Aortic Aneurysms

[Jmprosser.lab]

Hi everyone,

Quick question. I have mild to mod BAV which has been stable for many years. I also have a upper normal aortic root (3.6 to 3.8 depending on the year/test), and upper normal mid ascending aorta(3.7 to 3.9 depending on year/test). None of them have grown since they were found years ago.

Is it common to have two parts of the aorta enlarged? My cardios seem very not worried, but just want to confirm this doesn’t complicate my surgery prognosis significantly? Also, my cardio at UCLA and Cleveland Clinic both think it is still possible/are confident that both my bav an aneurysm(s) can be replaced at the same time with a minimally invasive procedure. Just curious if anyone has had that surgery to replace both? Is it just the very high volume/advanced treatment centers that are doing those more advanced procedures?

 

[John K]

Had surgery to deal with a ascending aneurysm that ended up also resulted in aortic valve replacement in January. Was done at Nebraska Med Center in Omaha, not sure if they are considered high volume of not. I have been told that since I had the one aneurysm that others could develop.

 

[bizinsider]

Six months ago I had my thought-to-be BAV (turned out to be unicuspid) valve, root, and lower AA replaced(via a bio-Bentall procedure) at the Cleveland Clinic. I also had CABGx1. I asked my surgeon, Lars Svensson, if it could be done minimally. He said it could but he had far better and more reliable results with a full zipper. I didn't argue - I just wanted it done right. All studies seem to show that after a few weeks – other than the scar – the pain is about the same. (And, frankly, I had little pain in my chest.) I have no idea how they do what you had and different surgeons take different approaches. You're doing right getting multiple opinions. I would definitely stick with high-volume centers and surgeons who personally have experience with what you believe you will need to have done. I flew from San Diego to Cleveland via LAX (when there was a nonstop, pre-Covid) and very glad I did. G'luck.

 

[DanielB]

Since first checked in 2010 , my Aortic Root has been stable around 4.1 and my ascending Aorta at 4.3. They did not make may difference in my having my Aortic Valve replaced in 2010. My surgery was open heart as my surgeon when asked, told me the best method was to do open heart, but I know techniques in less invasive methods have come along since then.
I had my surgery in San Diego where I live at a smaller hospital with a good cardiac unit. This year I have had a lot of experience with UCLA treating a very rare bone cancer and, though I have only had some contact with the cardio department, I can say I have been very impressed by the quality of the care at their hospitals. A lot of top surgeons and specialists there. Asking questions as you are is a good thing and don't be shy about second opinions.
Good luck on your treatments ahead.

 

[AZ Don]

I thought mid 3's is pretty normal for the aorta, 4 - 4.5 dilated, and larger is an aneurysm. If your aorta is less than 4 I don't know why anyone would be talking about surgery for your aorta. I am not aware of any options for minimally invasive surgery to repair an aneurysm of the root or ascending aorta.

There are centers that offer minimally invasive valve replacement operations. I'm not sure how wide spread this is yet. I would look for a high volume/advanced center for any heart surgery, and expect most of these would have experience with minimally invasive options. While minimally invasive surgery shortens the recovery time, it can be more challenging technically, as open heart surgery allows easier access for the surgeon. That said, I expect UCLA and especially Cleveland Clinic are well experienced with the minimally invasive options.

I don't think it is uncommon to have two parts of the aorta dilated. I had aneurysms of the root and ascending aorta. It is also not uncommon to replace the aortic valve while replacing the aortic root and the ascending aorta. In fact I think that they often have a valve attached to the aortic graft and put the whole thing at once. In my case, my BAV was well functioning so I had a valve sparing aneurysm repair. I think this surgery is less common and perhaps more difficult.

 

[Jmprosser.lab]

Six months ago I had my thought-to-be BAV (turned out to be unicuspid) valve, root, and lower AA replaced(via a bio-Bentall procedure) at the Cleveland Clinic. I also had CABGx1. I asked my surgeon, Lars Svensson, if it could be done minimally. He said it could but he had far better and more reliable results with a full zipper. I didn't argue - I just wanted it done right. All studies seem to show that after a few weeks – other than the scar – the pain is about the same. (And, frankly, I had little pain in my chest.) I have no idea how they do what you had and different surgeons take different approaches. You're doing right getting multiple opinions. I would definitely stick with high-volume centers and surgeons who personally have experience with what you believe you will need to have done. I flew from San Diego to Cleveland via LAX (when there was a nonstop, pre-Covid) and very glad I did. G'luck.

Thanks for this! Did they share their stars with you? Also did they say anything about long term prognosis post surgery/ life expectancy? Glad you enjoyed your time at Cleveland Clinic

 

[bizinsider]

Thanks for this! Did they share their stars with you? Also did they say anything about long term prognosis post surgery/ life expectancy? Glad you enjoyed your time at Cleveland Clinic

Hi JM, not sure what you mean by "stars." The only thing they said is that the valve could last anywhere from 8-15 years, but I think we all know the reality of that - could go longer or shorter. I've read studies on life expectancy and the studies show it'll be a normal life – not that anybody knows what else will crop up. I'm just trying to make sure I ambitiously exercise and keep my heart muscle as strong as possible so I'm good shape for the next replacement, whenever that will be. I believe that being in good physical shape going into surgery made a huge difference in the speed and quality of my recovery. I'm taking the view that I'll live until I don't!

 

[carolinemc]

Hi everyone,

Quick question. I have mild to mod BAV which has been stable for many years. I also have a upper normal aortic root (3.6 to 3.8 depending on the year/test), and upper normal mid ascending aorta(3.7 to 3.9 depending on year/test). None of them have grown since they were found years ago.

Is it common to have two parts of the aorta enlarged? My cardios seem very not worried, but just want to confirm this doesn’t complicate my surgery prognosis significantly? Also, my cardio at UCLA and Cleveland Clinic both think it is still possible/are confident that both my bav an aneurysm(s) can be replaced at the same time with a minimally invasive procedure. Just curious if anyone has had that surgery to replace both? Is it just the very high volume/advanced treatment centers that are doing those more advanced procedures?

 

[ATHENS1964]

Οbviously talking about the mini bentall process ,the dimensions, however, are far enough apart that it is an indication for surgery.