Upcoming: ascending aorta and valve replacement

[Nasredin]

I am an earlier participant on these forums, now age 77 (my lucky year ), who had an aortic valve replacement way back in 2001 and received a bovine insert. It has done swimmingly: though predicted to last 12 years, the valve has reached its 19th year... but is now a candidate for replacement once again. The complicating factor is that at the same time my ascending aorta has been dilating and is near the limit, so in all likelihood I will be heading sometime this year for a double replacement procedure, which I gather precludes the marvel of intravenous replacement and means more open heart surgery.

Que sera, sera. My questions are simply (1) on which forum might I find people with similar experience and/or (2) is there, to anyone's knowledge, another site where such folks gather? Any referrals or words of advice would also be appreciated. -- Peter Easton

 

[pellicle]

Hi

I had my ascending aorta done (up to the arch) some years back.

best wishes for a smooth recovery.

 

[dick0236]

Do a search on this forum for posts/threads on Aneurysm. Try looking up "Mended Hearts". It is an organization for people with various types of heart and vascular issues. They have chapters in many US cities and publish an internet forum similar to VR.org.

I was given a diagnosis similar to yours about 2 years ago. It is a tuff decision, especially at a senior age. After a discussion with a surgeon, my personal decision was that the "risk/reward" of aneurysm repair and removal/replacement of a "working" mechanical valve on a mid 80's man with a couple of other cardiac issues did not warrant such major surgical procedures. This type of surgery is dependant on individual circumstances. Good luck with your decision.

 

[Paleowoman]

Hi Peter @Nasredin - I haven't any words of advice other than I hope you stick around to let us know how things are going for you as I'm sure there are others here who may be in a similar situation, or may have been, or will be in the future. The Pre-Surgery forum on VR.org may be a good section to post on, here: Pre-Surgery as well as Heart Talk, here: Heart Talk But either way most people here will read new posts in any forum section.
All the very best, Anne

 

[Freebird]

As someone who is 58 and planning on going with a tissue valve, your story gives me so much hope! I wish you well on your upcoming surgery.

 

[Palious]

Hi, I had a Bentall procedure back in 2011 because of a Bicuspid valve and a significant aneurysm. I had a tissue valve (porcine) plus a vascutek replacement upper aorta and all has gone well (apart from much worse migraines which seems to more common than my specialist will admit to). I am now 65. These procedures are (almost) commonplace and as such are lowish risk for reasonably fit and (otherwise) healthy folk. I was out of hospital on the 7th day. I wish you the very best and I am happy to answer any patient specific questions you may have.

 

[Bryan B]

Hi Nasredin,

I also had a Bentall procedure in February of 2011 at the age of 50. I had a Ross Procedure in 2004 which replaced my bad aortic valve with my own pulmonary valve (autograft), and they replaced my pulmonary valve with a homograft valve. My aortic root began dilating a few years later and by 2010 I had reached the "magic number". I got a CE bovine tissue valve and my root/ascending aorta was repaired with a gortex graft. The surgeon that did my Bentall procedure was also leading the TVAR clinical trials at Duke at the time and was confident that I would be the perfect candidate for catheter replacement of my aortic valve when the time came.

It's been 9 years since I had the Bentall procedure and so far the bovine valve and graft are holding up well. I didn't find the Bentall procedure I had at age 50 any more difficult to recover from than my first OHS at age 43. In fact I would say it might have been a bit easier, mostly because I went into it knowing more of what to expect than I did with the first surgery. If you have any other questions I can help you with feel free to ask. As listed below in my signature, I had both of my surgeries at Duke Medical Center in Durham, NC and the surgeon who performed my Bentall procedure is Dr. G. Chad Hughes. I'm not sure where you are located, but if Duke is a geographic area convenient to you I think the world of Dr. Hughes and the staff that looked after me.

 

[Mike Eichhorn]

I had the Bentall procedure in May of 2018 at 49 years old. I also went to Duke and would highly recommend the team there. Just awesome care. My surgeon was Dr. Jeffrey Gaca. I went with the Bovine Valve and had the Dacron tube repair my Aorta. I was in the hospital three days and a recliner Netflix binging for a month. Sternum mas painful with to much laughter so I stuck to Si-Fi and Drama’s.

I found great support from HeartValveSurgery.com

Good luck with everything!

 

[Nasredin]

Many thanks for all these replies and helpful items of information! Happily, there is some unexpected good news.

I went in for my echocardiogram today here in Tallahassee... and then a follow-up appointment with my cardiologist . To my surprise (and his, too, I think), the results showed that my bovine aortic valve (now 18.1 years old) and the ascending aorta were both in about exactly the same shape that they were a year ago: dilation of 4.2 in the aorta and bovine valve still peppy. So no double operation (or even single one) in the immediate offing. I have had some issues with increasing blood pressure, so my cardio prescribed Losartan Potassium for 30 days (1x50 mg) and had me make an appointment to return one month hence for follow-up.

Though he said it's conceivable that both the aortic replacement valve and the ascending aorta might remain in the same benign state for a number of years yet, I imagine that at least the valve, given its age, will be checking out at some not-too-distant point. But if that is the only operation needed, I could get one of the intravenous versions and avoid another open-heart surgery.

There is also the question of whether -- given strong likelihood of eventual replacement needs -- it would be better for me to get the work done now when when I am a jaunty 77 years of age rather than wait until some period in my 80s... should I get there. He felt no, so that is how we are proceeding.

Nice to hear the strong recommendations for Duke, which is not that far away. At my last (55th) college reunion, I mentioned the issue to a classmate who is a cardiologist and his advice was "For that kind of a (double) operation, go to Cleveland Clinic."

Ciao.

 

[pellicle]

the results showed that my bovine aortic valve (now 18.1 years old) and the ascending aorta were both in about exactly the same shape that they were a year ago: dilation of 4.2

excellent news

as far as where to from here, I recommend you just get yearly inspections and play it by ear.

Aortic Aneurysm | ANZSVS

When do aortic aneurysms require treatment?

In healthy people the aorta (the main blood vessel that becomes swollen) is usually about 2.0-2.5 cms (20-25mm) in diameter although this can vary with age and whether you are a man or a woman. We know from two large studies in the USA and UK (Lederle FA et al, 2002) that aneurysms less than 5.5 cms (55mm) across can be safely watched as long as they are monitored on a regular basis. For aneurysms less than 4.4 cms across or less, a yearly ultrasound scan is sufficient to monitor aneurysm growth. For aneurysms between 4.5 and 4.9 cms across, a scan every 6 months is advised. An aneurysm greater than 5.0 cms across requires scans every 3 months although there is some variation in recommendations.​

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When an aneurysm reaches 5.5 cms most surgeons would consider offering surgical intervention. This is because, at this size, the aneurysm has a greater risk of rupture. It then becomes as safe to have an operation to repair the aneurysm, as it is to leave the aneurysm alone. Surgery may also be considered if your aneurysm is rapidly expanding on regular scans or it starts to cause other complications (see above).​