Valve Replacement vs Valve and Aortic Root replacement?

[Elgato]

I mentioned this as part of another thread but did not get much response.
I have been hammering the boards with questions and really appreciate all the help and responses.
Thank You!

I have had a TCE, TEE, Angiogram and Ultrasound of the throat area.

My surgeon said that he would recommend different valves depending on whether I needed a root replacement. I asked if I needed one and he was not sure and would just take care of it during surgery if necessary. I said that I would like to know in advance so he scheduled a Chest CT even though he did not really feel it was necessary.

Am I wasting time and money doing the CT? Did anyone here know they needed the root replacement before surgery?

Is a valve/root replacement more complex than a basic valve replacement? Does it introduce other issues?

He recommended the Medtronic Freestyle if the root was going to be replaced. He said that he fully expected that it would last 20 years IF used this way.
Any idea if doing a valve/root instead of valve only can have an impact on the life expectancy of the valve? It would almost make you want to do the root whether
you needed it or not.

For a straight valve only he likes the Sorin Mitroflow. He estimated 10 to 15 for this one.

He likes the Sorin Carbomedics for a mechanical but clearly leans towards the tissue valves.

I have not seen much talk on this topic and am completely confused.

Thanks Again.

 

[MrsBray]

My Dr told me there was no way he could know if I needed an aortic graft until he could measure it. My ascending aorta was slightly enlarged, but once he popped me open he measured the walls. I had no thin spots and no stress marks, and was only 39mm, so he did nothing but the valve replacement.
Yes, he's a surgeon and makes his living doing surgeries. He talked me out of a tissue valve (which I thought I wanted because I didn't want to be on anti-coags) and in to a mechanical because he said he would be very upset if I were back in a few years (less than 7) for a re-do. I have confidence that if my aorta needed help, he definitley would have done it when he was in there for the valve.

Ask him what he would do if it were his child/brother/spouse.

 

[pellicle]

It would almost make you want to do the root whether
you needed it or not.

well personally after needing to be reoperated on due to an aneurysm I'd tend to agree and add in "do the ascending aorta too" as a prophylactic measure.

I was reading recently that increasingly some researchers say that there is more harm done by waiting longer than by doing it earlier. I just wish I'd evernoted that one ...

He said that he fully expected that it would last 20 years IF used this way.

how old are you, and how old (meaning frail and less able to bounce back) did you want to be when you have your 2nd surgery?

 

[Superbob]

Even before I consulted with my surgeon, my cardiologist knew that I needed an aortic root replacement as well as a valve replacement. Leakage of the valve over the years had contributed to dilation of the aortic root.

I never had the option of only having a valve replacement. A surgeon not knowing the root replacement was needed until the surgery was underway is not something in my experience.

Certainly it would seem to be the case that a root/valve replacement is more complicated than just a valve replacement. My cardio back then said that some surgeons took 10-hours plus to do the procedure but because my surgeon was the best anywhere it took him only five hours. (Which is exactly how long it indeed did take him.) Length of operation is important because you don't want to be on the heart-lung machine any longer than you have to.

I picked the Medtronic Freestyle myself (and my surgeon concurred with my choice) because it made sense to me that it was a combined stentless device. As for longevity, all I can tell you is that I have had it for nine years now, and my new cardio said last week that results of my recent echocardiogram were "great." I have never heard any assurance of 20 years -- I think experience with the Freestyle has generally been good but there are no warranties on any type of replacement device. You just make your best choice and know that you are a lot better off than you would have been had you just "let nature take its course."

Wishing you all the best. I would be sure your surgeon has done many of these surgeries successfully. Don't hesitate to seek out another surgeon if you are not confident in this one.

 

[Guyswell]

For both of my surgeries, I had an understanding with my surgeon. He was happy to take my preferences into account and would accommodate my wishes if practical. He also reserved the right to make the final decisions about valve choice during the procedure since he couldn't know all the variables beforehand and there would be no possibility of consulting with me during the procedure. I was fine with the knowledge that he would do what he thought best.

 

[AZ Don]

Do you have an aortic aneurysm? What does your echo say about the size of your root? I think it is perfectly reasonable to want to know whether you are likely to need a root replacement or not. While there can be surprises and so some decisions can only be made by the surgeon during surgery, the criteria for repairing an aneurysm is pretty straight forward and so this is generally decided in advance. I've never heard of replacing the aortic root extending the life of a valve replacement. I would be interested to see supporting literature on this.

I can tell you that an aneurysm root repair combined with a valve replacement is probably easier than just an aneurysm root repair, because they can install an aneurysm graft with the valve pre-installed. Not sure that repairing both is easier than just the valve though. Grafting the aortic root involves a couple coronary arteries as they attach to the aortic root and so have to be attached to the aortic graft. I was in the opposite situation as you. My echo, CT, and a catheterization all indicated my BAV was well functioning but I was given the option to replace it when I had my aneurysm repaired. I decided to spare my valve if possible, but my Dr. reserved the right to replace it if he thought it necessary during surgery and we discussed in advance what valve to use if replacement was necessary. It wasn't. Some good things about an aneurysm repair: it is expected to last a lifetime and does not require anticoagulants.

 

[Owen]

I'll start off by saying - there are many here who know more about this than I do.....but hopefully my experience might be helpful.

My surgeon (and later, my cardiologist) told me that my aneurysm was caused by my BAV. My root had grown to 52mm. So both were taken care of.
Surgeon recommended the mechanical valve, and after some study, I concurred.

My thought is - if it is true that the aneurysm was caused by the BAV, at some point yours may end up the same way. Not definitely, of course, but I would think the strong possibility exists.
I think the chest CT is wise, and I'm surprised to hear a surgeon say he's not sure if you need the root replacement or not. I know that can be looked into before surgery. He should have a definite plan of attack before opening you up, I would think

I would lean towards having both done, in my humble opinion.

 

[Elgato]

OK,
Today I went in for the Chest CT.
This is where they inject die and do a CT scan.
When we finished I asked the tech if this was similar to a non-invasive angiogram.
She said that is what it is.

Any idea why the could not determine the condition of the root from the other tests or the invasive angiogram?

Pre Invasive I had asked why we couldn't just do the non-invasive. They said the invasive provided much more
detailed information and to avoid the radiation.

Thanks

 

[Elgato]

Today I asked the surgeon to clarify the advantage of replacing the root. He feels that replacing the root with the valve actually improves hemodynamics which contributes to the life span of the valve.
He felt that replacing the root, even though it is not necessary and a more complex surgery, would be an advantage.

On Tue. I met with a second surgeon.
Given that the root and aorta are within spec he felt that they should be left alone and that the operation should be valve only.
Of course he also recommends different valves. On-X for mechanical and Edwards Magna Ease or St. Jude Trifecta for tissue.
He did not like the idea of a stentless valve like the Freestyle in my case because of the bicuspid valve.

Now I have two great surgeons with very different solutions.