I've crossed the line into severe and need to make a decision

[newarrior]

Actually a CT scan with contrast is the most accurate and used in conjunction with a comprehensive echo. The echo's done in Cleveland are a step above in detail, from what I've experienced elsewhere.

Echo is not enough to fully diagnose the valve? I had no idea I'll have to run that by my surgeon here in Bangkok thank you.

 

[Chuck C]

Hey Chuck C, how about an update on where you are at in the process. I am close behind you, recently moved into the severe AS camp - but at age 51. Hope you are doing well!

Hi Bill.
I'm going to contact my cardiologist and my surgeon today to schedule consultations. At this point I am leaning towards getting surgery soon and I will talk it through with them. Since I am basing this on results from my last echo, I also want to get confirmation of the echo results. I have a very ovular annulus, which causes an ovular LVOT. There was a study published with individuals who have ovular LVOT, that, on average, AVA was overestimated by 29%, when measured by echo. The diameter reading to calculate LVOT area goes out the window apparently, because it assumes a circular LVOT. LVOT area is used to calculate AVA area using the continuity equation, so a low reading for LVOT diameter results in a low reading for AVA. In case any are interested, here is the publication: https://www.researchgate.net/public...VOT_and_Aortic_Valve_Area_by_Echocardiography

But, then again, my peak jet velocity and mean pressure gradient agree with the severe diagnosis. But, these are flow dependent and can increase if cardiac output increases. My HR tends to shoot up 20 to 40% above my resting HR during echo and my flow dependent numbers have bounced around a lot. So, I just want to get confirmation that I truly am in the severe category, especially since I don't see any slowing down with respect to my stamina. BTW, the above study resulted in a significant number of the participants grading being moved from severe to moderate AS.

 

[Chuck C]

Actually a CT scan with contrast is the most accurate and used in conjunction with a comprehensive echo. The echo's done in Cleveland are a step above in detail, from what I've experienced elsewhere.

I am going to request a CT scan with contrast for confirmation. I have some hope that they are overestimating my severity. 1) I have not felt any cardio slow down, even walking briskly up very steep hills 2) As I noted in another reply, I have an ovular LVOT, which very often leads to underestimation of valve area 3) velocity and mean PG are flow dependent and based on my heart rate shooting up during echo (I guess I'm somewhat anxious they'll say "it's time") there is some possibility that these are coming in higher than they should.

 

[Chuck C]

I'm new to this whole thing but I hear what you're saying about the mechanical valve you probably will not have to have multiple surgeries. Sorry to hear you're going through all this I'm glad you're still in such good physical shape and thanks for the amazing dialogue that you've inadvertently triggered. We're with you 110% along the way. Please keep us posted.

Thank you for the support

 

[Keithl]

Hi all.

I have really enjoyed being here on the forum for the past few months and appreciate all the shared experiences and knowledge. I’m 53. My BAV and moderate aortic stenosis was discovered 20 months ago. I’ve stayed in the moderate range on my echos, with AVA 1.1cm2 on my last two, but then last week it dropped suddenly to .87cm2, crossing the threshold into severe AS. Both peak jet velocity and mean pressure gradient appear to agree, at 4.2 m/s and 46mmHg. I’m being seen by a very competent team at a top valve clinic. My cardiologist has told me that we can operate now or wait for symptoms- my decision. I am asymptomatic and have not experienced any slowing down. I hike briskly up a 1,200-foot mountain daily and keep a very good pace. Occasionally my friends and I all push for time and I beat them all pretty handily, so I don’t believe that I am compensating by slowing down my pace. I feel great and have a lot of energy. On the one hand, I want to put off surgery as long as possible. On the other hand, I find the conclusion of the meta-analysis published last year in JAMA Cardiology very compelling, showing significantly improved long term outcomes when surgery was done for severe AS patients before symptoms vs severe AS patients who were symptomatic. “Early intervention was associated with a significant reduction in long-term mortality (hazard ratio, 0.38; 95% CI, 0.25-0.58).” I other words, the long-term mortality was reduced by 62%, if the surgery is done before symptoms present, in this meta-analysis of many studies- I find this result very compelling: Natural History of Asymptomatic Severe Aortic Stenosis and the Association of Early Intervention With Outcomes

