Aortic Reinforcement

[davidfortune]

Talking to my surgeon regarding reinforcement of the aortic annulus during aortic valve replacement. His approach is to use a strip of my own pericardium to reinforce the aortic annulus. I have heard of teflon/felt strips for reinforcement as well as pericardial strips. I'm going to follow up with him on this philosophy but thought I would pose the question to the research gurus out there.

What have you heard regarding pericardial reinforcement of the aortic annulus vs. teflon/felt reinforcement? Pros and cons as well as any links to research would be much appreciated.

 

[Susan BAV]

I don't know anything about this...

...Except, my coaractation of the aorta was repaired with a Dacron graft about 27 years ago. It was a large coaractation so they had to cut the narrowed piece out and sew the graft in. When I was being examined before the AVR, the doctors seemed all pleasantly surprised that the coaractation hadn't returned and the graft was still good. I don't know how that coaractation could return though, since it was cut out.

Perhaps none of that is relevant to your situation in any way. Or maybe the new Teflon is used similarly as the old Dacron?

The Dacron manufacturers should contact me to do a commercial for them and the longevity of their product!

 

[kodi]

Can't help but I really need a lesson now. Being a AVR recipient I guess I'm really not educated in a lot of things about the aorta. First what is the aortic annulus and pray tell where did a name like coaractation come from and what is it? I guess I could look these up in webmd but I know I'd get a better explanation here.

 

[Susan BAV]

Hi Kodi -

Coarctation of the aorta is a "congenital narrowing of the first artery out of the heart," as per a medical book I have. They're found with BAV patients -- but evidently not always, as most of the other BAVers on this site haven't mentioned that diagnosis. But I do believe that the reverse is true: that someone with a coarctation nearly always has a bicuspid. I've also read that about 75% of BAVers are men. But a lot of the BAVers on VR.COM are women so I can't explain that statistic.

Is that all about as clear as mud?

The scar for my coarctation is through my back. In many ways it was more painful than the sternum incision.

Now back to David's question regarding reinforcing the aortic annulus...

 

[Arlyss]

Hi David,

I too am aware of both of these methods being used. I understand my husband has teflon felt reinforcing the suture lines of his Dacron graft to aorta anastomoses. His last surgery (placing a tissue valve where a mechanical had been - highly complex for various reasons) involved the use of a pericardial patch to enlarge his aortic root/annulus enough to handle the new tissue valve. Whether or not there is any Teflon involved with that I did not ask.

Teflon felt is, I suspect, a sturdy material, but it also is a foreigner in the body. I would ask the surgeon how many of each he has done on patients like you, and try to determine if there is sufficient follow up time to indicate which has been more successful. "Patients like you" is not so easy to determine - how fragile/inelastic is your tissue compared to someone else? How can the surgeon tell? These are not easy to answer, but the surgeon can tell you what his experience has been and the basis for this thoughts.

Best wishes as you do your home work!

Arlyss

PS
What is the status of your aorta? What are plans for addressing that - now or in the future?

 

[davidfortune]

Arlyss,

Aorta normal in size and structure. Just recently confirmed with 64-slice CT scan. That is a relief since many BAVers have CMD and resultant dissection or aneursym.