen seems to care very much. They like to fix obvious stuff (like clogged arteries) and are troubled when asked to do real medical detective work. I'd be shocked if a doctor said this is why you feel neck pain, post-op, and this is what we can do to fix it (or it can't be fixed and you have to live with it). I read posts of guys running 2 miles without getting out of breath and I'm really glad for them but extremely jealous. But we all live on as best we can.

 

[MrP]

jax3172,
You're coming up on your first anniversary since surgery, and although everyone is different, you may start feeling "more normal" soon...this also means better memory and emotional control. I felt better at 1 year and much better at 2 years, and my running distance was gradually increased to 2 miles just a few months ago (I think this took longer for psychological reasons...I'm more determined now and find it easier to let go of old running habits).
With respect to neck pain, you mention you had this checked out. How? CT angiogram? Did they look for aneurysms on your carotid artery? Any chance the neck pain may be associated with your carotid artery "touching" nerves in your neck? What was this test like? What side is your neck pain on? Have you had any muscle spasms or twitching in one eye or eyelid? Does your neck pain get worse with postional changes like situps or neck moves? Sorry in advance for so many questions. Hope you get better soon.