New Member/Familiar Story

[DJE4MSU]

Hello everyone. My name is David. I am 57 years "young", married and have two wonderful children in college. I am physically active (regular 3-mile jogger; SCUBA; golf). For the past 6-7 years I have had annual echos/exams to monitor my leaking (severe regurgitation) bicuspid aortic valve. My EF has been within normal ranges and there has been no LV enlargemnt ... until now. My last echo reveals that my EF has dropped to 50% and there has been some LV enlargement. This has caused my cardiologist to recommend surgery for AVR. Currently, I believe I have an isolated bicuspid aortic valve; however, I am scheduled for catheterization next week, which should tell me more.

I know the recommended minimum age for a tissue valve has been 65. Given that the C-E bovine pericardial seems to be lasting 17+ years, do you believe it is a viable option at my age? If I can talk the surgeon into considering Ross for this old geezer, would that be a consideration? Your thoughts and opinions would be greatly appreciated.

This is a wonderful forum. Everyone seems so supportive. I'm very glad to have found you.

 

[Old clicker]

Hi David

This my opinion, and I'm not trying to make up youre mind for You. For Me, I went mechanical, and so far I'm glad I did. I hope that I dont have to go through another surgery. I think if I had to have my mechanical replaced, I would go mechanical again, no matter what my age.

Good luck on youre decision, its going to be a tough one.

LeRoy

 

[Mary]

Hello everyone. My name is David. I am 57 years "young", married and have two wonderful children in college. I am physically active (regular 3-mile jogger; SCUBA; golf). For the past 6-7 years I have had annual echos/exams to monitor my leaking (severe regurgitation) bicuspid aortic valve. My EF has been within normal ranges and there has been no LV enlargemnt ... until now. My last echo reveals that my EF has dropped to 50% and there has been some LV enlargement. This has caused my cardiologist to recommend surgery for AVR. Currently, I believe I have an isolated bicuspid aortic valve; however, I am scheduled for catheterization next week, which should tell me more.

I know the recommended minimum age for a tissue valve has been 65. Given that the C-E bovine pericardial seems to be lasting 17+ years, do you believe it is a viable option at my age? If I can talk the surgeon into considering Ross for this old geezer, would that be a consideration? Your thoughts and opinions would be greatly appreciated.

This is a wonderful forum. Everyone seems so supportive. I'm very glad to have found you.

David,
I would only go with a tissue valve if you're prepared to have a second surgery. When I had my bovine valve implanted(I'm 53), I shared a room with a marvelous lady who had a porcine implanted at the age of 78, and was back at the age of 90. She was adamant that she wanted another replacement, but no one really wanted to operate.
I also planned to have the Ross Procedure, and the surgeon I consulted was enthusiastic about my chances of having a successful one; however I was throwing small clots before surgery and decided to go with a replacement instead. I believe your age puts you in the borderline category, but if your surgeon is resistant, you might contact Dr. Paul Stelzer in New York for his opinion.
You sound like you're in very good health, so whatever your choice, I know you will do well.

 

[geebee]

Welcome David,
I don't know enough about the Ross to give out information. I think it can last a very long time but I am not sure. There will be others along who can let you know.
You are at a tough age for a valve decision. It is unlikely a tissue valve would last your lifetime. A mechanical should but there are never any guarantees. You just have to weigh the options and come up with the answer you feel you can live with.
We will help you get through.
Best of luck.

 

[ALCapshaw2]

Whatever you choose as your First Choice, be sure to have a SECOND Choice, "just in case". I wanted a Bovine Pericardial, and my surgeon agreed, but after opening me up, he deemed that the Bovine Valve for ME and implanted a St. Jude Mechanical.

I would give one of the third generation Mechanical Valves (On-X, Sorin, xxx - can't remember the 3 letter brand)serious consideration either as a first or second choice. Do a SEARCH for On-X to review previous posts on that valve and links to their (and other) manufacturer's websites.

'AL Capshaw'

 

[aussigal]

Hi David!

I just wanted to welcome you to this wonderful place thats become our second home...

You will get plenty of support and lots of wonderful advice to think thru as you learn in this very special club

I cant offer any advice on which valve to chose other than chose the one you can live with best...others who have already climbed the mountain will be along to offer clues on the differences between tissue and mechanical...

