BAV REPAIR at Mayo Clinic? ---Any data on this?

[WillieR]

All,

I'm a BAV with severe regurgitation, ~(70+ CC) no stenosis. I live in Minneapolis, MN so I'm close to the Mayo Clinic and was hoping to possibly do a BAV repair there but haven't found any data supporting them doing the procedure. With talks with the nurses they said there are 3 Drs. that perform the repair, Schaff, Pochettino, and Cecik. Does anyone have any info on the outcomes of repair at Mayo or has anyone had their BAV repaired there before by one of these 3 surgeons?

Sidenote: I have checked with Cleveland (Svennson) and he gave me the standard 70% chance for repair. I'm open to considering the travel to Cleveland but was hoping I could get by with a 1 hr car ride to Mayo.

 

[DJM 18]

This is a piece from mayo on the topic...

http://www.jtcvsonline.org/article/S...928-8/fulltext

[h=1]Expanding relevance of aortic valve repair—is earlier operation indicated?[/h]
Read at the 93rd Annual Meeting of The American Association for Thoracic Surgery, Minneapolis, Minnesota, May 4-8, 2013.


Objectives


To define the durability of aortic valve repair (AVRep) and the effect of surgical timing on late survival.Methods


From June 1986 to June 2011, 331 patients underwent elective AVRep for aortic regurgitation (mean age, 53 ± 17 years; 76% men). The repair methods included commissuroplasty (n = 270; 81%), triangular resection and plication (n = 106; 32%), resuspension or cusp shortening (n = 102; 31%), and perforation closure (n = 23; 7%).Results


In-hospital mortality was 0.6% (2 of 332). Four patients (1%) experienced early repair failure; two underwent repeat repair. Overall survival was 91% and 81% at 5 and 10 years, respectively. After adjusting for age, greater left ventricular end-systolic dimension (per 5 mm; hazard ratio

---

, 1.49; 95% confidence interval [CI], 1.23-1.79; P < .001) and lower ejection fraction (per 5%; HR, 1.42; 95% CI, 1.25-1.63; P ≤ .001) were significant predictors of long-term mortality. Patients with ejection fraction < 50% and left ventricular end-systolic dimension > 50 mm had significantly greater odds of late death (HR, 3.46; 95% CI, 2.05-5.82; P < .001 and HR, 2.08; 95% CI, 1.05-4.12; P = .036, respectively). The risk of aortic valve reoperation was 10% and 21% at 5 and 10 years, respectively. The presence of severe aortic regurgitation (HR, 2.2; 95% CI, 1.1-5.06; P = .02) and more than mild regurgitation at discharge (HR, 5.87; 95% CI, 2.67-12.68; P ≤ .0001) were predictors of late reoperation. Freedom from other valve-related events was 94% and 91% at 5 and 10 years, respectively. Forty-seven patients (21%) with intact valve repair were using warfarin at the last follow-up visit.Conclusions


AVRep can be performed with excellent late survival and freedom from valve-related events. Awaiting the onset of ventricular dysfunction increases the risk of late mortality, warranting earlier consideration of AVRep for patients with suitable ana

 

[WillieR]

Thanks, this is very helpful.

 

[DJM 18]

I am glad it is helpful and you may also want to give consideration to Bavaria at Penn who is very experienced. At the end of the day, what is most important is selecting a doctor who has ample experience with this procedure.

 

[cldlhd]

I am glad it is helpful and you may also want to give consideration to Bavaria at Penn who is very experienced. At the end of the day, what is most important is selecting a doctor who has ample experience with this procedure.

I had my bav repaired by Bavaria at Penn back in 2015, actually 3 yrs ago tomorrow, any questions I'll do my best to answer.

 

[WillieR]

cldlhd Congratulations on your anniversary!!! One of my questions with the repair is if it is a good enough "correction" to fully stop the regurgitation of the valve and reverse/stop the dilation of the LV? Whats your experience? Also, what was your thought process in going repair vs going bioprosthesis, both of which likely require a 2nd surgery?
My LV is beginning to dilate and I'm just outside the normal range now but I really want my fix to be corrective enough to not allow my LV to continue to grow. Keeping my native valve and getting 10-15 more years out of it sounds great but knowing a 2nd surgery is likely seems scary.....considering I haven't had OHS yet and don't fully understand how hard the recovery will be.

 

[cldlhd]

This is a piece from mayo on the topic...

http://www.jtcvsonline.org/article/S...928-8/fulltext

[h=1]Expanding relevance of aortic valve repair—is earlier operation indicated?[/h]
Read at the 93rd Annual Meeting of The American Association for Thoracic Surgery, Minneapolis, Minnesota, May 4-8, 2013.


