Ascending Aortic Aneurysm Surgery and RV lead replacement - Scared

[rufus]

Hi All,

Looking for some reassurance really, had a couple of appointments today neither of which have given me great news. My history is AVR dec 2007 due to bicuspid valve - CRT implant dec 2011, ascending aortic aneurysm 'found' October 2012 after routine watching my specialist has decided the time is right for me to have this repaired.

Routine pacemaker check this morning, i haven't been feeling great, went to a & e a couple of weeks ago due to feeling like passing out, heart stopping to be told I must have an 'inner ear infection' - the check up today identified my RV lead has detatched - I am to have the lead replaced within the next month followed in the new year with the big one.

Having spoken to my surgeon today I was surprised at the mortality rate for those having this operation. I am a 46yr old female and although I want this elective surgery as the thought of it rupturing is horrendous I really didn't realise that the operation will be more complicated due to the fact that I've already had my aortic valve replaced. In addition the 'bulge' goes up to the tip of the brachiocephalic artery which apparently makes the surgery harder to do. I am now petrified - do I have the surgery or do I just hope it doesn't rupture. I've been quoted 18-20% mortality rate........... I live on my own and have no partner

 

[Richie Rich]

Hi Rufus, sorry to hear about your problems. I understood that there was no more risk replacing the aorta with the valve than just replacing the valve, but there is more risk with a second or third op. I'd ask for a second opinion before deciding but either way an op gives you the best chance.

 

[ottagal]

Rufus,
I don't have any information for you, but so sorry to read your latest news. I understand how upsetting this must be. Are you comfortable with your surgeon and does he/she have a good track record of performing re-dos and aneurysm repairs. Would it help to get a second opinion? I certainly would.
Although scary, this is doable. There are a number of members who have been through a second re-ops. Hang in there...

 

[Lisa2]

Hi, Rufus. I don't have any knowledge of aneurysms/repairs but I can commiserate with you on feeling scared. Heart surgery is an emotional journey; not to mention that we have to go about the business of healing and getting back to living. There are tons of people that have had multiple repos, so I do think it's feasible.

 

[AZ Don]

I had a valve sparing aortic aneurysm repair and it is my understanding that it is actually more complicated to graft the aneurysm without replacing the valve. So if your aneurysm extends down to the aortic root, then it may be easier to just replace the valve again. I understand they have aortic aneurysm grafts with a valve already attached. I'm guessing the complexity of your surgery is primarily due to the fact that your aneurysm extends up to the arch. You could talk to your Dr. about the risks of living with the aneurysm for now but as aneurysms tend to grow, the risk of living with it only increases. You may be able to reduce the risk by controlling blood pressure, minimizing stress, and avoiding strenuous exercise, but you can't eliminate it. The way I looked at it, the surgery (and the associated risk) was inevitable. The only risk I could control was how long I lived with the aneurysm and so I had my surgery right away. My aneursym was at 5.1cm and at the time the guidelines suggested surgery at 5.0cm for those with BAV. io

If I were you I would focus on finding the best surgeon/hospital that you can, to lower the risks as much as possible. US News has information on hospitals and http://www.castleconnolly.com/ has good information on Doctors, for a small fee. If you can, it may well be worth some extra travel time to go to a top ranked Dr/Hospital, particularly one experienced in your type of surgery. I think re-do's may be more common than arch repairs so you really want to find a Dr, or ensure that your current surgeon has extensive experience working on the aortic arch.

 

[Dan Zulu]

Like AZ Don I had a David valve-sparing aortic root replacement. The surgeon replaced a total of 4 inches of my ascending aorta. When I found out about my aneurysm I was worried about the rupture risk too, but focused my energy on finding a qualified surgeon to fix it. It does take a lot of trust in medicine to go through with this type of surgery, but I was not going to wait and let it kill me.