Current age Aortic Graft(Dacron) Longevity

[dixitworld]

Hi All,

I am 32/M and have aortic valve replaced 8 years ago. I have been diagnosed Ascending aortic aneurysm (5.2cm) and Aortic root(4.4) and have ben told foe Bentall procedure for full replacement.
Cardiologist at Cleveland Clinic told me you will be lucky to see each day after 20 years when i will be in my 50's.

I checked online and found articles that multiple cases of Dacron graft rupture has been recorded in the past apart from other complication of pseudo aneurysms. Most of the articles are talking for surgeries happened from 1980 to 2005.

I was wondering why surgeons says that graft will outlast human life? I didn't find any article or any scientific study which shows graft can run for 40 years? Any of the esteemed members of this group has any information that current days graft are different than earlier ones and are more durable?

 

[pellicle]

Well ****, the posts disappear

Hi

Cardiologist at Cleveland Clinic told me you will be lucky to see each day after 20 years when i will be in my 50's.

Odd, I wonder why they said that?

I checked online and found articles that multiple cases of Dacron graft rupture has been recorded in the past apart from other complication of pseudo aneurysms. Most of the articles are talking for surgeries happened from 1980 to 2005.

Interesting. I can only assume that the grafts that failed were studied extensively and from that changes made.

My procedure was to replace a valve that was becoming incompetent and to address an aneurysm. That was 2011, and I have an ATS with a graft from manufacture.

I've been told it's not likely to rupture.

I was wondering why surgeons says that graft will outlast human life?

Probably because of testing in labs demonstrated that sort of longevity.

I didn't find any article or any scientific study which shows graft can run for 40 years?

And I guess equally you didn't find any examples of ruptures since 2005 either.

It's a tough question, but as I understand it the graft is covered with cells and tissue quickly (a few months), this is endothelialisation , this would then contribute to the strength of the graft.

Would you mind sharing the earlier studied you found?

Assuming that you go for a mechanical valve in that bental procedure I'd suggest that you are unlikely to require further surgery. Of course they'll also want to monitor the whole thing after implant, and will bee looking at how well the aorta does at the point where it attaches to the graft. They'll be looking for any signs of the aneurysm developing up there.

At 32 I suggest you should strongly consider becoming your own INR manager. I do exactly this and it's producing excellent results.

Reach out if and when you wish any assistance down that path, I have a few things I can help you with.

​​​​​​​Best Wishes

 

[dixitworld]

Hi Thanks @pellicle for whatever you are doing on this group along with some other great members. I keep reading your responses on most of users questions and its awesome always.

My Surgeon at Cleveland Clinic says that graft CAN remain life long , but cardiologist specifically said that i should be lucky to see 50's with second surgery in 30's.

I am otherwise healthy vegetarian person with no other disease so far.


About the links which i read :

https://pmj.bmj.com/content/79/932/348

One you already discussed on my other post : https://onlinelibrary.wiley.com/doi/abs/10.1046/j.1442-2034.2002.00147.x

https://www.sciencedirect.com/science/article/pii/S1533316707000143

and many more like this.

 

[dixitworld]

https://www.annalsofvascularsurgery.com/article/S0890-5096(06)62133-X/pdf

 

[pellicle]

https://www.annalsofvascularsurgery.com/article/S0890-5096(06)62133-X/pdf

Interesting, although to me I read that as being quite encouraging

Aneurysmal degeneration, or complete disruption of Dacron grafts (as opposed to anastomotic complications such as pseudoaneurysms), are not expected by vascular surgeons. We have noted two such cases. A 65–year-old male who had an aortobifemoral, double-velour Dacron graft in 1980, presented in 1995 with a large, pulsatile mass in the right lower quadrant, caused by disruption of the mid-portion of the right limb of the Dacron graft. In a second case, a 68-year-old man had a Dacron aortobifemoral graft placed in 1968 which developed diffuse aneurysmal defects, noted clinically in 1987. Both patients had successful graft replacement. A review of the literature indicates that this complication, although unusual, has been noted periodically. Between 1970 and 1996, we identified 11 case reports of aortic Dacron graft rupture, including knitted Dacron (4), double velour (3), woven (1), knitted thin wall (1), and unspecified Dacron grafts (2). An inquiry to the FDA disclosed another 68 cases of Dacron graft failure in addition to those reported in the surgical literature. We present these cases to alert vascular surgeons of the possibility of Dacron graft degeneration, as late as 19 years after implantation.

so they say they've uncommon and only identify a small number of cases, out of I wonder how many thousands in that period?

looks like very high reliability to me, riding my motorcycle is probably a bigger risk

Something I'm not ready to give up just yet (after like 40 years of doing it)

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[pellicle]

Hi

Hi Thanks @pellicle for whatever you are doing on this group

well I'm an Australian, and we have a (had a?) free to all citizens health care system which was / perhaps still is among the best on the planet. My first two surgeries were done at no cost to me or my family at the state health (*kinda taxpayer) and so it was closely associated with university training as well.