Objectives


To define the durability of aortic valve repair (AVRep) and the effect of surgical timing on late survival.Methods


From June 1986 to June 2011, 331 patients underwent elective AVRep for aortic regurgitation (mean age, 53 ± 17 years; 76% men). The repair methods included commissuroplasty (n = 270; 81%), triangular resection and plication (n = 106; 32%), resuspension or cusp shortening (n = 102; 31%), and perforation closure (n = 23; 7%).Results


In-hospital mortality was 0.6% (2 of 332). Four patients (1%) experienced early repair failure; two underwent repeat repair. Overall survival was 91% and 81% at 5 and 10 years, respectively. After adjusting for age, greater left ventricular end-systolic dimension (per 5 mm; hazard ratio

---

, 1.49; 95% confidence interval [CI], 1.23-1.79; P < .001) and lower ejection fraction (per 5%; HR, 1.42; 95% CI, 1.25-1.63; P ≤ .001) were significant predictors of long-term mortality. Patients with ejection fraction < 50% and left ventricular end-systolic dimension > 50 mm had significantly greater odds of late death (HR, 3.46; 95% CI, 2.05-5.82; P < .001 and HR, 2.08; 95% CI, 1.05-4.12; P = .036, respectively). The risk of aortic valve reoperation was 10% and 21% at 5 and 10 years, respectively. The presence of severe aortic regurgitation (HR, 2.2; 95% CI, 1.1-5.06; P = .02) and more than mild regurgitation at discharge (HR, 5.87; 95% CI, 2.67-12.68; P ≤ .0001) were predictors of late reoperation. Freedom from other valve-related events was 94% and 91% at 5 and 10 years, respectively. Forty-seven patients (21%) with intact valve repair were using warfarin at the last follow-up visit.Conclusions


AVRep can be performed with excellent late survival and freedom from valve-related events. Awaiting the onset of ventricular dysfunction increases the risk of late mortality, warranting earlier consideration of AVRep for patients with suitable ana

---

Thanks for the link. I found some interesting info including this: "The exclusion of patients with aortic sinus and/or root pathologic features or those otherwise undergoing aortic root surgery could be challenged by those who believe that annular stabilization maneuvers performed during aortic valve reimplantation are important. However, aortic valve reimplantation for AR in the absence of aortic root dilation has not been routinely used at Mayo Clinic to date."
I'm pretty sure my surgeon, Dr. Bavaria, and HUP generally believe that valve reimplantation and annular stabilization are important to repair success. I posted a Youtube clip out here where that point was brought up during a debate about repair vs tissue valve replacement.

 

[cldlhd]

cldlhd Congratulations on your anniversary!!! One of my questions with the repair is if it is a good enough "correction" to fully stop the regurgitation of the valve and reverse/stop the dilation of the LV? Whats your experience? Also, what was your thought process in going repair vs going bioprosthesis, both of which likely require a 2nd surgery?
My LV is beginning to dilate and I'm just outside the normal range now but I really want my fix to be corrective enough to not allow my LV to continue to grow. Keeping my native valve and getting 10-15 more years out of it sounds great but knowing a 2nd surgery is likely seems scary.....considering I haven't had OHS yet and don't fully understand how hard the recovery will be.

I replied to you but for some reason the post is being held up as potential spam....

 

[COfireftr]

I don't blame you for trying to find a surgeon at Mayo since you live so close. How lucky are you to live close to such a great place!

I had a BAV repair in July. I looked in to Mayo while Surgeon "shopping" and found the same thing. I just couldn't find much info about them doing repairs. I didn't dig too deep, though. I bet they have someone doing them. Question would just be how many.

I live in Colorado and ended up traveling to Dr Svensson at Cleveland Clinic. I have absolutely no regrets! Best decision of my life. I felt so fortunate to be a candidate for repair. The whole process was seamless. So glad I went to a high volume center with a surgeon who loves doing repairs. I felt very confident the entire time I was there and the recovery has been great. I've been back to my job as a firefighter for several months now and have never felt better.

The repair was what I wanted and needed. I couldn't do a mechanical valve because of the Coumadin and my job. I knew the tissue valve would have me back under the knife in less than 10 years with my age (40 at the time), lifestyle, and job. I am totally ok if I have to have another surgery in the future. With the tissue it would have been inevitable. The repair is unknown but I still feel it can last longer. With that said, open heart surgery isn't easy and is different for everyone. With the experience I've had I am not afraid to do it again if I have to.

Best of luck with your research! Let me know if I can answer any questions. I blogged my whole experience and would be happy to share it with you if it would be of any interest or help with the process. The process can be daunting, but you will make the right decision. It will just feel right. It's nice to have the time to work through it.

Take care,

Eric