My cardiologist believes that I will likely start experiencing symptoms within a year- of course, no one can say for sure when. So, if I wait for symptoms, I can possibly put it off surgery for months up to a year and possibly longer with some luck, but that day is coming soon enough in my near future. Put it off as long as possible or bite the bullet and go with the data from the meta-analysis finding better long term outcomes doing it before symptoms and get surgery now?

I welcome all thoughts, suggestions, and recommendations.

Much thanks to all.

We have a very educated board here that appreciate details, so I am editing to add the following information about my condition:
No aortic aneurism: Max aortic diameter is 3.4cm
Preserved ejection fraction: Consistently 73% to 74% per echo and MRI
LV wall thickness 1.15cm, with LV mass in the normal range

Reach out to Cleveland Clinic they will do a free consult if you tell them you may go there. They were fantastic before I even agreed to go there for surgery (although I knew I was going to get it there anyway). My guess is at 53 they will recommend mechanical, although at 58 they suggest tissue for me, even with the aneurysm replacement. I wanted one and done, so opted for On-X. I tend to lean toward do it while in best health possible. My recovered was great becasue they had been watching me for years. Surgery (full cheat crack) on a Thursday, started doing some email on Friday afternoon and Monday was sitting in chair in hospital room working 6+ hour days. I don't want to do it again, but for me it was not as bad as I thought it would be. 6 weeks of babying my chest and no turning back. By 6 weeks I was back to my 4x a week cardio workout. Do it while your body is in best condition.

 

[Chuck C]

Update: I have reached out to my cardiologist and the surgeon and have a pre-surgery consultation scheduled for next week.
I was considering getting 3D imaging, MRI or CT, to confirm my valve area, but have decided against it. Echo seems to be the gold standard for grading severity of AS and I have enough echo data to confirm that this is where I am at. I have had 5 echos in the past 20 months. There has been some variance in hemodynamic readings, but this is typical. If I throw out the outlier in each category, I get a pretty consistent progression from moderate to severe. AVA 1.0cm2; 1.1cm2; 1.1cm2; .87cm2. Mean pressure gradient: 40mmHg; 31.6mmHg; 40mmHg; 46mmHg. My peak jet velocity has progressed from about 3.1m/s to 4.2m/s.
It is very possible that 3d imagery would find my valve area a little larger than echo, but it seems like this is generally the case and one study found that the over/under threshold for 3d imagery should be 1.2cm2, with severity considered equal to or under 1.2cm2, compared to echo which is 1.0cm2 as the threshold.
It is time. I want to get it done while my heart is still in really good condition. I'm not going to wait for symptoms. Looking at the big picture, what is to gain in waiting a few months for symptoms, at the risk of permanent damage occurring during this time, or worse?

I appreciate all of the great comments and welcome any other suggestions.

 

[Unicusp]

Update: I have reached out to my cardiologist and the surgeon and have a pre-surgery consultation scheduled for next week.
I was considering getting 3D imaging, MRI or CT, to confirm my valve area, but have decided against it. Echo seems to be the gold standard for grading severity of AS and I have enough echo data to confirm that this is where I am at. I have had 4 echos in the past 20 months. There has been some variance in hemodynamic readings, but this is typical. If I throw out the outlier in each category, I get a pretty consistent progression from moderate to severe. AVA 1.0cm2; 1.1cm2; 1.1cm2; .87cm2. Mean pressure gradient: 40mmHg; 31.6mmHg; 40mmHg; 46mmHg. My peak jet velocity has progressed from about 3.1m/s to 4.2m/s.
It is very possible that 3d imagery would find my valve area a little larger than echo, but it seems like this is generally the case and one study found that the over/under threshold for 3d imagery should be 1.2cm2, with severity considered equal to or under 1.2cm2, compared to echo which is 1.0cm2 as the threshold.
It is time. I want to get it done while my heart is still in really good condition. I'm not going to wait for symptoms. Looking at the big picture, what is to gain in waiting a few months for symptoms, at the risk of permanent damage occurring during this time, or worse?

