Valve Repair Question

[pipersmith]

I am curious about your experiences involving repair vs. replacement. What typically qualifies someone for a repair? Does a repair typically last, or does it carry the same risk for reop as a tissue replacement?
None of my completed tests show any obvious valve deformation - just the regurgitation. They do show that my valve is not bicuspid. The surgeon did not discuss repair - only replacement. After reading, I am just curious about your knowledge on the matter...
Thanks!

 

[Tom F.]

I will assume you are referring to the aortic valve, so I will share what I know. In Dec. of 2002 I had a valve sparing procedure done to correct an aneurysm of the ascending aorta. Part of the aorta right next to the heart was replaced, and the aortic valve actually sewed up within the dacron sleve. Other than the regurgitation cause by the aneurysm, the valve was perfectly normal. Technically the procedure is known as a "T. David - V" procedure, after Dr. Tyronne David, the surgeon that first developed it. If you go into Google and search for "valve sparing" you will see a number of articles about the procedure. You can also look up Dr. David and learn a lot.

Thus far everything is holding up fine for me. Mine was the condition which was perfectly suited for a valve sparing procedure, specifically, an ascending aortic aneurysm but an otherwise normal aortic valve. My surgeon and cardiologist both believe that future surgery is unlikely. Thus far published reports seem to indicate that this is a durable fix, with a low level of resurgery. My surgeon has told me that the level of resurgery required on his folks is very low.

Now if one has a bicuspid aortic valve, or genetic tissue problems, your mileage might vary a lot, according to what I have read.

When I was first told of my condition I was going to doctors in suburban Chicago, and basically was given two options, mechanical or tissue valve, as a valve replacement used to be the standard in the face of an ascending aortic aneurysm. However, at my wife's urging I then went to two of the major teaching hospitals and learned all about things like valve repair and the Ross Procedure. As it happened my primary care doctor had never even heard of the Ross or the possibility of valve repair.

The lesson that I took from that was that it is wise to seek out the top heart surgeon near you, one that has been performing valve repairs for a while, and let them tell you whether you are suitable for this procedure. The valve repair is a technically more difficult surgery to perform that a straight up replacement, I am told, so there are fewer doctors able to perform it. Those are likely the docs that will fail to mention it as a possibility.

So my advice to you is to look further, to find a doctor that knows the procedure and can tell you whether it might work for you.

Good luck, feel free to E mail me if you have further questions.

 

[MikeHeim]

I can put in my $.02, although I am by no means an expert (other valvers - please correct any mistakes I make). Most valve repairs are done on the Mitral Valve, not the Aortic. I understand that there are several reasons for this. The first is that the Mitral Valve has much less blood turbulance associated with its function. The higher pressures in the Aortic area make it more difficult to get a solid repair that lasts for a lifetime. (This is also why the Mitral patients with an artificial valve are usually anticoagulated to a higher level than those with an artificial Aortic valve.) I believe the second reason is the structure of the valve itself. The Mitral Valve is naturally bicuspid, and I understand that it is easier to get two repaired leaflets to work together than it is to get the three leaflets of the Aortic valve to work together.

In general, repairs are favored by surgeons in the Mitral position when the valve is in good enough shape to be repaired. The statistics are very good for repairs standing up over time. I have quoted one study in previous posts where 85% of repair recipients operated on in the early 80's had not required any reoperation. (I will try to look for this link again and post it.) I think it's only fair to assume that the techniques and surgery have only gotten better since then.

The downside of repairs is that a certain percentage fail - some after only a very short period of time. There are several people on this list that have had repairs fail almost immediately or after only a few months. The upside is that there is a good record of durability without the requirement of ACT. Based on my experience from this list, I would recommend that if your highest priority is to minimize the risk of needing a second operation, you should go mechanical. If ACT concerns you, and you are willing to risk a second operation if things unexpectedly fail, a repair is probably the way to go. If your surgeon is pushing you to go mechanical you should almost certainly not push him into a repair. The durability and effectiveness of a repair is closely related to the experience, training, and skill of the surgeon doing that exact repair procedure. So if repair is the direction you want to go, you probably need to find another surgeon that specializes in Aortic repairs.

Anyways, hope this helps. The above is what I remember from my pre-surgery research, and I'm sure someone will be along to correct any errors that my memory might have made.

 

[DeWayne]

All I can say is that when I was very young (spent 5th birthday in hospital, 1959) They did a repair on my biscupid valve. I just had that valve replaced 8 weeks ago. So my repair lasted 47 years. The repair was to open up the valve as it was partly closed, I have always had a back flow of blood through that valve until it was replaced recently. My cariologist actually told me that if the problem had just been the valve they would not have had to operate,yet, but since I had a very large aneurism of the aorta they replaced all of it while they were in there.
I would find it hard to believe that if they could do a repair they would opt to replace. Repair is always the first option I thought.

 

[pipersmith]

Thank you

Thank you

...all for taking the time to answer. No one has mentioned a repair to me, and I had never even considered the possibility, until I read a post here. Considering that there is no obvious malformation of my aortic valve - I think I may approach the subject at my next visit. It may be an impossiblity - but it doesn't hurt to explore. I would prefer no more surgery (would we all ) so I was interested in the chances of reop.

Best of luck and health to all of you!!!

 

[Karlynn]

If they think a repair is possible, you will want to have a surgeon who does a great deal of repairs. This doesn't mean that then that surgeon can't replace it if it looks like it's needed. But repairs are trickier surgeries for the most part and you'll want someone in there that can do it in their sleep - well, almost.

 

[debster913]

I second what Karlynn says. My surgeon was 85% sure he could repair my valve, with the remaining odds in favor of a mechanical replacement. I think in my case, my cardio caught my regurgitation at the right time (but is there ever a right time? ) where my valve had a chance of being salvaged. Dr. Starnes, who did my surgery, is super-expert at MI valve repair and I wouldn't have anyone else try to do it.

As far as durability of a repaired valve, it all depends on so many factors: the skill of the surgeon, the consistency of the valve, etc. My cardio says the "baseline" is about 20 years, but there's always the chance it can last longer (hopefully until I'm 100, which will make it another 70 years! ), or I may need a replacement sooner than that. Despite my chances of maybe needing a second surgery, I'm glad my valve is repaired.

Good luck on your upcoming surgery!

Debi (debster913)

 

[WayneGM]

My case was the exact opposite....my surgeon only discussed repair not replacement except when I signed the consent form at admission where I granted permission to replace if it was thought necessary once they were inside. I had a mitral valve repair though. My Cardiac Surgeon was Dr. Tirone David in Toronto who I learned through web search is highly regarded internationally. Somebody mentioned him earlier in this thread. Don't know how I got so lucky as I had no idea who he was when my Cardioligist sent me to him. Gotta love this Canadian universal healthcare system

Anyway, he said in my case the repair should last my lifetime. I suspect there's no definitive answer as it probably depends on the situation.