BAV and Severe AR but normal Aorta....but.....

[Explorer]

I have an AVR scheduled for next week to fix my severely leaking BAV.
In a recent TEE report, the sinus was measured to be 34 ascending to 35.
My surgeon recommeds replacing the aorta as BAV patients are more likely to face an an aneurysm in future.
I thought measurements above >= 45 qualify for elective replacement of Aorta for BAV patients. Mine looks perfectly normal.
Anyone else got their BAV replaced with aorta with a normal reading.

 

[pellicle]

I have had my aortic valve replaced and a section of the aorta. I had an aneurysm form. Previously my valve was performing adequately with some mild regurgitation. Nothing that kept me from cross country skiing and cycling.

now I have a mechanical

 

[epstns]

I imagine the situation is patient-specific, and to a large extent, affected by your own surgeon's experiences with BAV patients. Some surgeons are very cautious because they may have had a lot of patients with BAV having to come back for a re-op due to subsequent problems with the aorta. Other surgeons may rely on the statistics, which might point to a lesser degree of subsequent events. Also at play, at least in the US, are the insurance guidelines. Here in the US, insurance companies often will not approve payment for procedures unless certain prerequisite conditions are present.

 

[Tirone]

Hi Explorer

I've met with two different surgeons to discuss AVR due to a severely leaking BAV. My aortic root is 41mm. One of the surgeons said the risk of a prophylactic replacement of the ascending aorta is in no relation to the actual risk of progression at this stage. He said he couldn't imagine anyone doing such a procedure at 41mm. The other surgeons said the opposite. He was convinced that there is no way around a replacement of the ascending aorta and every other cardiac surgeon would tell me the same.
As this examples shows there are different opinions between surgeons. Non of them is wrong, there just isn't enough evidence based literature yet, especially regarding "small" enlargements. I think 35mm is on the low end for a aortic replacement. A second opinion might be helpful.

 

[AZ Don]

People with BAV have something like a 20% chance of developing an aortic aneurysm.
http://my.clevelandclinic.org/heart/disorders/bicuspid_aortic_valve_disease.aspx

Generally the guidelines for aortic repair with BAV is at least 5.0cm, but the guidelines go as low as 4.0cm for genetic complications:

Patients with Marfan syndrome or other genetically mediated
disorders (vascular Ehlers-Danlos syndrome, Turner syndrome,
bicuspid aortic valve, or familial thoracic aortic aneurysm and
dissection) should undergo elective operation at smaller diameters
(4.0 to 5.0 cm depending on the condition; see Section
5) to avoid acute dissection or rupture (47,119–125). (Level of
Evidence: C)
See page 1529: http://content.onlinejacc.org/article.aspx?articleid=1142683

Seems aggressive to suggest repairing your aorta just because they are fixing your valve. I would ask those recommending this to explain their reasons.

My situation is the opposite. My aorta clearly needs repair but I have a "normal" BAV. I'm leaning towards a valve sparing operation for two reasons, I understand outcomes tend to be better and in general I believe if it ain't broke, don't fix it. I have a catheter test tomorrow and discuss options with my surgeon next week.

 

[Explorer]

On the day of surgery my surgeon mentioned he may not replace the aorta if it looks healthy once he sees it with real eyes. After surgery I was told it was just valve replaced as aortic root looked healthy at 3.1cm
I am happy with it ..(at least for time being)