I appreciate all of the great comments and welcome any other suggestions.

I completely agree. Exactly what I'm doing right now! Heart cath in a few hours.

 

[user 15848]

At 62 i also took the OnX, no interested in "Planing" to go again to a hospital x years after because tissue failed, for me, and my 2 doctor sisters, that was the best choice at 62. Older, well 70 sure i i take the tissue, but Warfarin is just a pill, How many people take PILLS after 60 ?, sugar pills, pressure pills, etc... for me, NOT Planing another Surgery was the factor. Yes, maybe i need another surgery , but it was not "Planned" like a tissue valve; and "for me" BIG Pharma is always looking for Recurrent Revenues.... Mechs, dont brake, so less Recurring Revenue, "MY opinion" ,can be wrong or not, after all, we are not in Communist China.

 

[Chuck C]

At 62 i also took the OnX, no interested in "Planing" to go again to a hospital x years after because tissue failed, for me, and my 2 doctor sisters, that was the best choice at 62. Older, well 70 sure i i take the tissue, but Warfarin is just a pill, How many people take PILLS after 60 ?, sugar pills, pressure pills, etc... for me, NOT Planing another Surgery was the factor. Yes, maybe i need another surgery , but it was not "Planned" like a tissue valve; and "for me" BIG Pharma is always looking for Recurrent Revenues.... Mechs, dont brake, so less Recurring Revenue, "MY opinion" ,can be wrong or not, after all, we are not in Communist China.

This is what is really steering me towards mechanical. I have known about my moderate stenosis for 20 months. It was not good news to receive at the time of diagnosis and follow up echos have been no fun. It is not like you ever hear "Great news! You're getting better and your stenosis is regressing." No, it is, more often than not, "slight progression of aortic stenosis", with a list of major and minor metrics advancing. It is not a good feeling waiting for that result, and then inevitably hearing that you have worsened a little. Although the idea of returning 100% to my active life before surgery, which includes combat sports, is very appealing, I don't like the idea of hearing at some point in the not too distant future that my valve has started to deteriorate and then go through that again- bad news every 6 months until it is time. Although the mechanical valve can't promise that you will never need a reoperation, biological valve will definitely need reoperation and there is a very good chance that the mechanical valve will last for life.

 

[gpr100rs]

There are many journal articles/studies re timing of surgery. Generally, and I'm no doctor but at 62 with mean gradient of 80, peak of 129, a .6 valve area and a 4.6 cm ascending aorta, but "asymptomatic," I've tried to look at this stuff pretty closely. To me, your risk of surgery and complications thereafter outweighs your risk of waiting. That is, your risk of death or "failure" of the valve, given your active life style, etc., is likely extremely low. This is a slowly progressive disease for most. I was playing squash up to the Covid lock down. During the lock down I replaced a small section of sidewalk; I broke out the old and purchased, loaded, unloaded and mixed 20 65 lbs. bags of concrete. No dizziness, shortness of breath, etc. A surgeon who reviewed my latest echo, done 2 weeks ago, was surprised, to say the least, I don't have symptoms; but the numbers don't lie. More recently I've experienced a little "thumpiness" in my chest. In any event, it's time. Leaning heavily towards mechanical because I want one and done. Having said that, your numbers look damn good Chuck. These are not easy surgeries. I had my prostate out robotically in 2015, and that was a walk in the park compared to cracking your sternum open. Surgery was 7 am day one and I was walking out of the hospital at noon day 2. But I still have issues, but no cancer thankfully. I get you don't want to wait too long, but to me, you've got many, at least several, years before your numbers would justify the surgery risk, especially where you're doing pretty much everything you want. No idea why your cardiologist is predicting symptoms within a year; that's what mine told me at my visit 2 weeks ago, but my numbers are way worse and I'm 9 yrs older! You didn't mention where you are treating, but make sure you're with a top-tier facility and consult with a surgeon whose got, AT MINIMUM, 500 procedures under his belt. I have been followed by the University of Mich, but will be going to the Clevland Clinic for the surgery, Dr. Roselli. Good luck brother.

