BAV repair and after few years stenosis started to get bigger

[Lada1]

BAV repair done in 2017 due to the regurgitation. 4 years after the surgery the stenosis(pannus or calcification) started to grow up (peak60/avg36 mm Hg). Would anyone undergo a next AV repair resp. full reconstruction? Thinking of the OZAKI procedure. Im highly against to be a daily warfarine user.
The surgeon has made (since 2016) over 250 OZAKI procedures with pretty good track record. My cardiologist was even against the first BAV repair. He highly recommends(insists) a mechanical one. His reasoning is one OHS for the whole life. Now adding if the pannusi/calcification has appeared it would probably happen with any biological material in some future as well.

For me(right now) only reasoning for the mechanical replacement is that there is always a chance for a warfarine due some other health issue.

 

[tommyboy14]

Hi Lada,

I think you can only have Ozaki at the first OHS. This is because the material used in Ozaki (the sack around your heart) normally gets cut up and then isnt usable anymore.

Once the valve get stenotic you pretty much have to replace. There isnt much more that can be done to save it.

There are very few surgeons who have that kind of experience with Ozaki in Europe. I would guess that your Surgeon must be Dr. Jaroslav Benedik.

We need more information about your age and gender to help you.

My view is that if you are female and still want to have kids it is reasonable to get a biological replacement. But if you are man below 60, I think mechanical valve is the best choice. I speak from experience. I had a bio replacement in 2014 and then needed one again in 2022. That time I went mechanical. I dont ever want to have another OHS again if I can avoid it. One is more than enough.

You should also be aware that you only get 3 fairly low risk OHS shots and things can happen in your life, such as other valves needing an intervention or endocarditis and so forth.

Please give us more info and we will all be happy to help you as much as we can.
(Gender and age info is I think crucial for your question).

Warfarin management has come a long way in the past thirty years. I just test with a machine at home. The only time I was really out of range was due to food poisoning.

All the best in making your decision

Tommy

 

[Lada1]

M 51yrs, office job. Hobbies/activities which might be questioned with regards to warfarin: road cycling, motorbike, downhill skiing; occasionally chainsaw garden/tree works. As Ive had a good recovery last time(including RFA of AVNRT performed after 2months from OHS) I have now the feeling to pass another ten OHS´s

Yes, I did talk/consult my case to J.Bernadik. He said it would depend on the actual pericardium conditions and the prior OHS should not be generally an issue.

S.Westaby mentioned in his Fragile Lives a case of a young woman with heart cancer where he performed like 5 or even more OHS to repeatedly remove it.