Salvage Aorta?

[Joe Cool]

Hello all,

You will be hearing more from me now that I have some information to work with. I got my angio done and sat down with two separate surgeons. Good news is my coronaries are great (all that exercise over the years paid off!), but of course there is the valve. They were both on the same page as far as the need for surgery, but the one surgeon suggested salvaging my aortic valve, which he thought might be OK and sewing it into a dacron aortic root. I asked him how many of these he has done and he said twelve. Also he said if he went prosthetic, that the aortic root might be OK to use still. Dr. Yokoyama, the other, more experienced surgeon said that the valve was shot and the anuerysm in the root was pretty bad requiring that to be replaced. I have a pretty good idea of which way I am going to go, but wanted input from all of your combined experience on the other end of the knife.

 

[Ross]

Joe they repaired mine when the aneurysm blew on me. I got 7 years out of the valve before needing it replaced. I did not want to go through another surgery and had no choice. My advice, if there is nothing wrong with the valve itself, it's fine to just do the aorta, but if the valve and root is messed up, go full replacement. I'm telling you, you don't want to do this again in the future.

 

[Mike C]

They both say to repair the anerysm with dacron, is that correct? I am a little confused "aortic root may be ok to use"

the optimal solution would be a valve sparing aortic root replacement if your valve is solid. also, have a backup plan if thats your decision, they may look at it during surgery and say no way, then is it tisse or mechanical and what kind.
if valve is not solid, i woudl seriously consider a tissue or mechincal valve as i am a proponent of limiting ohs, preferably to none nut i guess thats out.

 

[Joe Cool]

Mike,

Sorry I wasn't clearer on the use of the aortic root. What the one surgeon said was, that if he put a mechanical valve in that he would still try to use my root with the anuerysm, which is one of the things I am questioning. I wouldn't think it would be a good idea to keep faulty parts and from what I understand dacron is pretty good stuff. Ross expressed my sentiments in that I don't want to do this again, so I don't think I want to take a chance on my own valve even if it looks good. It is leaking now and could do it again. There is something more reassuring about carbon and titanium! I would probably go bovine if I were 60 or older, but if I did that now I would be guarenteed one or two more OHS.

 

[Ross]

Like I said, if your native valve is solid and the root is ok, use it. If questionable, replace. I'm sure the surgeon will make the right call once he's in and has had a look.

 

[rtblount]

rtblount

rtblount

If you have a bicuspid valve I would certainly opt for replacing both the valve and the root. I had a bicuspid aortic valve replaced by a St Jude mechanical valve about 8 and1/2 years ago and now have a 5.3cm ascending aortic aneurysm that will probably have to be replaced sooner than later. This appears to be a common scenario.

 

[tobagotwo]

They would likely resection the root if they were going to use it, meaning they would cut some of the largesse out of it, then stitch it back together, usually with some dacron/velour backing to permanently stabilize the work. As a mechanical valve wouldn't stretch or torque the way an original or xenograft valve could, the combination would be quite sturdy.

My thought is that there is a case for the valve-sparing approach, if you only have regurgitation (insufficiency, leakage) and not calcification. The question is how much damage has been done. That's something only the surgeon could determine at the time. I echo rtblount in believing that if the valve is bicuspid, I wouldn't attempt the save. Even if it works, the chances would be fair that it would would just be a clock ticking until you have to have it replaced anyway.

I would probably lean toward the full replacement myself. Before going in, I would want them to thoroughly check the ascending aorta for anything that even hinted at being slightly enlarged (MRA or similar), and make them promise me they would stabilize the tissue regardless of whether it was an immediate problem.

Best wishes,

 

[Joe Cool]

Thanks for all the input. I called my cardio, and feel a lot better about my decision. He didn't think the valve should be salvaged because of the leakage and there is no guarantee that it won't leak again if they repair it. The decision on the root he said would be made at the time of surgery, but more that likely it would need to be replaced. This is what I felt all along. Thanks again for all your input. Probably looking at the end of July for surgery. I'll keep you posted.