 

[newarrior]

Chuck--sounds like you want a one time only surgery aka mechanical, would rather do the surgery sooner rather than later and not have damage to your heart, etc etc

 

[Chuck C]

There are many journal articles/studies re timing of surgery. Generally, and I'm no doctor but at 62 with mean gradient of 80, peak of 129, a .6 valve area and a 4.6 cm ascending aorta, but "asymptomatic," I've tried to look at this stuff pretty closely. To me, your risk of surgery and complications thereafter outweighs your risk of waiting. That is, your risk of death or "failure" of the valve, given your active life style, etc., is likely extremely low. This is a slowly progressive disease for most. I was playing squash up to the Covid lock down. During the lock down I replaced a small section of sidewalk; I broke out the old and purchased, loaded, unloaded and mixed 20 65 lbs. bags of concrete. No dizziness, shortness of breath, etc. A surgeon who reviewed my latest echo, done 2 weeks ago, was surprised, to say the least, I don't have symptoms; but the numbers don't lie. More recently I've experienced a little "thumpiness" in my chest. In any event, it's time. Leaning heavily towards mechanical because I want one and done. Having said that, your numbers look damn good Chuck. These are not easy surgeries. I had my prostate out robotically in 2015, and that was a walk in the park compared to cracking your sternum open. Surgery was 7 am day one and I was walking out of the hospital at noon day 2. But I still have issues, but no cancer thankfully. I get you don't want to wait too long, but to me, you've got many, at least several, years before your numbers would justify the surgery risk, especially where you're doing pretty much everything you want. No idea why your cardiologist is predicting symptoms within a year; that's what mine told me at my visit 2 weeks ago, but my numbers are way worse and I'm 9 yrs older! You didn't mention where you are treating, but make sure you're with a top-tier facility and consult with a surgeon whose got, AT MINIMUM, 500 procedures under his belt. I have been followed by the University of Mich, but will be going to the Clevland Clinic for the surgery, Dr. Roselli. Good luck brother.

Thank you for your input. I will be going into my consultation next week with an open mind and looking for guidance, as I continue to research. You make an excellent point. I do feel really good, with no symptoms- and have stamina better than anyone I know in my age category. I have a lot of friends who hike this very steep mountain regularly- I do so about 5 days per week. It's a 1,200 foot elevation gain over 1.6 miles on the way up- which is a 14.2% grade- for a frame of reference- that really steep climb on the Tour de France is 11%. Occasionally we push for time for fun and I smoke them all pretty easily. Honestly, I am puzzled that I am able to do this if my valve is only .87cm2, but I guess the heart compensates. So, I am still a little torn. Sometimes I think that perhaps I should at least wait until I feel like I am slowing down. No one can say for certain when I will experience symptoms, but looking at the progression of my hemodynamics, I believe he is going on his experience in monitoring patients. As I have always said, I'd rather get it 6 months too early than 6 months too late. But, what if I am a few years early? This certainly is not an easy decision.

 

[Chuck C]

Chuck--sounds like you want a one time only surgery aka mechanical, would rather do the surgery sooner rather than later and not have damage to your heart, etc etc

That is certainly how I am leaning right now. But, as I process my decision, I certainly have moments where I am considering waiting a little longer- maybe get another echo in 2 months. It will be interesting to see what the surgeon has to say.

