Aortic Valve Surgery on the Road Ahead

[cldlhd]

For those who chose repair, what do the tell you is the likelihood that it will last (and how long) or need additional surgery down the road? Having gone through one OHS I can tell you that for me, I would not willingly do it again. So I have to think if I was forced to make that choice I would opt for replacement rather than repair. But thats only because I already know what its like to experience the surgery and recovery... whereas most in that scenario do not

First of all I'm on an expert but having had mine repaired by a guy who was considered an expert in the field of aortic valve repair, Dr Joseph Bavaria, I asked him a lot of things and picked his brain pretty good. Plus like most people these days I did a lot of my own research. I guess the best answer is it's hard to say and depends on a lot of things mostly the condition of the valve and what kind of valve it is. I think there's another threat out of here that goes into detail on it but There are what they call Sievers 0 ,1,2 or unicuspid. And even within those categories there's differences with geometry, the positioning of the coronary arteries, the condition of the leaflets, calcification etc. I was 80% set on getting a mechanical because the cause for my surgery was an aneurysm and I wanted to have a one and done. However since I had no calcification and I had a pretty rare sievers 0 which means I have to equal size leaflets and my gradients were great and I only had trace leakage ( which somehow in my latest echo shows up as no leakage, which I'm okay with) I ended up getting my aneurysm replaced and the valve repaired. I specifically told him I didn't want him to do this if he wanted to as a challenge for himself and I only wanted a repair if once he was in there doing it he thought it might last a lifetime. I was 45 at the time of the surgery so I made it clear to him that I considered a lifetime at least another 40 years. Apparently he came out of the surgery very excited and animated and told my mom and wife that I would never need it operated on again. Now obviously I don't take that as a certainty in any way and I worry about the future surgery but having done my research and asked the questions and made clear how I felt I ended up going with the expert.
I think it's important that for whoever is contemplating repair they have to ask themselves what they want out of it.

 

[Deepak khanka]

I fully agree with hectic . I had David’s procedure and it failed. Plus with bicuspic valve there is a possibility it Aortic aneurysm . Which I had . What are the completion of David’s procedure . I had injury to my coronary artery which led to a CABG . I would have always opt for entire change along and lived with warfarin . I am due to have one more surgery . It’s a bit complicated having a CABG. But my friend change the valve all repairs are short lived

 

[Deepak khanka]

Possibility of * Complication *

 

[cldlhd]

I fully agree with hectic . I had David’s procedure and it failed. Plus with bicuspic valve there is a possibility it Aortic aneurysm . Which I had . What are the completion of David’s procedure . I had injury to my coronary artery which led to a CABG . I would have always opt for entire change along and lived with warfarin . I am due to have one more surgery . It’s a bit complicated having a CABG. But my friend change the valve all repairs are short lived

Well I'm biased as I had a repair and I think I went through this earlier regarding your post and I'm not trying to be negative but that is your experience not necessarily all of them. When I had my BAV repaired 6 years ago I showed as having trace leakage and no calcification at my most recent echo a year and a half ago it showed no leakage and no calcification. Again my surgery My surgery wasn't for my valve primarily it was to replace my aneurysm The valve was just tuned up while they were in there. Also I don't know if it's this threat or not but there has been some extensive information put out here regarding the fact that BAVs vary a whole hell of a lot from one to a next.

 

[Deepak khanka]

Hi I am very pleased to know that the repair went well for you . My surgeon told me prior to the David’s procedure that if the procedure was successful I will need one more surgery in 15 -20 yrs that will be for the valve . I was ok with this . As It could be a TAVI. Moreover there would also be advancement in the technology . I took few other advices in London prior to the procedure and they proposed full change. But I opted David’s . Any ways I was expressing my experience and it’s not necessary others may undergo what I went through

 

[vp69]

Hi I am very pleased to know that the repair went well for you . My surgeon told me prior to the David’s procedure that if the procedure was successful I will need one more surgery in 15 -20 yrs that will be for the valve . I was ok with this . As It could be a TAVI. Moreover there would also be advancement in the technology . I took few other advices in London prior to the procedure and they proposed full change. But I opted David’s . Any ways I was expressing my experience and it’s not necessary others may undergo what I went through

