Aortic valve replacement with thoracic aortic aneurysm

[ks1490]

Hi all,

Was told around eight months ago that I was not yet a candidate for surgery, but if my aortic valve regurgitation worsened, I should consider getting the valve replacement and possibly the aneurysm fixed as well.

Fast-forward to my most recent test results, and the regurgitation is now considered moderate. Mild aortic stenosis. The aneurysm might have grown slightly, but not very much if at all over that time.

Now the surgeon is telling me I am a candidate for surgery, and that if it’s going to feel like it’s hanging over my head we should just do it now. Otherwise, we can wait until next fall for another set of tests.

Generally speaking I feel pretty good. I do have some periods where I am very exhausted, but that’s been going on for a while and I’m not convinced it’s linked to my heart. I recently discovered that my hemoglobin a1c is borderline pre-diabetic, and that seems like the more reasonable explanation for the fatigue (increased average glucose levels).

I’m in my early 50’s and concerned about a lot of factors related to surgery.

How will things change after? Will I have any long-term restrictions? Will being somewhat overweight make the surgery more difficult, complications more substantial, etc.?

It’s hard to get time with the cardiologist and cardiothoracic surgeon, which makes it difficult to get questions like this answered as well.

Planning for pushing for more of their time, and some resources to better educate myself.

Anyway, that’s my intro, hoping to hear from other people who had those two surgeries done.

Your story is similar to mine, I was diagnosed with a leaky aortic valve and aortic aneurism quite by accident, my cardiologist and I watched it for 4 years until finally it was time to do the AVR. I was slightly overweight and was told it was always better to lose weight but it was never a factor in my preparation, the surgery itself or post-surgery. I am actually 13 years on now and my tissue valve is leaking, I will have to have a TAVR soon to replace it, but I will never regret the 13 symptom/worry-free years I've had as my kids grew and I have been in the prime of my life.

 

[ATHENS1964]

I have a question and I am posting it here so as not to open another thread.
When I had the surgery for bicuspid aortic valve replacement the aorta was 4.2 all the surgeons said they would decide at that time if a replacement was needed otherwise when it reaches 5.0.
The question is if it ever needs to be replaced, do they change the valve as well or just the aorta and leave the mechanical valve as it is?

 

[pellicle]

The surgeon said he would use a mechanical valve, I believe primarily because of my age and not wanting to need to repeat at some point in the future.

on this point I find it interesting to follow the psychology. It often is that people are on utter tail-spin shock about needing a surgery. Then while they knew nothing at all about heart anything (let alone surgery and long term issues) they suddenly get sold on the idea that "its just surgery" and start planning for having more (but they tell themselves they won't because: I'll be different, I'll get 20 years or more, My surgeon said ...) all because they are in dread of something else they don't know the first thing about: warfarin and AntiCoagulation Therapy.

I don't know where to start on this particular tangled thread of wool, but rather than assume that they don't know much and that even starting on the literature review will require months of full time and guided research (they don't usually have a research background) they latch onto exactly what they want to hear and believe that. They then do what they call research, but what every researcher will call "confirmation bias support" and only read what supports their hypothesis.

I guess its no skin off my nose, but don't let it be skin off your nose is what I'm saying.

I've had 3 surgeries because I started younger than most people here (ten years old), I can assure you I don't want a 4th. I can further assure you there are many surprises not in the product disclosure for having redo surgeries.

Its entirely your call. But you can't go back and choose again, so pick wisely what path you start.

 

[Lucker]

I have a question and I am posting it here so as not to open another thread.
When I had the surgery for bicuspid aortic valve replacement the aorta was 4.2 all the surgeons said they would decide at that time if a replacement was needed otherwise when it reaches 5.0.
The question is if it ever needs to be replaced, do they change the valve as well or just the aorta and leave the mechanical valve as it is?

I think it depends if the aortic root is involved in the aneurysm. The coronary arteries are connected to the root and need to be reattached to the new prosthetic aorta. This is the delicate step in a surgery, there's no need to risk and leave what few is left below the coronary arteries, since redoing the coronary arteries is significantly more difficult.
I think @Superman had his mechanical valve replaced with a valved conduit in treatment of his aneurysm.

 

[tom in MO]

I think it depends if the aortic root is involved in the aneurysm. The coronary arteries are connected to the root and need to be reattached to the new prosthetic aorta. This is the delicate step in a surgery, there's no need to risk and leave what few is left below the coronary arteries, since redoing the coronary arteries is significantly more difficult.
I think @Superman had his mechanical valve replaced with a valved conduit in treatment of his aneurysm.

I can't name anyone specific but do remember others have had mechanical valves replaced when they had to go back in to repair an aneurysm.

 

[TheGymGuy]

I was close to 5cm aneurysm and replacing aortic root with all that it entails was part of the surgery along with mechanical valve. I agree with others who encourage 1 surgery to get it all done together versus multiple ones. This was the advice I received before and I'm greatful for not having to do this second time.

 

[Gail in Ca]

I’m one that has had my mechanical valve replaced, due to bacterial endocarditis which damaged the tissue around the valve. I was given a valve in graft created by my team during my surgery. No plucking one off the shelf for me! This 3rd surgery was the first that involved my coronary arteries. My surgeon moved the valve up along the aorta. My original graft from my 1st surgery (aortic aneurysm w porcine aortic valve) was determined to be needing replacement due to the bacteria. One never knows what the future may hold…