Valve repair vs. replacement

[Der Biermeister]

My latest echo (a TEE) has upped my category to "moderate severe" -- so I will be getting surgery sometime.

I have a "torn or flailed" portion of the right coronary cusp of the aortic valve.

Questions for the brain trust:

1. With a long history of high bp, would this be the likely cause?

2. The doc mentioned a possibility of it being repaired instead of replaced. Does anyone know what the longevity is in a repaired valve?

3. Has anyone ever had AVR done at a major medical center employing "minimal invasive surgery"? Is the success rate as high as having it done via OHS? AND -- if you know about the minimal stuff - can they also repair a valve this way?

Thanks for your answers
DB

 

[Phyllis]

Found this for you:

"Valve Repair Versus Replacement
The decision to repair versus replace the aortic valve is based on complex factors, as well as the experience and results of the particular heart center. At Cedars-Sinai a repaired valve is expected to have a life of at least ten years (comparable to the minimum expectation for a bioprosthesis). If the repaired valve is not projected to last at least that long, the valve is replaced rather than repaired. However, preferably a repaired valve should last a lifetime.

There are factors unique to each patient that must be evaluated regarding valve repair. The anatomy of the aortic valve, nature of the tissue and comfort level of the surgeon in performing the repair all are factors in the resulting durability of the repaired valve. Careful scrutiny is required for bicuspid aortic valves. In young patients where the bicuspid valve functions well with minimal calcification, or if there is localized prolapse of only one leaflet, a durable repair may be possible. However, generally for any given group of bicuspid aortic valves, approximately 75% of them cannot be repaired with acceptable durability and should be replaced. When a normal trileaflet aortic valve is present, there is greater potential for repair. Particularly during surgery for ascending aortic dissection involving a normal aortic valve, lifetime durable repairs are often possible."
Dick had minimally invasive AVR at Brigham and you can have a valve repaired with minimally invasive surgery. As always- pick the top hospital and a surgeon with a lot of experience with the procedure. Under those circumstances, the success rate will be as high. If the catherization shows you need bypass as well, they can not do minimally invasive. Don't have the answer about the blood pressure- I'm sure someone else will. Dick had moderately high blood pressure before surgery and still has it now.

 

[Natanni]

Repair/Replace Bicuspid Valves

Repair/Replace Bicuspid Valves

Nathan went to the Mayo after being followed for approx 5 years by the U of M;
The University of Minnesota would only give my husband the option of replacement with a mechanical valve. We then went to the Mayo for a second opinion (his endocarditis was already in the works little did we know...) He had a bicuspid valve with an ejection fraction of about 51% with moderate left ventricle enlargement, 65% ml/cc regurtitation. There was no calcification/stenosis. In June his regurg was classified as 'moderate' per cardiac cath at the U of M and progressed to 'severe' per a one hour ultrasound done at the Mayo. We were interested in repair initially and Nathan's surgeon, having done valve surgery since the seventies, said he didn't feel a repair would be optimum for Nathan as it may only buy him 2-3 years, and they didn't consider him a candidate for the Ross. etc.

Now, I could be wrong, but having a valve replaced via that Minimal Invasive approach would still be considered Open Heart Surgery (OHS) just not open sternum. The facility Nathan had his surgery is only doing the mitrial valves via the minimal invasive technique as they are not able to provide good exposure of the operative area of the aortic valve at this time, but I think people here may have had it done.

Good Luck on your research!

 

[Randy & Robyn]

Two names come to mind for incredibly gifted surgeons who are very adept at valve repairs, both mitral and aortic.

Dr. Cosgrove at Cleveland Clinic has been doing them longer than probably anyone with an excellent track record. And I recently had my aortic valve repaired by Dr. Zehr at Mayo. He thinks it will last my lifetime but there are never any guarantees. I don't think you could go wrong with either choice.

Minimally invasive surgery can be done with valve repairs. However, my surgeon wanted full access so I got the complete zipper job. Not a big deal in my opinion.

Best of luck,
Randy

 

[jeffp]

If it is amenable to a minimal incision repair or replacement, it can be done. The fellow in the CICU in the next room over during my recovery was a few days behind me (time wise, healing wise he was doing alot better than me) after having his valve replaced in this manner. I don't know if he went tissue or mechanincal, I was too out of it to even think of asking. I was envious of his little wad of gauze for a bandage. It turned out he has my niece's band instructor. He had his surgery done at Chippenham by Tom Christopher. Last I heard, he was doing just fine (that was about 3-4 months after the surgery. Who were you planning on doing your surgery?

 

[MelissaM]

I had my valve repaired by minimally invasive surgery (mitral valve, so a little bit different) and feel like I walked away with the best-case scenario. Two-plus years later, my surgery is starting to feel like some sort of distant memory. . .surgery? What surgery? Heart problems? What heart problems? I am on no medications, have no restrictions, and virtually nothing outside of a rapidly diminishing three-inch scar to remind me that the surgery happened. Even the wires are gone. . .

If it is a feasible optioin for you, find the best doctor and best facility you can (these really DO matter - the first two docs I spoke to would not do a repair. The third was Cosgrove, and a repair was no problem for him) and take the plunge.

Melissa

 

[Der Biermeister]

Who were you planning on doing your surgery?

Jeff - at this time, I am still working with the Virginia Cardiology Specialists group. Their surgeon is fellow named Wolfgang something. He has an excellent reputation, but they do not do any of the "minimal" stuff.
I meet with my cardiologist in a week and will get a better assessment at that time. However - I do remember him telling me, when he did the TEE, that I might want to at least explore the big centers.
DB

 

[Der Biermeister]

Who were you planning on doing your surgery?

One more thing Jeff -- just realized his full name (the surgeon) -- Timothy Wolfgang. Since you are local here in Richmond, perhaps you can ask around and see if he really IS as good as I've heard.
Thanks
DB

 

[Der Biermeister]

Hey everyone - I really appreciate all this good info. Keep it coming

 

[jeffp]

Tim Wolfgang is good, no doubt about it. He's a careful surgeon and has a good success rate. He's very conservative and is not the type to experiment to "see how it works out if I try this". Really anyone in the group is good as they are VERY selective as to whom they ask to joint the group. Any of the VCS surgeons does 100's of cases annually and none of them are "right out of school". (Their credentials are impressive, you can check out their web site, but remember that credentials don't really meant that much.)