Cross sectional area and prior open heart surgery

[Bigred]

Hey guys, I haven't been on the board in quite some time. Here's a lititle background. Born with congenital bav, had aortic valve replaced with St. Jude mechanical valve back in Oct. '89. As of 2 years ago, ascending aortic aneurysm measuring 4.8cm. I'm due for another ct scan but had a question in the meantime.

I know 5.5 is the new recommendation for surgey, especially for those of us with prior surgeries due to the scar tissue the surgeons will have to deal with. But what about the surgeons that follow the cross sectional area measurement?

I intend to go to Cleveland Clinic and have Dr. Svensson (or his team) perform the surgery when it's time. And I believe that it was he and his team that came up with this measurement to begin with. I'm just curious if my prior surgery will affect that measurement.

I reached out to Cleveland Clinic but they only say they will be happy to review my records. At the moment I'm not ready to pay for a review that in all likelihood will just tell me to wait. I'm at 10.3 on the cross sectional measurement but am waiting for my next ct scan to see if there is any change before considering having my records reviewed. Just wondering if anyone has any additional info on this.

 

[AZ Don]

I have not seen any surgical criteria that accounts for prior surgeries. I understand that the second surgery can be more difficult and the risk can be more than the 1st op, but of all places, the Cleveland Clinic seems to minimize these risks, recommending tissue valves at much younger ages than most hospitals/Dr's. At the same time, in following the cross sectional guidelines they are saying that they think dissection risk increases beyond a measure of 10. I'm not clear why you think they will tell you to wait. It seems to me the likely possibilities are that they still follow the cross sectional guidelines and agree to go ahead with the surgery, or they take into account your history and their review of your scans, in which case it is a complex decision that you probably cannot predict. I don't know how much their review costs but if it were me I think I would do it once I had the latest scan results.

As of 2011 they were following the cross sectional guidelines:
http://my.clevelandclinic.org/servi...n/webchats/aorta-disease/1207_aortic-aneurysm

Dr_Lars_Svensson: I understand your concern and the problem is that we don't have accurate data on when we should operate on patients with Turner Syndrome. We have tended to use the same criteria as for Marfan Syndrome as far as recommendation for surgery and the same applies for patients with Bicuspid aortic valves. We try to deal with this issue with the Thoracic Aortic disease guidelines published by the American Heart Association and the American College of Cardiology. With our current level of knowledge, we continue to believe that a good way to decide when a patient should have surgery is taking their cross sectional area of the aorta in centimeters and dividing the height in meters and if that ratio exceeds 10, we recommend surgery. The issue is weighing out the risk of surgery vs. the benefits of preventing aortic dissections.

 

[Bigred]

AzDon,

Thanks for the reply. I'm not sure if I would be told to wait on surgery or not. The only thing I have to go on at the moment is that when I had met with Dr. Cameron at Johns Hopkins a few years ago and the recommendation was still 5.0 cm for surgery he stated that he would want to wait until it was 5.5 cm due to the prior surgery.

I wasn't sure if anyone had been told to wait from any surgeons that use the cross sectional area formula if they had a prior surgery.