how to make a new heart?

[Evgenii]

Hello to the community of strong people who voluntarily decided to cut their body in half. I am 44 years old and I have known about my bicuspid aortic valve for 8 years. I also have 2 implants in my spine and other surgeries were also done by me. 3 months ago, the average pressure gradient increased to 38 and one of the hospitals concluded that a valve replacement was needed, but other hospitals continued to insist that a replacement was not yet necessary. I was offered the Ozaki procedure as a treatment and I began to look for other surgeons and ask their opinions about it. As a result, after 3 months, I found out that my fibrous ring 28-30 mm is too big and the Ozaki procedure is not the best choice for me. I don’t know what happened to me because of the stress from such news or I worked out too much in the gym and pool, but the aorta has now also grown from 41 to 43 mm and now I don’t know what to do

 

[Chuck C]

Welcome to the forum Evgenii.

now also grown from 41 to 43 mm and now I don’t know what to do

Sorry to hear this. Your situation is similar to mine, only I was about 9 years older and my aneurysm was not as large as yours. I opted for a mechanical valve, as I did not want any future surgeries. Even though my aneurysm was not at the threshold to require replacement, my surgeon knew that I wanted to be one and done, so he made a decision once he got a look at my aorta to replace it. When the valve is replaced and part of the connecting aorta as well, it is called a Bentall Procedure. It is a common procedure and many of us here have had it.

With an aneurysm of 43mm, I would strongly recommend going with a surgeon who is onboard to take care of that at the same time he takes care of your valve. At age 44, the guidelines call for a mechanical valve to give you the best chance at having a normal lifespan. However, this is a personal choice that each of us must make, in consultation with our surgeon and cardiologist.

You should know that the Bentall procedure is routine at any competent high volume hospital and the outcomes are excellent. There was even a study which found that those who get a Bentall Procedure have the same life expectancy as someone who has not had valve surgery.

Also, it sounds like you are very physically active. I was physically active before my procedure and, once I had recovered fully from surgery, I was able to resume all of my physical activities, including running, lifting, biking and martial arts.

Best of luck in your valve replacement journey.

 

[Evgenii]

Welcome to the forum Evgenii.


Sorry to hear this. Your situation is similar to mine, only I was about 9 years older and my aneurysm was not as large as yours. I opted for a mechanical valve, as I did not want any future surgeries. Even though my aneurysm was not at the threshold to require replacement, my surgeon knew that I wanted to be one and done, so he made a decision once he got a look at my aorta to replace it. When the valve is replaced and part of the connecting aorta as well, it is called a Bentall Procedure. It is a common procedure and many of us here have had it.

With an aneurysm of 43mm, I would strongly recommend going with a surgeon who is onboard to take care of that at the same time he takes care of your valve. At age 44, the guidelines call for a mechanical valve to give you the best chance at having a normal lifespan. However, this is a personal choice that each of us must make, in consultation with our surgeon and cardiologist.

You should know that the Bentall procedure is routine at any competent high volume hospital and the outcomes are excellent. There was even a study which found that those who get a Bentall Procedure have the same life expectancy as someone who has not had valve surgery.

Also, it sounds like you are very physically active. I was physically active before my procedure and, once I had recovered fully from surgery, I was able to resume all of my physical activities, including running, lifting, biking and martial arts.

Best of luck in your valve replacement journey.

thank you for your kind words
where can i read about the quietest mechanical valves?
Does warfarin therapy cause complications such as hemorrhoids and others?
what is known about J-Sternotomy and how much better is it than the classic approach
Should I look for a surgeon who will install a biological valve or do plastic surgery?

 

[pellicle]

Good Morning

where can i read about the quietest mechanical valves

Here's the thing I've observed in the years I've participated here: mechanical valve noise is highly individual, there is apparently no relible correlation between valve brand and noise, noise is louder in the first months after surgery (when everything is still inflamed).

My guidance is pick the valve with the longest history , however there is really nothing between them. I suggest you read this post and the linked study

https://www.valvereplacement.org/threads/aortic-valve-choices.887840/page-2#post-902334

Best wishes

 

[Chuck C]

where can i read about the quietest mechanical valves?

