Discussion about aortic aneurysm from Dr. Birdi

[Chuck C]

I believe Dr. Inderpaul Birdi does a good job describing ascending aortic aneurysm and also the 2022 ACC/AHA guidelines for when surgery is indicated.

The guidelines differ depending on whether a person has a bicuspid aortic valve or a tricuspid aortic valve and also depend on whether you are receiving OHS for another reason already, for valve surgery, for example. The idea is that if they already are going to be in there for another reason, take care of the aneurysm a little earlier than one normally would, so as to potentially avoid another OHS down the road. I also like the graph showing the risk of having an aortic complication, depending on the size of the aneursym depending on the patient's size.

Bicuspid valve:

Surgery indicated at >5.0cm.

If the patient is already getting valve surgery, then sugery is indicated at >4.5cm

Tricuspid (normal) valve:

Surgery indicated at >5.5cm

If the patient is already getting valve surgery then surgery is indicated at >5.0cm.

There are other factors which come into play, such as whether the aneurysm is enlarging at >0.5cm/year or whether there is a family history of aneurysm.

Check out the video:




For me personally, my surgeon replaced my aortic root and my ascending aorta well below what the guidelines call for. My aortic diameter was 3.6cm and the guidelines would have indicated that it should have been replaced at 4.5cm, in that I was a) BAV and b) getting OHS for my valve. He made a judgement call, based on his experience. He has had the benefit of having done thousands of valve surgeries, and when he got his eyes on my aortic tissue, in his experience, it had the look of the type of tissue that would probably need replacement due to aneurysm down the road. He took into account the fact that we had consulted prior to surgery and he was fully aware that I wanted to be one and done and desired to avoid a future OHS. So, there are the guidelines, but your surgeon also can make a judgement call outside of the guidelines based on their experience and your individual situation.


Dr. Birdi is a heart surgeon in London.

https://www.thekeyholeheartclinic.com/inderpaul-birdi-top-heart-surgeon/

 

[pellicle]

Tricuspid (normal) valve:

Surgery indicated at >5.5cm

interesting that he recognises that without the BAV presentation of associated connective disorder the amount of "give" is reduced.

An interesting discussion, thanks.

 

[BionicBuddy]

My aortic diameter was 3.6cm and the guidelines would have indicated that it should have been replaced at 4.5cm, in that I was a) BAV and b) getting OHS for my valve.

Hi Chuck. I must have missed this post on my search for info.

Do you know how the measurement is calculated? All I see on hubby's echo is in mm not cm: aorta sinuses 36 mm and prox ascending aorta 37 mm. I wonder how you got 3.6 cm?

Did your surgeon say how much more of a surgical risk a Dacron graft would be, seeing as your measurement was normal? (or was your measurement even normal?)

Thanks in advance for your response.

Also, that body calculation graph was helpful and interesting. Thanks.

 

[Chuck C]

Do you know how the measurement is calculated? All I see on hubby's echo is in mm not cm: aorta sinuses 36 mm and prox ascending aorta 37 mm. I wonder how you got 3.6 cm?

To convert to cm, divide the mm number by 10. For example 36mm = 3.6cm.

Did your surgeon say how much more of a surgical risk a Dacron graft would be, seeing as your measurement was normal? (or was your measurement even normal?)

He did not. The risks are comparable, however. See the study linked below. In this study patients who received an aortic valve, and a dacron graft (known as a Bentall Procedure) had better life expectancy than those who just received the aortic valve alone. In fact, the life expectancy for those who received the Bentall were about the same as the age matched, non valve surgery, population. It makes sense when you consider that many of those who get aortic valve surgery need to have another surgery down line, to have their anerysm repaired, as is often the case for those with BAV.

See below and link:

"We have found that operative mortality after the Bentall procedure in BAV patients is comparable with that of aortic valve replacement or repair, but that the Bentall operation is associated with superior long-term survival and a lower rate of aortic reoperation [30, 31]"

https://www.annalsthoracicsurgery.org/article/S0003-4975(07)00667-4/pdf

 

[BionicBuddy]

To convert to cm, divide the mm number by 10. For example 36mm = 3.6cm.

OMG. I just came back to delete this part of my previous post so I didn't look so stupid, but I see you were too efficient in responding and I can't edit your post! Ha! It has been a long flight and I was tired. I plead stupidity due to tiredness.

He did not. The risks are comparable, however. See the study linked below. In this study patients who received an aortic valve, and a dacron graft (known as a Bentall Procedure) had better life expectancy than those who just received the aortic valve alone. In fact, the life expectancy for those who received the Bentall were about the same as the age matched, non valve surgery, population. It makes sense when you consider that many of those who get aortic valve surgery need to have another surgery down line, to have their anerysm repaired, as is often the case for those with BAV.

See below and link:

"We have found that operative mortality after the Bentall procedure in BAV patients is comparable with that of aortic valve replacement or repair, but that the Bentall operation is associated with superior long-term survival and a lower rate of aortic reoperation [30, 31]"

https://www.annalsthoracicsurgery.org/article/S0003-4975(07)00667-4/pdf

Good to know!! You are so full of valuable info. Thanks again.

I just looked at his progression. In the last 15 years his aorta increased by 6 mm, from 30 to 36. Maybe at that rate, by the time he's 80 it will be 42. We'll see what the surgeon says.

I know you will gasp, but his AVA is 0.7 and mean pressure is 62. It's time. No symptoms now and that is a blessing.

Thanks Chuck.

 

[Chuck C]

I know you will gasp, but his AVA is 0.7 and mean pressure is 62. It's time. No symptoms now and that is a blessing.

Yes, it is most definately time. Good luck in the decisions that remain and please keep us posted.