Captain Cavemen
Member
- Joined
- Jun 4, 2021
- Messages
- 21
So yesterday had a Private Consultation with the surgeon from the Royal Brompton simply one of the nicest, caring and most professional people I have ever spoken to in 51 years on this earth. We discussed the previously given options at length and we came to the following conclusions:
1. Mini-sternotomy plus Osaki Procedure + Ascending Aorta Replacement may last a long time then TAVI or future variation of.
Not really for me reserved mainly for some of his (the surgeons) Middle Eastern clients who when paying fully for their surgery (It’s expensive) are very particular about what objects they like being put into their bodies. I think these clients see the Osaki as being a more natural solution. The reliability of the operation is good but for my taste slightly unpredictable, can accept TAVR but also possible OHS.
2. Ross Procedure with probably median sternotomy, future TVAR or equivalent
Surgeon has excellent results (often >20 years) with the ROSS or Modified Ross when repairing aneurysms but it is the old why compromise another valve problem. It is an option but possibly not for me.
3. Edwards Resilia plus Ascending Aorta Replacement via Mini-sternotomy. Hope for 15-20 plus years out of the valve then as surgeon stated most if not all valves will be polymer based and replaced via percutaneous methods. Surgeon stated that the Foldax Tria as a TAVR looks promising.
The surgeon can do Aortic Valve and Aneurysm repair via a 4-6cm Mini Sternotomy with the Edwards Resilia Valve. In fact he typically does >95% Aortic, Mitral Valve and Aneurysm surgery using minimally invasive methods. Interestingly they have done some trial operations using right anterior thoracotomy (3-4cm) for Aortic Valve and Aneurysm replacement with excellent results e.g. Home after 3 Days and back at work after 2 Weeks. In essence, they inflate you like a balloon and he said you are quite big and accessible on the inside once this is done. Sadly not yet widely available. In the future, he anticipates using this approach for full Root and Arch replacements quite amazing really. In my age group he is almost exclusively fitting the Resilla Valve (80%) / mechanical valve (20%) and (when I was confident he is not in the pocket of the manufacturer to which he gave me a weblink to all his external interests and payments) we had a long conversation about the Resilia valve technology and its pedigree. He has fitted the Magna Ease on which the resilla is based for 14-15 years as he was part of the trials process. This valve has shown excellent life expectancy and they are expecting typically 15-20 years for most of his patients so he has great confidence in the Inspiris Resilia valve bettering this performance. I asked him about early SVD in tissue valves and he said possible but rare the deal he said is his patients are typically very compliant with diet, weight, drinking, exercise, strict blood pressure control and taking statins plus I think he said daily aspirin e.g. they look after themselves. Typically these valves fail to a regurgitative or stenotic state over a very long period and fail by so called 'graceful degradation' and not suddenly but yes something needs to be done at this stage. Additionally he no longer uses Warfarin at all for Afib post op for these tissue valves preferring alternative drugs and targeted ablation which he said works in a very high (>98%) of patients with no INR monitoring or dietary restrictions (not as I understand there really is with Warfarin as you dose the diet). So the logic is I'm 51 assume 15 years from the valve (I'll be 66 if it did last 25 years that would be 76) and then TAVR or if need be a less invasive surgery again (My wife’s uncle had AVR with a zipper at 79 as was / still is fine in fact it Turbo Charged him he is now 87). In terms of TVAR he said in reality in 15 years time almost all Aortic Valve and Ascending Aneurysms will be repaired via sutureless replaceable valve implantation via TAVR (likely tissue but possible polymer) and the Aneurysms repaired via custom stent grafts inserted in Hybrid Cath Labs they are already starting to do this its quite amazing in the consultation he said they can position these stents within 100th of a mm: Nexus stent | Royal Brompton & Harefield Hospitals Specialist Care (rbhh-specialistcare.co.uk)
4. Mini-sternotomy proven tech mechanical valve + Ascending Aorta. Replacement in future via less invasive method e.g. right anterior thoracotomy
Essentially as option 3 he has the full choice of mechanical valves but if valve fails (really by pannus growth, infection as I understand he has professionally never seen a mechanical failure of a mechanical valve as the main failure mode would be fatigue and the valve mechanism, materials and Duty Cycles are designed below the materials Endurance Limits for those who are materially minded so it can never physically fail in this way), will need surgical replacement admittedly via a minimally invasive surgery. Good results with possible (but not guaranteed) lifelong fit but requires diligent anticoagulation control within recognised therapeutic range he prefers INR 2.5-3.5 possible alternatives to Warfarin on the horizon but yet to be approved for heart valves I think these may not be active on Vitamin K and hence no dietary restrictions and I think he said you would not even need to monitor INR just take a pill a day (sorry I was on information overload at this point). Also some expected limitation in activities e.g. Contact Sports. Ahh the infamous ticking he said there is no real answer for some not a problem, others it drives to despair. This is another area where they are investigating anti phase noise cancellation to limit the impact but tech way off yet.