Over the years I've served as a kind of "training patient" for young interns who would work underneath my surgeon. I reguard this as being quite the least I could do for being granted the privileged of being alive.

As my university education too was provided by the government I consider that its appropriate that I put as much of that experience (combined with the being alive still bit) to as good a use for society as I can.

So here I am.

I am otherwise healthy vegetarian person with no other disease so far.

well then, I guess that means you're stuck here for life then ...

*kinda taxpayer because most of the funding from Queensland Health came from government monopoly on "lottery tickets" ... back in those days the Qld Government funded the health system from the takings of that. So as I'd never buy a lottery ticket for the possibility of winning, I consider it a voluntary tax. PS Federation resulted in more and more power being handed to the Federal Government after WW2, and when even more taxation right was handed from the States to the Feds there was pressure from the Federal Govt to cease our Queensland Health funding system.

Best Wishes

 

[Agian]

Cardiologist at Cleveland Clinic told me you will be lucky to see each day after 20 years when i will be in my 50's

Why the hell would someone blurt that out, even if it was true? I would have loved to have been there. All I would have asked is what he bases this opinion on and sat back and listened to the anxious **** that came out of his mouth. Dixit, what he told you is made up ********. This is a person that enjoys watching people get anxious. I would have held up a mirror to him. I doubt any of us had such a conversation with any doctor (cardio or surgeon).

 

[pellicle]

Why the hell would someone blurt that out, even if it was true?

in my post which was then made into "spam" and thus vanished I proposed it was because he was an arrogant arsehole

(lets see if this one goes)

 

[dixitworld]

Yes this has increased lot of anxiety in my mind and am debating if I should then wait for surgery till aneurysm reaches 5.5( lot of researches shows less risk till 5.5) for bicuspid patients also. May be will increase few years of my life

 

[pellicle]

Hi

Yes this has increased lot of anxiety in my mind ...

well I encourage you to put a steadying hand on that anxiety and relax. Don't let one input from someone with a poor sense of appropriate comment (or perhaps he just is an arrogant **** (are you in India?)) ruin your day.

Some advice from the Stoics:

We suffer more often in imagination than in reality. (Seneca)

....

What upsets people is not things in themselves, but their judments about the things.

Our emotions are a combination of two elements: an affective movement within the body and a judgement. Suffering arises when we attach judgements to these affective movements that are beyond our control. For example to love someone is within your control, the judgement that this love should be returned and should be so forever is not.

Contrary to popular belief, the goal is not to repress or eliminate the emotions, to become devoid of feelings; the goal is to attach the right judgments to them.

We can find happiness, and love and beauty as long as we experience it without desiring more than is within our control. We can enjoy music if we do not at the same time wish for it never to end. We can enjoy a cold drink in the sun if we do not at the same time wish for the moment never to pass.

True happiness is to enjoy the present, without anxious dependence on the future, not to amuse ourselves with either hopes or fears but to rest satisfied with what we have, which is sufficient, for he that is so wants for nothing.

and am debating if I should then wait for surgery till aneurysm reaches 5.5( lot of researches shows less risk till 5.5) for bicuspid patients also. May be will increase few years of my life

well I'd put a hand also on the debate and say that without information debate is just a fly buzzing around in a bottle attempting to escape. Wait till you have more information, but know that it will be sooner than years away.

http://www.anzsvs.org.au/patient-inf...rtic-aneurysm/

Small aneurysms less than 5.5cms in diameter have an annual risk of rupture of less than 1% (1 in 100).
...
When an aneurysm reaches 5.5 cms most surgeons would consider offering surgical intervention. This is because, at this size, the aneurysm has a greater risk of rupture. It then becomes as safe to have an operation to repair the aneurysm, as it is to leave the aneurysm alone.
...
There is still some debate on the treatment of aneurysms between 4.0 and 5.5cms despite the large UK and North American trials indicating that there is no clear benefit. Looked at in another way though, there was no clear disadvantage to having the aneurysm treated at an earlier stage. Overall 60% of all patients in the trial would eventually require an operation so why not step in at an earlier stage? Taking patients with aneurysms over 5.0cms the argument is even more convincing, as over 80% of these patients eventually require surgery.

now all we need in the discussion is more data and begin the search for who you would entrust with this.

 

[pellicle]

note: affect and effect are different

 

[dixitworld]

Currently am in Usa and unfortunately Cleveland clinic is the number 1 hospital of Usa

 

[Agian]

Dixit what he told you was ********. If people who had valve replacements only had a 20 year life expectancy don't you think people would know about it? Just because Cleveland is a good hospital it doesn't preclude at least one tool working there. Ask the people here about it. Pel had his first operation as a kid and is now in his 50's. There is no reason why you can't have a normal life expectancy.

 

[pellicle]

Currently am in Usa and unfortunately Cleveland clinic is the number 1 hospital of Usa

I agree with Agian ... a top hospital is about a whole team, not one tool.

