Major Confusion-HELP PLEASE

[djexec]

Hello again,
I am scheduled for surgery in less than 10 days to correct my ascending aortic aneurysm and possibly have my BAV replaced as well. My aneurysm measures 5.2 and i have mild aortic insufficiency. Well, today I received a call from the nurse of Joseph Coselli, who operated on my father in 1998 for the same condition. Since he knows some of our family history and since he is renowned in the field of aneurysm repair, I sent him my most recent echo report along with the cd rom of my cardiac MRI and asked him to give me his expert opinion of whether he would recommend surgery now or later. According to his nurse, his recommendation is to wait until my aneurysm reaches 5.5 or until there is significantly more leakage from the valve. My head is spinning as I have mentally been preparing for this surgery for the past couple of months.

I feel quite certain that the overwhelming majority of you would still recommend that I go forward with surgery but this news has definitely given me some uncertainty regarding timing and Im wondering if any of you have any suggestions. I am prepared to go forward with this surgery if it is indeed whats best, BUT now I am somewhat confused. Any thoughts?

Deane

 

[Karlynn]

We have a few members who's aneurysms blew at 4.8 and were lucky enough to survive. 5.0 seemes to be the readily accepted standard. 5.5 is pressing your luck.

I'm glad you are going ahead with your surgery. It's not going to get better, so you might as well get it fixed. I would shut out any uncertainty of whether you are making the right choice.

My Mom died suddenly from an undiagnosed ascending aortic aneurysm. I would have been very interest to know what the size was prior to it discecting.

Best wishes!

 

[PJmomrunner]

Oh for crying out loud! Should I? Shouldn't I? Is it too soon? Am I too young? Is it best to wait?

I certainly feel your pain--just when you were about to resolve things! If it were me I don't think I could handle going back into waiting mode having finally arrived at a decision...but I'd force myself to examine the relative benefits of both surgeon's recommendations. I don't suppose you could get Coselli to talk to your surgeon? I do wonder why you sort of second-guessed your surgeon...did you have second thoughts anyway? I'm guessing your valve is in pretty good shape and your surgery was scheduled mostly based on the size of the aneurysm? Personally, I'm waiting for 5cm and both: a. can't wait until I get there (to get rid of the time-bomb in my chest) and b. am doing everything possible to see that I never get there (like BP control and living within my restrictions), so I'm really no help at all!

Another random thought: Coselli is definitely a guru (I think he was Rachel Howell's go-to guy???), but is he more the guy for last-ditch efforts and accustomed to taking greater risks than you (and most surgeons) might be comfortable with?

 

[Mike C]

My opinion is have the surgery now...most surgeons agree on the 5.0 as the mark for people with BAV's. The number has come down as the risks of heart surgery have come down. Look aroung the web at major hospitals.

At 5.5 you start to get near the number that they would do the surgery right away. MGH will not let you go home over 5.5.

Its not going to get any better, only worse so you will need surgery its just the timing. If you have surgery now, the mortality and complication rate is low, if its dissects it is much higher.

Mine was repaired at 5.2, everyone said get it repaired right now because we do not know how quickly it was weakening. Surgeon said he would feel comfortable waiting a couple of months. After surgery, first thing he said, you made right decision at right time, the tissue was very thin.

 

[djexec]

Thanks for the quick replies. PJ, I was not second guessing my surgeon, Coselli just took a long time to get back to me. Almost 2 months to be exact. As for whether Coselli is more of an emergency surgeon, I am not sure. My father went to him on an elective basis and from what I know, he is one of the best known "aneurysm guru's" around. Like you, I am a youngun at least I like to think we are...I am 36 years old and my aneurysm was diagnosed when I was 29. Since that time, neither my aneurysm nor my aortic insufficiency has gotten any worse. Also, I might add that my father and 2 uncles, both had the same condition and were operated on in their mid 60's. I'm still leaning towards getting this behind me but I may try and get one more opinion. Again, I welcome all your thoughts and comments.

Deane

 

[Granbonny]

Deane

Deane

I would still go with Dr. Wolfe..Get it done now at St. Joseph's in Atlanta. I re-read to make sure..one of your November posts. Dr. Wolfe is a partner with my surgeon. Great surgeons..10 of them..and great hospital. 5 star Nurses.. ...Why wait?........Bonnie

 

[carista]

I agree you should go ahead and get it done also...better safe than sorry right?

Carista

 

[tobagotwo]

I agree with the 5.0 standard. It really seems to be a dividing point. No offense to the good surgeon, but two months to get back to you?

My opinion is that time is danger at this point. Can he fix it after it gets larger than 5.5? I'm sure he can. But can he guarantee your aneurism will make it to 5.5 without dissecting?

My vote: Git 'er done!

Best wishes,

 

[Mary]

I'd pose the questions that have been raised in this thread to Coselli. If you have been at this same measurement for 7 years, you probably have time to wait for his answer.

 

[aussigal]

I am going to hop on-side with the others who have offered their thoughts...

I have also read how theyve lowered the threshold due to advances and all...and also how they are wanting to intervene before any Aortic Insufficiency appears so as to avoid subjecting the heart to less than ideal conditions, instead now it improve things for the future of the patient if they are operated on BEFORE....

kinda like fix the broken wheel before you break your car....

some of the material I have been reading is suggesting thresholds even lower than the popular vr.com standard 4.8 ..

go-on be a trail-blazer...I'll swap turns with you but you have to agree to feed my 3 kids

 

[ALCapshaw2]

Do a Benefit - Risk comparison of waiting vs proceeding.

Risk: It might BLOW and / or your heart condition may deteriorate.

Benefit: You get to agonize longer over your decision and fears. This is a benefit??? I don't think so.

It will NOT get any better without surgery.

SO, what are you waiting for? Get it fixed.

'AL Capshaw'