In summary this was an awful lot to think about but I'm trying to take not only my surgeons advice but also this forums members valuable experiences into consideration. Its a bit rambling but I think option 3 is my personal preferred option but I'm still thinking it over.
1. Mini-sternotomy plus Osaki Procedure + Ascending Aorta Replacement may last a long time then TAVI or future variation of.
Not really for me reserved mainly for some of his (the surgeons) Middle Eastern clients who when paying fully for their surgery (It’s expensive) are very particular about what objects they like being put into their bodies. I think these clients see the Osaki as being a more natural solution. The reliability of the operation is good but for my taste slightly unpredictable, can accept TAVR but also possible OHS.
2. Ross Procedure with probably median sternotomy, future TVAR or equivalent
Surgeon has excellent results (often >20 years) with the ROSS or Modified Ross when repairing aneurysms but it is the old why compromise another valve problem. It is an option but possibly not for me.
3. Edwards Resilia plus Ascending Aorta Replacement via Mini-sternotomy. Hope for 15-20 plus years out of the valve then as surgeon stated most if not all valves will be polymer based and replaced via percutaneous methods. Surgeon stated that the Foldax Tria as a TAVR looks promising.
The surgeon can do Aortic Valve and Aneurysm repair via a 4-6cm Mini Sternotomy with the Edwards Resilia Valve. In fact he typically does >95% Aortic, Mitral Valve and Aneurysm surgery using minimally invasive methods. Interestingly they have done some trial operations using right anterior thoracotomy (3-4cm) for Aortic Valve and Aneurysm replacement with excellent results e.g. Home after 3 Days and back at work after 2 Weeks. In essence, they inflate you like a balloon and he said you are quite big and accessible on the inside once this is done. Sadly not yet widely available. In the future, he anticipates using this approach for full Root and Arch replacements quite amazing really. In my age group he is almost exclusively fitting the Resilla Valve (80%) / mechanical valve (20%) and (when I was confident he is not in the pocket of the manufacturer to which he gave me a weblink to all his external interests and payments) we had a long conversation about the Resilia valve technology and its pedigree. He has fitted the Magna Ease on which the resilla is based for 14-15 years as he was part of the trials process. This valve has shown excellent life expectancy and they are expecting typically 15-20 years for most of his patients so he has great confidence in the Inspiris Resilia valve bettering this performance. I asked him about early SVD in tissue valves and he said possible but rare the deal he said is his patients are typically very compliant with diet, weight, drinking, exercise, strict blood pressure control and taking statins plus I think he said daily aspirin e.g. they look after themselves. Typically these valves fail to a regurgitative or stenotic state over a very long period and fail by so called 'graceful degradation' and not suddenly but yes something needs to be done at this stage. Additionally he no longer uses Warfarin at all for Afib post op for these tissue valves preferring alternative drugs and targeted ablation which he said works in a very high (>98%) of patients with no INR monitoring or dietary restrictions (not as I understand there really is with Warfarin as you dose the diet). So the logic is I'm 51 assume 15 years from the valve (I'll be 66 if it did last 25 years that would be 76) and then TAVR or if need be a less invasive surgery again (My wife’s uncle had AVR with a zipper at 79 as was / still is fine in fact it Turbo Charged him he is now 87). In terms of TVAR he said in reality in 15 years time almost all Aortic Valve and Ascending Aneurysms will be repaired via sutureless replaceable valve implantation via TAVR (likely tissue but possible polymer) and the Aneurysms repaired via custom stent grafts inserted in Hybrid Cath Labs they are already starting to do this its quite amazing in the consultation he said they can position these stents within 100th of a mm: Nexus stent | Royal Brompton & Harefield Hospitals Specialist Care (rbhh-specialistcare.co.uk)
4. Mini-sternotomy proven tech mechanical valve + Ascending Aorta. Replacement in future via less invasive method e.g. right anterior thoracotomy
Essentially as option 3 he has the full choice of mechanical valves but if valve fails (really by pannus growth, infection as I understand he has professionally never seen a mechanical failure of a mechanical valve as the main failure mode would be fatigue and the valve mechanism, materials and Duty Cycles are designed below the materials Endurance Limits for those who are materially minded so it can never physically fail in this way), will need surgical replacement admittedly via a minimally invasive surgery. Good results with possible (but not guaranteed) lifelong fit but requires diligent anticoagulation control within recognised therapeutic range he prefers INR 2.5-3.5 possible alternatives to Warfarin on the horizon but yet to be approved for heart valves I think these may not be active on Vitamin K and hence no dietary restrictions and I think he said you would not even need to monitor INR just take a pill a day (sorry I was on information overload at this point). Also some expected limitation in activities e.g. Contact Sports. Ahh the infamous ticking he said there is no real answer for some not a problem, others it drives to despair. This is another area where they are investigating anti phase noise cancellation to limit the impact but tech way off yet.
In summary this was an awful lot to think about but I'm trying to take not only my surgeons advice but also this forums members valuable experiences into consideration. Its a bit rambling but I think option 3 is my personal preferred option but I'm still thinking it over.
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