Mayo also has a good rep, if you happen to be unhappy with Cleveland. I went to a hospital which is ranked #1 but only in my state of Queensland, who cares if its #1 2 or 3? All will be bloody good.

and Agians not quite right ... I'm not leading a "normal life" ;-D

 

[dixitworld]

Hi Again it’s not about valve it’s about aortic Dacron graft. Valve always had risk of failure or can run while life.
pellicle why you are not leading normal life? Any issue after third OHS?

 

[pellicle]

pellicle why you are not leading normal life?

as a young lad I looked around at normal and decided it wasn't for me. I sought out happiness in other directions

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Any issue after third OHS?

nothing that hasn't settled down to a dull background... happily among my personality flaws being anxious is not one of them

http://www.valvereplacement.org/foru...the-2012-issue

you can google the 2012 issue if you feel inclined ... but if your the freak out anxious type I don't suggest you do.

But I'm fitter and more active than most of the city dwelling IT folks my age group and I lead an active life.


given that I do off trail cross country skiing for enjoyment ...


even in weather that would have others questioning my sanity.

So, not really "normal" at all

 

[pellicle]

... and "normal" people don't take the time and effort to write up stuff like this:
http://cjeastwd.blogspot.com/2014/09...ng-my-inr.html

and make it available for free (although perhaps if I charged $1000/hour for consulting services people may value it more).

Perhaps only "driven" people do that

 

[tom in MO]

Hi All,

I am 32/M and have aortic valve replaced 8 years ago. I have been diagnosed Ascending aortic aneurysm (5.2cm) and Aortic root(4.4) and have ben told foe Bentall procedure for full replacement.
Cardiologist at Cleveland Clinic told me you will be lucky to see each day after 20 years when i will be in my 50's.

I checked online and found articles that multiple cases of Dacron graft rupture has been recorded in the past apart from other complication of pseudo aneurysms. Most of the articles are talking for surgeries happened from 1980 to 2005.

I was wondering why surgeons says that graft will outlast human life? I didn't find any article or any scientific study which shows graft can run for 40 years? Any of the esteemed members of this group has any information that current days graft are different than earlier ones and are more durable?

Maybe you misunderstood what was said.

If dacron grafts are 40 years old, that's the only time period one can be sure of, it also might have been a bad joke. Some doctors like to joke and their sense of humor is not always self-evident.

My blind dog with a brain tumor bit me good and of course it got infected, so I was worried about endocarditis as my hand and arm swelled. I had to go in every 3-days, and after examining me and ordering another shot, the old man would joke "Well hows the dog doing?" We both got a laugh out of the fact that I didn't "let sleeping dogs lie."

The funniest thing I heard a doctor say was to a friend, "Have you ever been pregnant?" "No." "Are you sure?"

 

[pellicle]

Hi

Maybe you misunderstood what was said.

this is something I suggested too ... I've had quite a lot of glib remarks from Dr's over the decades. I'm quite sure they are not meaning anything more than that. For instance one Dr commented as he was walking up to me (while I was sitting on the bench) "wow, that quite a diesel you've got fitted in there".

Myself I laughed, but I know others would be upset by that.

Also, I believe its entirely likely as the Dr mainly only deals with elderly) that he / she just pulled out that number because it sounded "long"

Some doctors like to joke and their sense of humor is not always self-evident.

in my biochem days at Uni in the student common room I usually sat with those who were Firemen and Ambos because we all had the same "black" sense of humor ... the more tender "kept at home kiddies" in the class used to leave the room sometimes. (note: I'd already had one OHS and three surgeries surrounding my heart valve back then)

My blind dog with a brain tumor bit me good and of course it got infected, so I was worried about endocarditis as my hand and arm swelled. I had to go in every 3-days, and after examining me and ordering another shot, the old man would joke "Well hows the dog doing?" We both got a laugh out of the fact that I didn't "let sleeping dogs lie."

at first I thought that was a joke, then I opened this post fully and saw it wasn't ... lol

The funniest thing I heard a doctor say was to a friend, "Have you ever been pregnant?" "No." "Are you sure?"

was your friend male?

 

[dixitworld]

Maybe you misunderstood what was said.

If dacron grafts are 40 years old, that's the only time period one can be sure of, it also might have been a bad joke. Some doctors like to joke and their sense of humor is not always self-evident.

My blind dog with a brain tumor bit me good and of course it got infected, so I was worried about endocarditis as my hand and arm swelled. I had to go in every 3-days, and after examining me and ordering another shot, the old man would joke "Well hows the dog doing?" We both got a laugh out of the fact that I didn't "let sleeping dogs lie."

The funniest thing I heard a doctor say was to a friend, "Have you ever been pregnant?" "No." "Are you sure?"

No Tom I didn’t misunderstood , he was firm in what he said.
today also I heard from one lady that her aorta graft dissected after 20 plus years.

I am trying to find if the Dacron graft used now is different than earlier age grafts or they are same.