Question about Medtronics Freestyle Stentless Valve

[tigerlily]

Hello everyone,

The surgeon I interviewed recently, highly recommended a stentless valve for me and in talking to his nurse I discovered that he uses the Medtronics Freestyle and does a root replacement on all of his patients who choose this valve. She said the reason he does this is because in the early days of his working with this valve, those patients who did not have a root replacement developed problems. Somewhere on this site I read that if you have your aortic root replaced, it may limit the kinds of replacement valves you could have in the future. Can anyone explain this to me? Does this rule out a future mechanical valve? If my aortic root is healthy, would it be to my advantage to keep it?

Another thing that bothers me about this valve is that it only has about a 13 year history. So far so good though. The doctor I spoke with has done many of these valve replacements so I think he can handle the challenges of implanting stentless valves fine.

I know this is a pretty technical question but you guys seem up to it. I would be lost right now without this forum. Thank you all so much.

 

[Superbob]

This is precisely the device I received in surgery last February, but my aortic root was severely enlarged and needed replacement. The freestyle seemed a good choice to me, and so far so good. However, I have never heard of replacing the root as a preventive measure, before there are problems. I am no expert, however, and I am sure others will come along who can speak authoritatively to that.

 

[OldManEmu]

I spoke to my surgeon on this very issue however it was post operation. It all depends on your age and if a redo is likely to be required. If a redo is going to be required because the valve is going to wear out before you do, having a root replacement if it isn't necessary makes the initial surgery more complicated than it need be and makes the redo more complicated. This is because the coronary arteries have to be detached from the Aorta and then reattached to the new Aortic root; this has to be repeated on the redo. My surgeon said these types of valves are good; however he only uses them in limited situations because of the previous reasons.

 

[tobagotwo]

Well, it just goes to show that there's always someone who'll get even a good idea and then go overboard with it. With BAVs, there are a fair number of redos that are based around root enlargement. It does seem to be badly underestimated as an issue. Strictly from what I've read, it's a primary cause of Ross procedure failures as well.

If you have a BAV and show signs of enlargement or deformation of the root, or of aortic aneurisms (they can be markers for later root problems), then it makes sense. It actually is preventative of a real problem.

However, if he's just doing it for everybody, it would be very concerning.

If you have a "normal" aortic valve with three cusps, you are having the valve replaced due to stenosis from calcification, and don't have any connective tissue problems, then it's just unnecessary in my opinion. I wouldn't want it replaced under those circumstances. I have one of those roots, and if I thought there was a chance it would expand and cause issues for me later, I would definitely have fought to have it replaced. I do not believe it ever will.

If you have a BAV, but no other signs, then it's a tossup as to the value. I would still probably not want it replaced under those circumstances.

Yes, it does limit your choices later, and the surgery will take longer both this time and if or when it's done again. Whatever is chosen for the next time will have to either replace all of it, or tie into it smoothly.

The valve itself is a current-generation valve. It does have low pressure fixation and anticalcification treatments. It should last a long time. It's currently popular with some surgeons to cut the new Freestyle valves down and use just the valve as a stentless porcine valve, without replacing the root.

However, you should be sure you understand what your valve situation is first, in terms of BAV, aneuristic tendencies, and current root status, before you decide the surgeon is steering you wrong. It's not complicated information, and you should be able to get it from your cardiologist or his people, such as a nurse practitioner. Don't ask about the surgeon's approach first. Get the information first. Then if you want to ask about the surgeon's approach, you already have what you will need to make an independent decision afterwards, such as to get a second surgical opinion.

I think you are wise to look askance at this surgeon's statements. I would get the information and consider a second surgical opinion (i.e., a different surgeon) if your circumstances don't seem to merit the whole root replacement.

Best wishes,