Thank you Deepak for sharing, if you don't mind who was your surgeon? If you don't want to post publicly but are willing to share over PM or not at all that's fine too

 

[cldlhd]

Hi I am very pleased to know that the repair went well for you . My surgeon told me prior to the David’s procedure that if the procedure was successful I will need one more surgery in 15 -20 yrs that will be for the valve . I was ok with this . As It could be a TAVI. Moreover there would also be advancement in the technology . I took few other advices in London prior to the procedure and they proposed full change. But I opted David’s . Any ways I was expressing my experience and it’s not necessary others may undergo what I went through

That's all I was getting at, it was your experience You were relating but you were expressing it as all repairs will be short lived. I'm sorry your surgery went that way. So you were told you would get 15 to 20 years if the repair was successful? I was told that if the repair went well I might not ever need another surgery because, according to the surgeon, there are plenty of BAVs that last a full lifetime and never require surgery. As I said in my post my valve didn't require surgery either my aneurysm did. I hope when you go in for your next surgery it will be your final one and it will last a lifetime and everything goes well.

 

[Deepak khanka]

Thank you Deepak for sharing, if you don't mind who was your surgeon? If you don't want to post publicly but are willing to share over PM or not at all that's fine too

I don’t mind sharing with you separately. You based in UK.

 

[Wiles Darkwinter]

What are the potential complications post surgery of having your root replaced with a Dacron tube long term? I can’t find any in my research but say if the repair is totally durable can replacing the aortic root cause future problems? I know the surgery itself becomes more complex but curious about any known long term issues with getting rid of your native aortic root. Any advice or opinions or experience on this would be helpful. Thanks!

The Dacron will outlive you. Always risk of complications post surgery, but there is evidence to suggest if you're alive and well after the postoperative period, your will dacron will endothelialize and become just as strong (or stronger) as a normal functioning aorta. Tough one given that your aorta isn't at the recommended size for replacement.

 

[Wiles Darkwinter]

That's all I was getting at, it was your experience You were relating but you were expressing it as all repairs will be short lived. I'm sorry your surgery went that way. So you were told you would get 15 to 20 years if the repair was successful? I was told that if the repair went well I might not ever need another surgery because, according to the surgeon, there are plenty of BAVs that last a full lifetime and never require surgery. As I said in my post my valve didn't require surgery either my aneurysm did. I hope when you go in for your next surgery it will be your final one and it will last a lifetime and everything goes well.

I had the David and my surgeon said the same. The stats tell us (again, only 20 years worth of data on the David) that if the valve repair is done well, that is, it meets certain commissure measurement requirements, that you'll be unlikely to need another surgery. However, everyone's underlying pathology is different, obviously.

 

[cldlhd]

I had the David and my surgeon said the same. The stats tell us (again, only 20 years worth of data on the David) that if the valve repair is done well, that is, it meets certain commissure measurement requirements, that you'll be unlikely to need another surgery. However, everyone's underlying pathology is different, obviously.

That's exactly what I've been trying to get at. I mean of course I'm leaning towards the optimistic side for me, also for you, but I understand some people have a bad result and that makes them declare the surgery itself no good .Don't get me wrong I had my surgery about a month before I turned 46 and I was definitely leaning towards a mechanical ( my surgeon wholeheartedly agreed that if my valve needed replacing that I should go mechanical) as I thought it was my best chance at a one and done but the condition of my valve (no stenosis or calcification, only trace leakage, the geometry, gradients etc.) We're such that my surgeon said it was an ideal candidate for a long repair but he would only know once he was in there. So I trusted his judgment, I asked him multiple times to not do a repair if he thought I would almost certainly need another surgery 10 or 20 years from now or if you wanted to do it because it was a more challenging and interesting surgery. At the end of the day he said it was one of the top five repairs he's ever done, who knows maybe he says that to everybody..., and he showed my surgery at the first annual North American valve repair symposium in Philadelphia as a good case for early intervention and repair in 2015. Who knows none of us have a crystal ball but obviously I hope for the best for all out here. Cheers.