 

[Chuck C]

There are many journal articles/studies re timing of surgery. Generally, and I'm no doctor but at 62 with mean gradient of 80, peak of 129, a .6 valve area and a 4.6 cm ascending aorta, but "asymptomatic," I've tried to look at this stuff pretty closely. To me, your risk of surgery and complications thereafter outweighs your risk of waiting. That is, your risk of death or "failure" of the valve, given your active life style, etc., is likely extremely low. This is a slowly progressive disease for most. I was playing squash up to the Covid lock down. During the lock down I replaced a small section of sidewalk; I broke out the old and purchased, loaded, unloaded and mixed 20 65 lbs. bags of concrete. No dizziness, shortness of breath, etc. A surgeon who reviewed my latest echo, done 2 weeks ago, was surprised, to say the least, I don't have symptoms; but the numbers don't lie. More recently I've experienced a little "thumpiness" in my chest. In any event, it's time. Leaning heavily towards mechanical because I want one and done. Having said that, your numbers look damn good Chuck. These are not easy surgeries. I had my prostate out robotically in 2015, and that was a walk in the park compared to cracking your sternum open. Surgery was 7 am day one and I was walking out of the hospital at noon day 2. But I still have issues, but no cancer thankfully. I get you don't want to wait too long, but to me, you've got many, at least several, years before your numbers would justify the surgery risk, especially where you're doing pretty much everything you want. No idea why your cardiologist is predicting symptoms within a year; that's what mine told me at my visit 2 weeks ago, but my numbers are way worse and I'm 9 yrs older! You didn't mention where you are treating, but make sure you're with a top-tier facility and consult with a surgeon whose got, AT MINIMUM, 500 procedures under his belt. I have been followed by the University of Mich, but will be going to the Clevland Clinic for the surgery, Dr. Roselli. Good luck brother.

And yes, it is a major clinic- UCLA. I feel that my team there is very competent. They want to get the timing right, just like I do. My cardiologist has not pushed in either direction and has taken the time to go over the literature with me, discussing the pros and cons of doing it now or waiting.

 

[Unicusp]

Thank you for your input. I will be going into my consultation next week with an open mind and looking for guidance, as I continue to research. You make an excellent point. I do feel really good, with no symptoms- and have stamina better than anyone I know in my age category. I have a lot of friends who hike this very steep mountain regularly- I do so about 5 days per week. It's a 1,200 foot elevation gain over 1.6 miles on the way up- which is a 14.2% grade- for a frame of reference- that really steep climb on the Tour de France is 11%. Occasionally we push for time for fun and I smoke them all pretty easily. Honestly, I am puzzled that I am able to do this if my valve is only .87cm2, but I guess the heart compensates. So, I am still a little torn. Sometimes I think that perhaps I should at least wait until I feel like I am slowing down. No one can say for certain when I will experience symptoms, but looking at the progression of my hemodynamics, I believe he is going on his experience in monitoring patients. As I have always said, I'd rather get it 6 months too early than 6 months too late. But, what if I am a few years early? This certainly is not an easy decision.

Sounds similar to me as far as pushing physically. You may have mentioned it before, but also take a look at the measurements and comments regarding the left ventricle. It may already be slightly enlarged and at some point irreversible damage will occur. So, there are other advantages to taking action prior to worse symptoms happening. You are working your heart hard and it will respond by getting bigger, not always a good thing! Just my opinion!

 

[coffeelover]

Hi all and Chuck C! Chuck, your valve scenario of asymptomatic severe stenosis sounds like what alot of us experienced. Some of us were asymptomatic even with vigorous activity like running, etc..As for me, once I got to 'severe' stenosis I worried about passing out while running and no EMS around... where you are at with Echo results, I think your decision to pursue your surgery before symptoms is very wise.!

 

[Chuck C]

Sounds similar to me as far as pushing physically. You may have mentioned it before, but also take a look at the measurements and comments regarding the left ventricle. It may already be slightly enlarged and at some point irreversible damage will occur. So, there are other advantages to taking action prior to worse symptoms happening. You are working your heart hard and it will respond by getting bigger, not always a good thing! Just my opinion!

