AVR time for moderate to severe AS

[ashadds]

My echo today revealed gradients of 62mmHg / 36 mmHg with Vmax = 3.92m/s .No LVH , can you tell me when did you decide surgery at what gradients ? My doc is suggesting ballon valvuloplasty first as I am 26 if gradient rises to 75mmHg, but he told it could take a few years.

 

[Paleowoman]

It was my cardiologist who suggested when it was time for me to have referral for surgery, and then it was up to the surgeon. My cardiologist based his reasons for referral on the rising pressure gardient when it rose extra steeply - it had risen from 54 mmHg to 68 mmHg in the space of a year whereas previously it had been rising more slowly each year. I had no symptoms though.

 

[epstns]

With older patients they often say that after certain valve area criteria are met (once it gets smaller than XX cm2), the patient usually tells the surgeon when it is time for surgery. The patient may not be in any immediate medical danger but gets tired of being tired, and says "It is time." With younger patients such as yourself, I would bet that the surgeon will be more driven by your valve measurements, at least until you present any of the "cardinal" symptoms. These are the "red flag" symptoms of shortness of breath (SOB), syncope (fainting) or angina (chest pain). If you develop any of these major symptoms, they will usually investigate and if the symptom is caused by the valve, they will suggest surgery sooner rather than later.

That said, aortic stenosis is highly variable. I was initially diagnosed at "moderate to severe" AS, but it took almost 10 years before I was ready for surgery. YMMV.

 

[ashadds]

Paleowoman Thank you so much for the clarification . I got a second opinion today my gradient was better than before...around 56mmHg peak and velocity was 3.69 m/s . My second opinion doctor looked at a lot of things including valve mobility and the bigger picture including LV behavior , ejection fraction , calcification and overall enlargement. He classified me as moderate and does not want me to have surgery now. He thinks its much too soon
epstns Absolutely right , I dont have symptoms yet and my doctor would prefer me to be in monitor mode . I think they look at the benefit of surgery and risk without surgery ! seems like I would have a greater risk with surgery because of my age

 

[epstns]

Paleowoman Thank you so much for the clarification . I got a second opinion today my gradient was better than before...around 56mmHg peak and velocity was 3.69 m/s . My second opinion doctor looked at a lot of things including valve mobility and the bigger picture including LV behavior , ejection fraction , calcification and overall enlargement. He classified me as moderate and does not want me to have surgery now. He thinks its much too soon
epstns Absolutely right , I dont have symptoms yet and my doctor would prefer me to be in monitor mode . I think they look at the benefit of surgery and risk without surgery ! seems like I would have a greater risk with surgery because of my age

As the math was explained to me, they consider your odds of death with surgery versus your odds of death without it. As long as your odds of death are better in waiting, they will wait. Once the scales tip, they recommend surgery. Some of us choose to take some risk in deciding when, though, as I probably could have had my surgery months earlier than I did, but chose to wait until a better time in my life. My cardio and I have a wonderful working relationship, so I was and am confident that he would have been very clear with me if he felt it not prudent or safe for me to wait.

All of our cases are different. Listen to your body, but don't talk yourself into doing anything foolish, like waiting too long. You could do irreversible damage.

 

[ashadds]

As the math was explained to me, they consider your odds of death with surgery versus your odds of death without it. As long as your odds of death are better in waiting, they will wait. Once the scales tip, they recommend surgery. Some of us choose to take some risk in deciding when, though, as I probably could have had my surgery months earlier than I did, but chose to wait until a better time in my life. My cardio and I have a wonderful working relationship, so I was and am confident that he would have been very clear with me if he felt it not prudent or safe for me to wait.

All of our cases are different. Listen to your body, but don't talk yourself into doing anything foolish, like waiting too long. You could do irreversible damage.

I fully understand , I took two opinions and both of them have told me to wait. Do you remember the gradients and velocities you had before surgery ? Did you have "Symptoms" ? They have asked me about symptoms more than anything ?

 

[epstns]

Sorry, ashadds, but I really don't remember my final pre-op gradient or velocity. I do remember that my calculated valve area was 0.8 cm2. I had none of the "cardinal" symptoms at all. My only symptom was that I was tired more often and my exercise tolerance was dropping. I was still jogging 5 days a week until a week or so before surgery. Time per mile kept extending, but I was able to keep going. I finally told my cardio that "I'm tired of being so tired." My wife also said that my skin tone was grayish, and that it returned to normal almost immediately after surgery.