 

[Chuck C]

At the end of the day he said it was one of the top five repairs he's ever done, who knows maybe he says that to everybody

It also makes me wonder if he gives honest feedback to each client:

"Your repair was about middle of the road for me."

"To be honest, I was having a bad day- just felt off, and I'd have to rank your repair as one of my bottom five ever."

 

[pellicle]

it meets certain commissure measurement requirements, that you'll be unlikely to need another surgery.

I'm curious, does age at operations count in that set?

 

[cldlhd]

It also makes me wonder if he gives honest feedback to each client:

"Your repair was about middle of the road for me."

"To be honest, I was having a bad day- just felt off, and I'd have to rank your repair as one of my bottom five ever."

Who knows? I mean the fact that he did feature my surgery at the symposium I guess counts for something. He didn't seem to be the overly BSing type more like the kind that would just tell you if it went so so but it wouldn't be his fault because he has a bit of confidence if you know what I'm saying

 

[Wiles Darkwinter]

I'm curious, does age at operations count in that set?

I’m looking for a study that takes age into consideration with the David procedure, can’t find one. You’d think age would indeed effect that statement. I’ve been lead to believe that the David is better for younger patients - but I suppose it all comes back to that 20 year limit on the data. Frustrating.

 

[pellicle]

I’m looking for a study that takes age into consideration with ... Frustrating.

it is often frustrating.

A friend of mine (who I've mentioned) has often lamented the understanding of statistics in the health area (and he's a physicist who made surgical catheters).

 

[cldlhd]

I’m looking for a study that takes age into consideration with the David procedure, can’t find one. You’d think age would indeed effect that statement. I’ve been lead to believe that the David is better for younger patients - but I suppose it all comes back to that 20 year limit on the data. Frustrating.

Well if they've only been doing it for 20 years....

 

[vp69]

Hello everyone, I found this forum a few months ago and it has been extremely helpful in being able to read all the stories of people here who have gone through similar valve related issues. I'm currently in my mid 20s and was diagnosed over a decade ago with aortic valve regurgitation that was moderate after contracted rheumatic fever. I was recommended for AVR but up till now have not undergone it. The last couple years my LVEDD has been pushing the high 6s and LVEF dipping into the lower 50s and although I have no symptoms unless I exert myself (get SOB after a while and obv cannot meet my age standards on a stress test) so I think it's just about time to do something this year. I'm encouraged to see the advances being made in field of aortic valve repair and after all this time I have severe AR because of a RCC prolapse, no calcification or stenosis, no enlarged root issues so it is an isolated aortic insufficiency problem. I would prefer to be able have this repaired rather than having to deal with the prospect of a mechanical valve and warfarin or multiple ops with tissue valves failing quickly in younger people.

If anyone has any experience with undergoing repair for isolated aortic valve insufficiency or any stories that would be helpful. I'm hopeful that the introduction of the HAART annuloplasty geometric ring and more experience overall in aortic valve cusp pathology will help repairs be more durable, obviously given the size of my ventricle I would only want to have a repair attempted if a good and durable repair with little to no AR is possible

well after calls with several surgeons it looks like what I'll be having is an aortic valve repair attempt if the surgeon determines he can repair the valve without pericardium and there will be no root replacement just an annuloplasty but if he determines he cannot repair it without using pericardiial patches I'll be having the ROSS procedure as a backup , worst case if that's not possible due to any pulmonary valve issues which I don't think will be in my case I will opt for the Inspiris Resilia. Procedure most likely going to happen in September. Thanks everyone for all the input

 

[vp69]

had a heart catheterization in preparation for my operation early next week, good news is no blockages or evidence of CAD after decade of high blood pressure due to severe AR.

repair will be attempted if possible, if not ROSS is the backup
excited!

It will be done at Mount Sinai by Dr. El-Hamamsy and I could not have asked for a better surgeon

 

[Chuck C]

good news is no blockages or evidence of CAD after decade of high blood pressure due to severe AR

That's great news Vp69! Best of luck with your surgery. Hoping that a repair is all that is needed. Please keep us posted.