Good comment about the compensation of the heart- the LV enlarges in response to the increased pressure required to pump through a smaller opening. So, the story on my LV size; Back in June 2019, when I was first diagnosed with my BAV and AS, they also diagnosed me as having mild LVH, with LV wall thickness of 13mm. My AVA was 1.0cm2, but my local cardiologist told me that he felt I was probably still years away from needing surgery- I had just gone 19:20 (level 7) on their treadmill stress test and he said that he had never seen anyone go that far and that usually by the time someone is ready for surgery they can only make it a couple of minutes on the stress test. I did some research and was not convinced that he was correct, and self referred to a very well respected surgeon at Cedar Sinai to seek his opinion. This was July 2019- he looked at my echo and recommended we operate now- literally next week. His main issue was my LVH and noted that it would only get worse. I explained to him that I had read a good deal of literature on this and wondered if my borderline high BP and extreme athletic activities might be also contributing to my LVH -a condition known as athlete's heart. He was adamant that it was the stenosis causing my LVH. So, I sought a third opinion, given that the opinions so far were "many years away from surgery" to "operate now". I also set about losing 25 pounds with a goal of reducing my BP from 135/85 to ideal. I also stopped all vigorous activities and only walked for 4 months. Within 2 months I had lost the weight and brought my BP to 115/75 without meds. Well, it looks like the surgeon had it wrong, because I reversed my LVH. Within two months my LV mass was normal and my wall thickness came down to 12mm. 6 months later 11mm, then 10mm. Last echo it was 1.15mm. Although the thickness is just slightly above the normal range, at this thickness my team is not at all concerned about the current level of thickness.
I am a real believer in multiple opinions and getting opinions from major clinics that do hundreds of procedures per year. My local cardiologist would probably have me wait until I was in heart failure mode and the Cedar Sinai surgeon was literally ready to book me the very next week. I find it remarkable how different their views. I think that they both meant well.

 

[Chuck C]

There are many journal articles/studies re timing of surgery. Generally, and I'm no doctor but at 62 with mean gradient of 80, peak of 129, a .6 valve area and a 4.6 cm ascending aorta, but "asymptomatic," I've tried to look at this stuff pretty closely. To me, your risk of surgery and complications thereafter outweighs your risk of waiting. That is, your risk of death or "failure" of the valve, given your active life style, etc., is likely extremely low. This is a slowly progressive disease for most. I was playing squash up to the Covid lock down. During the lock down I replaced a small section of sidewalk; I broke out the old and purchased, loaded, unloaded and mixed 20 65 lbs. bags of concrete. No dizziness, shortness of breath, etc. A surgeon who reviewed my latest echo, done 2 weeks ago, was surprised, to say the least, I don't have symptoms; but the numbers don't lie. More recently I've experienced a little "thumpiness" in my chest. In any event, it's time. Leaning heavily towards mechanical because I want one and done. Having said that, your numbers look damn good Chuck. These are not easy surgeries. I had my prostate out robotically in 2015, and that was a walk in the park compared to cracking your sternum open. Surgery was 7 am day one and I was walking out of the hospital at noon day 2. But I still have issues, but no cancer thankfully. I get you don't want to wait too long, but to me, you've got many, at least several, years before your numbers would justify the surgery risk, especially where you're doing pretty much everything you want. No idea why your cardiologist is predicting symptoms within a year; that's what mine told me at my visit 2 weeks ago, but my numbers are way worse and I'm 9 yrs older! You didn't mention where you are treating, but make sure you're with a top-tier facility and consult with a surgeon whose got, AT MINIMUM, 500 procedures under his belt. I have been followed by the University of Mich, but will be going to the Clevland Clinic for the surgery, Dr. Roselli. Good luck brother.

