Surgery date 6-7. Great consult with D. Raissi at Cedars

[coryp]

Hello ALL,

I have taken your advice and seen Dr Raissi today (taked to Arlyss 2 days ago, she is great). I liked everything I heard from him. Here it the forecast, please chime in with your comments and thoughts I would really appreciate it;

1) I will have the entire Ascending Aorta removed
2) I will have to have a hemiarch (under circulatory arrest)
3) I will have the root remodeled (but the coronaries will remain in tact) no button
4) We will go with a EDWARDS BOVINE valve

Let's go over this a little. As per Rachel's last post the entire Ascending must be removed, mood point next, Apparently in Dr RAISSI's experience to make certain that the Aneursym does not re-occur a Hemi-arch MUST BE DONE (clamping the Aortic ARCH is not acceptable at 1-2 inches because the potential for Aneurysm is great). I like the idea of having the ROOT remodeled and not having to reimplant the coronaries (any idea if this is better), sounds better to me.
The last part is the valve selection, I was hoping to go with a Tissue but from what I have read 7-12 years would be the max it would last esp at my age. But I was as you may have read concerned about taking the Coumadin and the other issues regarding the mechanical, well he made it real simple, he suggested that BICUSPIDS (like me) usually with tissue disorder (like me, now I understand thank you Bob) do not do very well on Coumadin long term for many reasons. Also my blood type is 0- and very thin (he said that is also quite common is Bicuspids. We discussed the Porcein vs Bovine and he almost uses Bovine Edwards exclusively, sighting that 96% of patients will get 20 years out of this valve (exactly what I wanted to hear). Actually I went in thinking that if I could get him the committ to 15 years it may very well be worth going with the tissue vs the mechanical for just a few years difference and freedom from the changes. He gave me more than that I feel that if I am able to last 15-20 with this valve then I will be about 55 when I need the next (and hopefully final) valve replacement and at that time he said most should be done by cath, so the real fear of having to do another OPS is greatly reduced.

A few others on this site have voiced similar points and one individual from Texas (sorry I forgot your logon, but I will find it and post you directly) is about to make the same decision.

Please respond with your feedback to this post with thoughts and opinions. I have not finalized officially but we are looking at a surgical date of the 6/7. I feel pretty good now, first time since starting with the surgeons.

Thank you

 

[Granbonny]

Cory

Cory

I put you on our VR.Com calendar...Same date..as Mary is havingher surgery..she lives in Mo...and a favorite member..so many good wishes will be coming for the 2 of you that day.. Bonnie

 

[tobagotwo]

You give up on your threads too early, Cory. Rachel, Mary, Robhol and I replied to your previous thread.

Just to chime in a few more notes, in a choice between the excellent porcine Mosaic (which I have) and the also excellent bovine Edwards Perimount Magna (or another from that series), based on the desire for the longer-lasting one, I would also choose the bovine, as your surgeon has suggested.

I am glad that you have had an opportunity to discuss your prognosis and the most appropriate approaches to your personal situation with an interested and expert surgeon. After all, no one standing on the sidelines can know exactly what your circumstances are, and it's tough to pitch worthwhile advice to a somewhat complex case from the bench. There are some things, I'm sure your surgeon told you, that even he won't be completely certain of until he is actually there firsthand. The good part is that he sounds like a real pro, and he will know what to do when he gets there.

I can't say I'm terribly disappointed about the idea of you going tissue, something that was important to me as well. However, I have only one reoperation to face at my age. I did feel it was important for you to fully explore your options and understand the slightly more exotic factors that go into the decision when the aorta is also involved.

I am interested to hear about your surgeon's theory regarding bicuspids and long-term Coumadin (warfarin) anticoagulation therapy. Maybe sometime after your surgery: you have more than enough to think about right now.

Can the bovine tissue valve go twenty years? Theoretically. The problem again is age, where younger people go through tissue valves faster than us old fogies. There aren't that many who have had these valves (actually, their immediate - and untreated - predecessors) at all for twenty years, so there may have been some hyperbole in your surgeon's statement. Edwards claims a 90% retention at 18 years rate, 80% at twenty. But the large majority of the patients in those studies, and probably most of your surgeon's patients, are twice as old as you, so the age bias is built in to those figures.

The new anticalcification treatments, which have been out for less than two years, should help these valves last longer, but it is not very likely that you'll get a whole twenty out of it this time around. However, I believe you would not have to face the "five-years-and-out" issue you heard about anymore, either.

I am impressed that you have adapted yourself to do this exploration as rapidly and well as you have. It is a difficult series of discoveries to have to assimilate about yourself, and is very emotionally draining.

I wish you well,

 

[hensylee]

Goodness, two of our most prolific posters having surgery the SAME DAY! We will be discombobulated without you. Hurry back - if you can. You have been in the waiting room for some time now; who have you left in charge to be sure there's fresh coffee/tea/snacks? Blessings to you. We'll have your send off wishes in another thread.