Aortic root replacement gives better long term results with BAV

[markp66]

Hi again.

Last time I spoke to my surgeon he said he may need to replace my aortic root so he can get the biggest valve in possible which would give a lower mean gradient (although he said this was 50/50 as It isnt dilated in any way at present).

At first this worried me slightly as it seems to be an added complication. However, after doing my research it seems as if long term outcomes are substantially better when the aortic root is replaced. Does anyone know why this is? One potential reason I can think of is that people with BAV tend to develop aortic aneurysms and root replacement prevents part of this over the next 20-30 years. A lot of surgeons seem to be doing this at present which is very promising, especially if it means they can get a bigger valve in.

The Bentall procedure also seems to offer excellent long term results (for people who need it) although again, it seems like there is more to go wrong in the long term. However, I think I'm underestimating the materials, surgical techniques that are available today.

I've been told that the dacron grafts will last a lifetime and once replaced they need monitoring every year but in theory they can last hundreds of years!

Anyone else have anymore info on this?

 

[ElectLive]

Yes, according to my surgeon, grafts should theoretically never need replacing. Pioneered by the well-known Dr. DeBakey around 1955, they do have quite a track record. About 6 weeks after surgery, the grafts get covered over by the body's own tissue, and in the words of my surgeon: "the bloodstream doesn't even know there's anything artificial there." In my case, after going back and forth considering all the potential problems with either valve type, having a "fix it and forget it" aneurysm graft was music to my ears!

I'm going to let others advise on your specific question about the root, though. My graft was as simple as they get, isolated and did not impact either the root or arch. But root replacement with a mechanical valve was "Plan B" for me, and a potential option once he opened me up. The surgery was said to be longer and slightly higher risk, but not enough to discourage.

 

[markp66]

yeah this is what I heard but apparently it can be more better in the long run. I think it is a plan B for me. I don't have any aneurysm, it's just that he wanted a bigger valve. Currently I have a 23mm which is fine although with a root replacement I could potentially get a big valve which is always a good thing, especially causing a lower gradient and reduced risk of Pannus.