Second time around, with a new wrinkle

[Guest]

Hello folks. A recidivist here, on his second time around.

I developed (or was recognized with) aortic stenosis back in the 1990s, joined this forum -- and benefited greatly from it -- in 2000-2001... and ended up getting a bovine valve in September 2001, a scarce week or two before 9/11. The valve has functioned very well and lasted wonderfully: now closing in on its 16th anniversary as I leave my own 75th in the rear view mirror, with no signs yet of breakdown or shortness of breath. How long can these things last, anyway? I suspect that I am pushing the envelope and don't think we'll see many more St. Patrick Days before it's time for the Replacement.

There appears to be one complication, though, that others of you may have experienced. My cardio -- the same who treated me leading up to and after the first operation -- says that, while the bovine valve is holding out famously, my upper aorta is widening. That, I gather, means that the whole shooting match may need to be replaced when the time rolls around, not just the valve itself. And that is definitely a more complex operation, from what I understand.

If anyone out there has related experience, I'd appreciate knowing a bit more about what to expect.

 

[Nasredin]

Don't know how I came out simply as "Guest." Must admit that I've forgotten most of the routines on the forum. In any case, my user name is Nasredin.

 

[Paleowoman]

Hi Nasredin - Nice to hear that your bovine valve has lasted as well as it is doing, but sorry to hear your aorta is widening and that “the whole shooting match” may need to be replaced when the times comes for your valve to be replaced.

I am not in that situation yet but will be in a similar one according to my surgeon. My aortic valve was replaced with a bovine valve three and a half years ago when I was 60. I’ve been having rising pressure gradients and it turns out that the valve I was given, a 19mm one, is too small. To fix this problem I will need an aortic root replacement so that a bigger valve can be put in. I do not know the timeline for this - the surgeon writes in his report that the “risks are not justified at this stage” so I’m being closely monitored with echoes six monthly. I’m not quite sure why the surgeon says I will need a root replacement rather than a root enlargement which would be a safer surgery (my ascending aorta is also getting "dilated" - maybe that's why - I will have to ask next time I see surgeon). Aortic root replacement is definitely a very complex operation from what I’ve been advised - advised by other doctors. In aortic root replacement surgery the coronary arteries have to be disconnected from the aortic root and then reconnected to the replacement, the new valve is put in replacement aortic root. That’s a very simplified version of what happens, suffice to say it’s a very much longer and more complex surgery than valve replacement one.

I am doing my best to find out more as doubtless you are. First and foremost I've been advised to make sure the surgeon has a lot of exerpeince of doing this type of surgery as it is very specialised.

 

[epstns]

Nasredin - I can't help much with what you should expect, but I wanted to stop by and welcome you back. I joined a few months after your surgery, and watched your posts. I finally had my native valve replaced with MOO (bovine pericardial valve) in February, 2011, so I am watching for any bovine valve recipients' experiences regarding the longevity of their valves. They told us that these should last a long time, and I'm glad to hear that yours is doing well.

It stinks that you may need more work, though.

 

[ClickityClack]

I think it's known as a Bentall procedure. You can Google it.

I had one a few months ago using an On-X Ascending Aortic Prosthesis (mechanical). They measured my ascending aorta at 5.2cm when it came out, as I recall. I know they can do the same type of procedure using a biological valve instead. I'm not sure if the bio versions come as unit or if the surgeon would sew them together during the procedure.

My surgeon was Dr. Peter Knight in Rochester NY. He's done a bunch.

 

[Nasredin]

Thanks to all for comments and to ClicketyClack for giving a name and ID to the replacement of the ascending aorta' I did Google "Bentall procedure" with interesting results. That TRIPLE intervention (replacement or aortic valve, aortic root and ascending aorta) seems called for when there are problems at all three levels. In my case, I think it is two out of the three -- aortic valve and ascending aorta but not aortic root... which seems to call for the slighly modified procedure that Dr. Thierry Carrel describes at https://www.ctsnet.org/article/comp...root-ascending-aorta-and-proximal-aortic-arch .

"Another situation that calls for the repair of the aortic root and ascending aorta is the patient that presents with severe aortic valve stenosis (either bicuspid or tricuspid aortic valve) and with post-stenotic dilation of the ascending aorta. In this category of patients, if the sinotubular junction is maintained and the aortic root diameter at the level of sinuses of Valsalva does not exceed 4 cm, the author usually proceeds with a separate aortic valve replacement and supracoronary replacement of the ascending aorta with a prosthetic graft."

More fun and games, but pretty much idle speculation until I have my next cardio appointment.