It seems to vary person to person. I have a St Jude and mine is very quiet. I rarely hear mine unless I take deep breaths. Others report that they can hear their St Jude. Same with On-x. Some report that it is quiet and others find theirs is loud. Even for those who can hear their valve, it seems that the vast majority report that they get used to it.

Does warfarin therapy cause complications such as hemorrhoids and others?

I've been on warfarin almost four years and I've never experienced anyone reporting that it causes hemorrhoids. If one has a bleeding hemorrhoid and is on warfarin, it might bleed more compared to if they were not on warfarin, but the warfarin would not likely be the cause of the hemorrhoid.

what is known about J-Sternotomy and how much better is it than the classic approach

There are pros and cons to the minimally invasive incisions. There will be a quicker healing time of the surgical opening, but the negative trade off is that the surgeon has limited access. Sometimes once they get in there they discover over things that need to be done and need to to a full sternotomy to get better access. That means more time on the heart and lung machine, which is not good. In that you have a 4.3cm aneurysm, you will probably be getting a Bentall Procedure, with part of your aorta replaced. It might be possible for your surgeon to do a Bentall through such a small opening, if he is extremely skilled, but if it were me, I would opt for the full sternotomy so that he has better access. Personally, I had a mini-sternotomy and I did get a Bentall Procedure, but I suspect that if my surgeon knew going in that he was going to do a Bentall, he might have opted for the full sternotomy. I've never asked him that question.

Should I look for a surgeon who will install a biological valve or do plastic surgery?

I'm not sure what country you are in, but in the US your surgeon will likely give you a tissue valve if that is what you want. They do that all the time for patients in their 40s, even though it is not recommended by the guidelines. The patient's choice trumps the guidelines.

 

[dornole]

thank you for your kind words
where can i read about the quietest mechanical valves?
Does warfarin therapy cause complications such as hemorrhoids and others?
what is known about J-Sternotomy and how much better is it than the classic approach
Should I look for a surgeon who will install a biological valve or do plastic surgery?

I just had mitral valve replacement in October, chose mechanical because that’s the guideline and I don’t want repeated surgeries. I am 56. So I personally would not look for someone to do a bio valve when you are 44 unless there is a good reason for example you have a disease that means warfarin would be bad for you - a bleeding disorder,or maybe a mental health or substance use disorder that means taking pills daily and testing every couple weeks would be a challenge for you.

I haven’t noticed any effects from warfarin. No hemorrhoids. In fact I bruise less than when on aspirin. Small cuts seem exactly the same.

You do need to test your INR and keep it in range because if your blood is not anticoagulated properly you can have bleeds or strokes. It is not super hard but you can’t be lackadaisical about it.

I had the full sternum version of OHS and honestly I don’t think that incision was the biggest issue. More just the heart needing to recover and the lungs needing to recover from being on the machine. I was Tylenol only long before I left the hospital and basically no pain meds at all once home. 12 weeks out sternum is a non issue. Personally I chose a surgeon who was capable with a lot of experience, got the valve that he and the national guidelines recommended and let him put it in the way he thought would have the best result.

I think the Bentall advice you got makes sense though I do not have aortic issues

Hope this helps

 

[Evgenii]

Guys, thank you all for your answers! Do any of you smoke cigarettes or did you smoke before the surgery? How are things going with that? Will it be possible to smoke after they allow you to walk?

 

[Evgenii]

ascending aorta 43 aortic root at the level of the sinuses 40
aortic walls are thickened
this is what you called an aneurysm?

 

[Evgenii]

I've been on warfarin almost four years and I've never experienced anyone reporting that it causes hemorrhoids. If one has a bleeding hemorrhoid and is on warfarin, it might bleed more compared to if they were not on warfarin, but the warfarin would not likely be the cause of the hemorrhoid.

I have periodic episodes of hemorrhoids and I remember how during the times of covid from xarelta they were larger and more voluminous, this worries me

 

[Evgenii]

I had the full sternum version of OHS and honestly I don’t think that incision was the biggest issue. More just the heart needing to recover and the lungs needing to recover from being on the machine. I was Tylenol only long before I left the hospital and basically no pain meds at all once home. 12 weeks out sternum is a non issue.

I have several herniated discs in my thoracic spine and I don't know how a full sternotomy will affect this.