I find this study very compelling. It was an older group- average age close to 80. They are all severe aortic stenosis, broken into 4 groups.
Asymptomatic and had AVR
Symptomatic and had AVR
Asymptomatic and did not have AVR
Symptomatic and did not have AVR.
This seems to be very suggestive that it is better to get surgery rather that wait for symptoms, which is what I am seeing in every outcome study I am reading. Note, the bottom line of the graph is in days, not months.

https://www.ncbi.nlm.nih.gov/pmc/articles/PMC3954323/figure/fig3/
https://www.ncbi.nlm.nih.gov/pmc/articles/PMC3954323/

 

[tom in MO]

There are many journal articles/studies re timing of surgery. Generally, and I'm no doctor but at 62 with mean gradient of 80, peak of 129, a .6 valve area and a 4.6 cm ascending aorta, but "asymptomatic," I've tried to look at this stuff pretty closely. To me, your risk of surgery and complications thereafter outweighs your risk of waiting. That is, your risk of death or "failure" of the valve, given your active life style, etc., is likely extremely low. This is a slowly progressive disease for most. I was playing squash up to the Covid lock down. During the lock down I replaced a small section of sidewalk; I broke out the old and purchased, loaded, unloaded and mixed 20 65 lbs. bags of concrete. No dizziness, shortness of breath, etc. A surgeon who reviewed my latest echo, done 2 weeks ago, was surprised, to say the least, I don't have symptoms; but the numbers don't lie. More recently I've experienced a little "thumpiness" in my chest. In any event, it's time. Leaning heavily towards mechanical because I want one and done. Having said that, your numbers look damn good Chuck. These are not easy surgeries. I had my prostate out robotically in 2015, and that was a walk in the park compared to cracking your sternum open. Surgery was 7 am day one and I was walking out of the hospital at noon day 2. But I still have issues, but no cancer thankfully. I get you don't want to wait too long, but to me, you've got many, at least several, years before your numbers would justify the surgery risk, especially where you're doing pretty much everything you want. No idea why your cardiologist is predicting symptoms within a year; that's what mine told me at my visit 2 weeks ago, but my numbers are way worse and I'm 9 yrs older! You didn't mention where you are treating, but make sure you're with a top-tier facility and consult with a surgeon whose got, AT MINIMUM, 500 procedures under his belt. I have been followed by the University of Mich, but will be going to the Clevland Clinic for the surgery, Dr. Roselli. Good luck brother.

The way valve failure progresses was described to me by two doctors, is like being on top of a hill. The road slopes gently down until it gets much steeper and then you hit the edge of a cliff and plummet to your death. People with a simple undiagnosed BAV have died running races. Lack of symptoms and being active does not mean you don't need surgery. Your imaging shows when your at the "much steeper" part of the hill. Wait too long and if you are lucky it will be unplanned surgery done while your on vacation at some small hospital.

Open heart surgery seems scary, 'cause it's your heart, but it is common and successful except in cases with severe complications.

Like you, I thought I needed an "experienced" surgeon. When I asked my surgeon how many valve replacements he did a year, he laughed and said he didn't know, because he does so many. When I asked him how many were unsuccessful, he said a few a year, but those cases had severe complications and/or very old patients and didn't apply to me, an fat man aged 55. More important than your surgeon is the team they work with. Choose a hospital you trust with depth in their surgeons, cardiologists, nurses and cardiac rehabilitation.

 

[Luckyguy17]

Excellent thread Chuck C and contributors, very informative.

To add on why certain tests.
My sept 2020 echo indicated my 10 yr old prosthetic bio aortic valve is failing and an aortic redo/replacement is needed soon, .456 was my echo result. Interventionist upon revue of echo scheduled a CT scan.
My dec 2020 CT scan with contrast, determined that an OHS procedure is less risk vs. a TAVI procedure.
Am meeting with OHS surgeon next week. By my understanding, an angiogram will next be scheduled to determine condition of arteries.
The CT scan with contrast also picked up a cyst on pancreas, so i will be scheduled for an MRI for pancreas and a follow up with a different surgical team
Two surgeries now seem likely for me and soon.