Time for Aortic Aneurywm Repair?

[gntelbear]

Hello all.....i havent been on in some time. I had my Aortic valve replaced in 2010 with a St Jude 25MM mechanical valve. I also had a Medtronic pacemaker Implanted. At
the time I had an Aortic Aneurysm but they felt it was too small to repair then. It has been growing slowly and at my recent Cardio visit it grew from 4.6 cm to 5.0 cm. Using
the Cleveland Clinic Formula, the resulting end calculation is 11.02 . My Cardiologist wants me back in 6 months rather than a year for another CT scan and then go from there.
My Question to you all is since my qualifying number is 11.02 and greater than 10, wouldn't that signal its time for surgery? By no means am I looking forward to jumping under
the knife a second time, but I am 62 and feel it may be better to get it over with than to wait until i am the least bit older and possibly even less healthy. I'd love to hear your
thoughts on this topic, especially you who have had your Aortic Aneurysms repaired. Thanks so much......Mike

 

[pellicle]

Hi

I don't now much about this technique but it may be worth investigating ...

https://www.ncbi.nlm.nih.gov/pmc/articles/PMC3853825/

https://www.ted.com/talks/tal_golesworthy_how_i_repaired_my_own_heart?language=en

I stumbled across it in researching other things some time ago, and thought "hmm, I wonder why this isn't more common".

I don't really have anything valuable to contribute to your question but myself I'd be asking the same questions you are. I had an aneurysm repair done at the same time they replaced my aortic valve (which had been replaced earlier with a homograft in 1992). I got a mechanical valve on that surgery (2011) and hope that I won't need another.

 

[gntelbear]

Thanks so much for the reply and the web sites.

 

[Catie]

Cleveland Clinic used that formula when I consulted them. They considered my body size, aneurysm size, and the bicuspid valve as risk factors. I was over 11 and therefore their threshold; they recommended surgery, which I had 9/29. My aneurysm was 4.9 cm at largest point. I'm 5'4".

 

[rob1010]

Is this aneurysm of aortic root? I was told by Cleveland Clinic that a prosthetic heart valve and the scar tissue resulting from AVR will stabilize the aortic root and it is unlikely to become a problem. This would be true if tissue is normal. If it's thinning then different story. They told me sometimes they see patients 20 years after AVR and aortic root hasn't expanded at all. What kind of aorta repair are they suggesting?

 

[AZ Don]

Hi,
The way I looked at it, once you get close to the surgical criteria, surgery and the (small) associated risks are inevitable. I've read that beyond 4.7cm aneurysms tend to keep growing. The longer you wait the larger the (small) risk of an incident prior to surgery, so waiting increases your overall risk. Not all Dr's use the same criteria. The general guidelines say the criteria is 5.5cm (without other complications) and that there is not enough evidence to apply the bodysize criteria. Yet a number of top Dr's subscribe to the bodysize criteria so I think it has merit. If I were you I would start looking for a surgeon that subscribes to the bodysize criteria. The Cleveland Clinic Dr's do.

 

[gntelbear]

Rob, My aneurysm is of the Ascending Aorta close to the arch.

 

[Owen]

I'm surprised they chose not to repair the aneurysm at the same time as replacing the valve, especially with it's proximity to the valve. I realize the threshold is 5.5, but given your age I would have thought they would want to to one surgery instead of waiting for the aneurysm to grow, then doing another surgery.
I had a BAV and aneurysm in the same place as yours (mine started at the root and went all the way to the top of the arch), and was 5.1 . At the time (3.5 years ago), the threshold was 5.2. My surgeon said he saw no reason to wait for it to grow further when he's already in there replacing the valve anyway (now have mechanical valve.) And I'm only 47.
It would make sense (at least to me) to just get it done.

 

[Warrick]

I was told the same thing about the scar tissue stabilising the tissue, my aorta was 4.1 cm, having this on the young end theres plenty of time for this to pan out one way or the other

Researching this after surgery I found that there are many variations in what is recommended, from Cleveland clinics formula to a recommendation I read that if they were in there for the valve then 4.0 cm was the threshold. I guess repeat business is good for business.

 

[cldlhd]

Unless there are negatives with replacing the aneurysm while in there ( scar tissue? ) I can't see why they don't do this while in there if it's a size where they think it will continue to grow and need replacing one-day.

 

[David W]

Hi there

I had an aortic aneurysm and valve replacement. Im unsure of the numbers you used in your thread earlier (11.02) What does that denote. I was lucky as mine was found by chance. I was told by my surgeon on London that they would normally get someone in when the aneurysm is 5cm, mine was 6.2 cm. So i was lucky. Thats a bit weird that they didnt attend to the aneurysm when they had a play about with your valve?

 

[AZ Don]

Thats a bit weird that they didnt attend to the aneurysm when they had a play about with your valve?

It's just a different set of criteria. Not all aneurysms progress to the point that they are a significant risk. I believe there is a more aggressive criteria used to evaluate whether to fix an aneurysm when also fixing a valve, vs. when dealing with just an aneurysm. I don't know offhand what that criteria is, but it is not unusual for small aneurysms to be left alone during valve surgery. There is a new procedure in the UK that basically puts a sleeve around the aneurysm, without cutting the aorta I believe, so that might make more sense for someone with a small aneurysm who is having their valve replaced or repaired.

I had the opposite case. I have a BAV that was well functioning at the time my aneurysm needed to be addressed. It was estimated I had a 50% risk that I might someday need to have my valve fixed,