Valve-sparing option vs. replacement

[KMS]

Hello friends -

I just came from my pre-op appointment (as you can see from my signature, surgery's slated for next Friday). I've decided to go with a tissue option (probably the Medtronic Freestyle).

I'd discounted an option that my surgeon presented to me during our initial consultation -- a valve-sparing technique that has been used for 8 to 10 years, and he's been specializing in for the last 5. He said that if I chose that option, he'd make the call when they had me open and would only do it if the valve could function successfully at 100%. If not, we'd go to my "Plan B", which would be a tissue or mechanical valve.

I'd discounted that option for a couple of reasons: 1) he felt that because of the way my BAV is formed, I'm not an ideal candidate (he said there was only a 70% chance that he'd be able to save it), and 2) it's still considered a "cutting edge" (his words) option because of the lack of long-term data and the possibility of re-operation in the near term. I weighed the risks, spent a tremendous amount of time on this and other sites, consulted with medical professionals and determined that tissue was right for me.

So, you ask, "if you discounted the valve-sparing option, why are we discussing it?" Well, here I sit, a week prior to surgery, thinking about the tantalizing possibility of my own spared valve. I have a surgeon (Tom Gleason, Northwestern) who is one of a handful of CT guys who is doing this with regularity...and it's got me thinking (too much time on my hands, not running, just thinking). Odds are, I'll opt for the Medtronic Freestyle, have a successful procedure next week and move on with my life.

However, I'm wondering what the group's thoughts are -- clearly understanding all of the risks -- on the valve-sparing option as a first choice.

Kristine

 

[tobagotwo]

Don't know. Odds for successful aortic valve repair are much lower than for mitral valve repair. However, it doesn't mean it can't work or that they haven't found a better method. You're right: it's tantalizing. To keep one's own flesh is a great temptation.

If it were me, I'd have to feel it was an ideal circumstance. I've seen too many quick reops for aortic valve repairs (A.K.A. valve-sparing surgery). Do you have anything on the success rate they're having?

Best wishes,

 

[Karlynn]

I think you need to go with what feels most right to you, deep down.

 

[Kate]

Hello again, Kristine,
These choices are so difficult. It is good to have options, but when considering something so serious, it is hard not to second guess yourself (at least that's how I felt.) I think whatever choice you make will be the right one, especially if you focus on what seems most in keeping with your general personality style (for example, are you willing to take big risks for potentially huge gains with your investments or at work?) One thing you might want to keep in mind is that if you go for the repair and for some reason it doesn't work out as well as hoped, you could be looking at two surgeries within a relatively short period of time. Many people on this site have been through this and it certainly isn't undoable. However, as each surgery does increase the risks, this could make the option of a tissue valve less realistic for someone your age who already has had one surgery. Perhaps you don't feel that strongly about this, but it's something to consider. Take care, Kate

 

[RCB]

Instuctions to surgeon

Instuctions to surgeon

After assessing the valve first hand, If you think there is a 100% you can repair it and that I will get at least 15 years out of the repair- repair it.
If he is not a sure of the success or duration, then go with the tissue valve.

With the tissue valve, you can be pretty sure to get the same duration- 15 years. No surgeon can predict these things, but unless he is sure of his repair, go with highest chance of success- the tissue valve. Good Luck.

 

[Superbob]

Kristine,

I think RCB is right on the money. I don't have anything to add, but just wanted to offer my moral support. I know these are tough decisions to make. I wish you the best.

Bob

 

[KMS]

Sometimes you just need to hear it

Sometimes you just need to hear it

Friends,

Thanks for your feedback. Each of your comments means a great deal to me, especially at this sensitive time.

You know, I know in my heart what I need to do (Karlynn, you were so right). My decision to go with a tissue option is right for me. I think that during these last few days, some stray thoughts may blow around, and it's so good to have this forum for discussion and affirmation. I am grateful for your counsel.

Bob, to answer your question, I don't have statistics, but I know they aren't great. Frankly, because I'd discounted valve-sparing early in my decision-making, I didn't spend time with research.

Once again, the answers we seek are often right in front of us.

Thanks again,

Kristine

 

[Andyrdj]

Valve repair - my experience

Valve repair - my experience

Well, I had a valve repair age 17, I'm 31 and looking at re-op in a few years.

At the time, the tissue valves available weren't so durable and I was younger, but it was thought best (and I agreed) to take this path to avoid a mech valve at that age.

If I'm optimistic, from what I've seen the best tissue valves today should last longer than a valve repair, especially for someone like you who wasn't a good candidate for repair.

Plus, the haemodynamics are probably better in a tricuspid prosthetic than a bicuspid repaired valve.

So I think you have made a good choice there.

 

[OldManEmu]

It's a difficult choice

It's a difficult choice

I am in agreements with RCB, if the surgeon thinks he can do a good repair that will last the 15 years I would go with this and the aneurysm repair. I would let him know if this wasn't possible to go with the porcine AVR, as Andy has pointed out he has had 15+ years already out of his repair. Unfortunately we can't see into the future and none if the surgery comes with a guarantee.