I at 41 will definately be going mechanical as they havent perfected the kangaroo-valves yet for them to be a viable option! (I want to do all I can to avoid further surgery).

Ask lots of questions...that way you will get lots of answers!

 

[xbxb]

Valve

Valve

One thing you may want to check is to see if a Tissue Saving Aortic Valve Repair is an option.
I had a repair and root replacement last August. There is very little data - my older surgeon had only done 15 in his whole career- with no failures. Before I had my surgery at the Mass General in Boston. I had 3 other opinions - all from surgeons who had done the repair - The Cleveland Clinic, Texas Heart Institute, Brigham and Woman's before choosing MGH. The thinking is it is your own valve. I was told a 50-80% chance of repair before the surgery by all the opinions from other DR's. After my TEE test my surgeon thought there was an 80% chance of repair was possible.
The Ross was discussed but for the surgeons I spoke with before the surgery - they did not feel it offered me many benefits - especially if a repair was an option. Part of this may be be because most of them did not do many Ross procedures.
You need to find a surgeon that has done an Aortic Valve Tissue Saving Repair. There is very little data - and what data is available is old. Most have not - and automatically replace them. Your own valve cannot be stenotic for them to try a repair.
I would suggest making a list of pros and cons on the options that are available. An animal valve is hoped to last as long as 20 years however 12 -15 may be more realistic. My surgeon was extremely conservative and he said a lot of data on the new "treated" valves is marketing hype and they just don't know how long they will last. 20 years if your lucky but, their is a very realistic chance it most likely will be less. That said I had chosen an animal valve if a repair was not possible. I was quite active and did not want to change my lifestyle at all, and the Aorta specialtist I see - in his words "does not fear a second surgery", knowing I would have it at an experienced hospital - even though the risk factor goes up on the second surgery.
At the end of the day this is your decision, go with your gut feeling and once you do don't look back.
FYI - 50% of people with bicuspid valves also need a root replacement. Good Luck.

David

 

[DJE4MSU]

Familiar Story/Update Following Catheterization

Familiar Story/Update Following Catheterization

Hello all. David again. I underwent a catheterization yesterday (3/24). The good news is that I appear to have isolated bicuspid aortic valve, with minimal calcification and minor root and aorta dialation. The surgeon has given my cardiologist an initial opinion that even at my age (57) he considers me a good Ross candidate (formal meeting with the surgeon is next Wednesday, 3/39). I keep telling myself to "keep it simple stupid". Consequently, I am leaning toward a C-E Perimount Magna (bovine pericardial), with stabilization of the root and aorta. What concerns me about Ross is the risk of re-surgery for the pulmonic replacement. If I may need a second surgery in any event, why implicate a second heart valve?

Thanks for your thoughts and opinions. As you all know from experience, this is a difficult decision. The information gained from this forum, however, has made the process easier.

 

[gijanet]

Congratulations

Congratulations

on the good news. I hope the surgeons concurs. If you put in Ross under the search function, you should be able to pull up some threads pertaining to the Ross. WE will be looking for updates. Many hugs. Janet

 

[DJE4MSU]

Choice Made/Surgery Scheduled

Choice Made/Surgery Scheduled

Hello, all. This is David, the individual who started this thread. After much reasearch, reflection and a conference with my surgeon I have decided to get the Carpentier-Edwards Perimount Magna pericardial valve, rather than a Ross Procedure. I could not get away from the idea that I should "keep it simple stupid." I realize I may require one more valve, but I am willing to assume the risk of a second surgery for the life-style advantages of a tissue prosthesis. The surgeon indicated he would first explore possible repair, then proceed to valve replacement if repair was not feasible. My surgery is scheduled for April 17 -- now the dreaded waiting period!!

I am fortunate to have very supportive wife and children. I can't imagine having to go through this process without family.

I really want to express my appreciation to the members of this forum. The information and support found here were very helpful. This site made a difficult and trying decision a little easier. Thank you, all.

 

[Mary]

David,
I'm glad you were able to arrive at a decision. I will put you on the calendar for April 17. Don't forget that we're here when you have questions.
Good luck!