Excited - surgery date confirmed

[sandra]

After what seems like ages and ages, I finally have a surgery date. I feel excited. Going into surgery on the morning of the 12th March to have a redo of my aortic valve. I previously had OHS in December, 2014 when I received a tissue bovine valve to replace my severely deteriorated BAV. In July, 2023 after a routine Echocardigram I was surprised to be told that my valve had deteriorated dramatically. I was told then that surgery would be imminent, but due to the cardiologists and surgeons being puzzled as to what might have caused my valve to suddenly decline, it was decided to put me onto blood thinners first (in case it was a clot). After three months I had another echocardiogram and my gradient had worsened to 73 (from 58). I then had a Transesophogeal echocardiogram and a Cat Scan in October, 2023 which both showed the gradient at 68. This was followed by an angiogram. On November 22nd, 2023 I was put onto a waitlist for surgery, and that is where I have been until yesterday. I am incredibly grateful to be going into surgery to receive another tissue valve. I will have the same two surgeons operating on me as I had nine years ago for my first OHS. My current valve is a 19mm one, and this time the intention is to put in a 21mm valve (if there is space), which will hopefully give me the option of a TAVI for a third procedure should I need it.
Counting down the days. I feel like my life has been on hold for ages. So looking forward to getting fit again and climbing mountains.

Thanks for reading.

I hope to document my journey through this next procedure. This time I am planning to have a lot less social interaction (eg. visitors in hospital), so that I can rest more and listen to my meditations and write and reflect and heal. I currently live alone, so it will be interesting to see how my recovery might be different from last time.
At least the long wait has given me plenty of time to organise things and to put everything into place. I bought a new little freezer for my garage and have cooked lots of yummy meals for my recovery time. It will be Autumn here where I live and I have a lovely garden to sit in for when I am home again.

 

[Survived03]

Sandra, may I ask what bovine bio you currently have? Thank you

 

[Paleowoman]

Hi Sandra - all the very best for your redo aortic valve replacement....I'll be interested to hear if they are able to give you a 21mm valve this time as I'll be in the same boat at some point in time !

 

[pellicle]

At least the long wait has given me plenty of time to organise things and to put everything into place. I bought a new little freezer for my garage and have cooked lots of yummy meals for my recovery time.

Good thinking!

I hope it all goes smoothly

 

[sandra]

Hi Sandra - all the very best for your redo aortic valve replacement....I'll be interested to hear if they are able to give you a 21mm valve this time as I'll be in the same boat at some point in time !

Thank you Yes, we have had similar pathways with our BAV journey. I will update here as soon as I can

 

[sandra]

Sandra, may I ask what bovine bio you currently have? Thank you

I have an Edwards Lifescience 19MM. Model 3300TFX. It was implanted on 4.12.2014. For the first seven years I had such minimal change that it was expected that I would get at least 15 years. Would love to know why it declined so rapidly in such a short space of time. Guess, I will get more information once they've opened me up

 

[sandra]

I have an Edwards Lifescience 19MM. Model 3300TFX. It was implanted on 4.12.2014. For the first seven years I had such minimal change that it was expected that I would get at least 15 years. Would love to know why it declined so rapidly in such a short space of time. Guess, I will get more information once they've opened me up

Carpentier-Edwards PERIMOUNTMagna Ease Pericardial Bioprosthesis Model 3300TFX Aortic

 

[pellicle]

Would love to know why it declined so rapidly in such a short space of time.

I wasn't going to reply until I got to here.

The answer is that its well known that bioprosthetic valves degrade in a non linear way, rather like this:

where the X axis is time and the Y (vertical) axis is performance from new.

From this review: https://academic.oup.com/ejcts/article/25/3/364/380558

Conclusions: These analyses indicate that current bioprostheses have significantly better durability than discontinued bioprostheses, reveal a detrimental impact for smoking after AVR and MVR, and indicate an increased reoperation risk in patients with a small aortic bioprosthesis or with persistent left ventricular hypertrophy after AVR.​

as of right now, if you don't want SVD then your can only choose a mechanical (and accept ACT as the tradeoff).

HTH

 

[sandra]

Thanks for the graph and the linked journal article. Relating my heart valve replacement to this, my decline has followed an almost predictable journey. Strange that my cardiologist seemed perplexed about my decline, stating that in 17 years she had only seen one other patient deteriorate so quickly in such a short space of time. My small 19mm heart valve and my younger age at first operation contributed also it would seem. Lucky I am not a smoker!

My new tissue valve will be an Inspiris Resilia. It's a newer valve and supposedly is longer lasting, and I am nine years older; Plus my surgeon is hoping to somehow fit a 21mm valve in. With these odds - I am hopeful of getting fifteen years+
And I am not about to take up smoking!

 

[Paleowoman]

Would love to know why it declined so rapidly in such a short space of time. Guess, I will get more information once they've opened me up

Hi Sandra - I do hope the surgeons will let you know the state of the valve, I should think they will be interested. Did a lot of calcification show on the transoesophageal echo ?

 

[sandra]

Hi Anne,
Not only them, I am extremely interested to know also. The TEE report did show a lot of something (calcium, pannus) especially through the middle area of the valve (sounds a bit odd to me). Most clear was the calcification of one of the leaflets of my valve. It was stiff and not moving at all. Jammed open, so a lot of regurgitation occuring. My CT images noted an aberrant origin of the right coronary artery, which arises near the origin of my left main artery, but that was there all along so not an issue (I hope).

 

[pellicle]

trange that my cardiologist seemed perplexed about my decline, stating that in 17 years she had only seen one other patient deteriorate so quickly in such a short space of time

I'd ask about the average age of her patients

see if that's a factor

 

[Paleowoman]

Hi Anne,
Not only them, I am extremely interested to know also. The TEE report did show a lot of something (calcium, pannus) especially through the middle area of the valve (sounds a bit odd to me). Most clear was the calcification of one of the leaflets of my valve. It was stiff and not moving at all. Jammed open, so a lot of regurgitation occuring. My CT images noted an aberrant origin of the right coronary artery, which arises near the origin of my left main artery, but that was there all along so not an issue (I hope).

No wonder your pressure gradients went high Sandra ! Good job they're replacing the valve now !