3 Choices - Any Experiences?

[Magic8Ball]

Ok, at this point in time i think i have three choices for my op and i'm trying to rationalise between the three before i meet with my surgeon in a couple of weeks.

1. Full bentalls
2. David's where they leave the bicuspid valve in and hope it lasts.
3. Not sure of the name but a 'David's' combined with a separate valve replacement, effectively leaving the root intact with all the associated arteries.

i think my current pecking order of preference is

1. David's, would mean a re-op if the bicuspid valve fails later on but i'm willing to take the risk if the surgeon assesses that the valve is ok.

2. Full bentalls, 'complete re-bore'.

3. Separate valve replacement combined with ascending aorta replacement...seems too fiddly to me and seems to have too many stitches to go wrong, would prefer bentalls and can't see the benefit of this option.

Has anyone had to make a similar choice ?

My bicuspid valve could last anything from 2 hours to a lifetime so i'd be hoping for 15-20 years out of the little mutant before i have to be cracked open again to get a plastic valve or whatever is available at the time.

The benefit to my first choice, no warafin = 'can still ride motorbike' and can still have a little drink or two' without having the constant INR issue. I think if i can get 10 years of 'quality' before a re-op i'll be happer.

Regards.

 

[Ross]

I wasn't given a choice. It was Bentall period and I would have to say, after being through surgery 2 times now, you don't want additional surgeries. I don't care how many times you think you can, you simply don't want to go there.

By the way, you could still ride your bike and have your drinks (In moderation) while on Coumadin. What causes constant INR issues are people that don't know how to manage the therapy.

 

[DeWayne]

I had the separate valve attached to the prosthetic aorta. My Surgeon said that if and when that valve needed replacement he had set it up so that replacing the valve would be easy to do. I have had no leakages since day 1, no problems with anything, in fact this weekend 10 weeks after surgery I was out doing yard work including sawing up dead tree branches and pulling tomatoe plants mowing the yard etc. (40 foot long dead tree branch fell on tomato plants just a couple days before surgery, so I had to wait till now to saw it up, hand saw, not chain saw lol)
In my research I called upon my Neice who works in the cardiac care area of the Mayo Clinic, when I was churning over what valve etc. First thing I was made aware of was all the ablations they did at the mayo Clinic, people with A-fib who were on coumadin and had this surgery to get off it. I figured if all those people were going that far to get off coumadin I didn't want to be on it.
Then she asked one of the main Surgeon's (no names given to me here) if it was THEM which would they chose, his answer was he would do a maechanical valve if it was the valve only, but with replacing the arota he would go tissue. Since this is the decision I had made the day before she sent this I felt comfortable in my choice.
Coumadin is ok for some not so good for others, problem is you don't know till you have been on it. It was not a chance I wanted to take, along with the noise issue which wayed heavily on my mind, I like it real quiet, and was worrried about the way things might change with the noise. The good thing is I had a choice, we did have a backup plan of going with the mechanical if things worked out that way, but I got my (and seemingly my surgeon's choice)of a tissue valve.
I made my choice, and once I did I didn't look back, there is no wrong answer, as for valve repair, if that was an option once again I would have taken it, as I had my valve repaired when I was 5 and it lasted 47 years.
Good luck, make your decision and be comfortable in what YOU want, but take note of what the Surgeon suggests as he knows what he is comfortable with as well. Once you decide you won't believe the relief and you will be all but ready for the next step.

 

[Magic8Ball]

Having spoken to my cardio today the pecking order has changed.

#1 is just the aorta replacement.
#2 is the aorta replacement and separate valve.
#3 is the full bentals.

As my Aortic root is fine and 3.9 cm's it apparantly makes no sense to remove and reattach the main arteries as they are fine, doing so actually makes it a more complicated procedure.

Now i have it clear in my head its time to see the two surgeons i've selected and have it all turned upside down again with their personal/professional opinions to be taken into consideration.

To be honest i'm now so comfortable with whats about to hit me i'm happy with any of the above as long as they work, living is the key, if i have to give up a few things then so be it, no biggy.

 

[OldManEmu]

You Now Have Options

You Now Have Options

If the surgeon agrees with the cardio then you only have to make the decision. To me option one would be my choice, however I have signed up for more surgery down the track.

 

[marky]

Not an easy decision
I guess you need to go with what 'you' feel best about. and certainly what your surgeon would prefer.
My surgeon was pretty clear with me about what and why.. so I respected his decision..
In the end you are the one that needs to live with the outcome.. so if option 1 makes you feel the best.. I guess you have made your decision.
I can't shed much light on the proceedure b/c mine was a different surgery.. but wanted to let you know that I am in your corner..
Keep us posted!

 

[Mike C]

As my Aortic root is fine and 3.9 cm's

Soemthing to consider when making your choice:

I am not so sure the above is accurate. Your root is already larger than normal, you have a bicuspid valve and an aneruysm in your ascending aorta. The defect that affected the other two affected the root, With your age you may be looking at replacing the root at some point too if not done now. just factor into decision making.

 

[Philip]

Good luck with you decision process and recovery after the big event. Your post has raised some questions for me: What size is normal for the aorta or aortic root? At what diameter do most feel the need for surgery? The ACC/AHA guidline that someone recently posted used 50mm as a determining point for surgery for those in need of AVR, does this 50mm apply if the existing valve (replaced or OEM) is functioning well?
Please excuse me for taking a detour on this thread, this seemed like a good place to ask since people with experience in this were posting.
Philip

 

[Superbob]

Bentall's

Bentall's

I wasn't given a choice. Was told I needed the Bentall's Procedure. It made sense to me -- having it all done "seamlessly," so to speak, rather than piecemeal. I've been pleased with the results so far. But I'm not sure our conditions are/were exactly the same.

 

[Magic8Ball]

Soemthing to consider when making your choice:

I am not so sure the above is accurate. Your root is already larger than normal, you have a bicuspid valve and an aneruysm in your ascending aorta. The defect that affected the other two affected the root, With your age you may be looking at replacing the root at some point too if not done now. just factor into decision making.

Mike, the measurement is from my latest echo and the 'fine' is a repeat, parrot fashion of the statement the surgeon made during a quick 5 minute chat when he was in between surgery's and i was having my angiogram.

Where the hell do you find details of what a 'normal' heart should be in size for your own physical size? you say 3.9 is bigger than normal but i'm 6ft4ins and 18stone so my normal is not the same as george bushes normal (note the US relative content )

I'm still waiting for my records from the UK to arrive so hopefully i will find the historical information to make a trend comparison.

 

[Mike C]

Ignore the size for the moment, you have a defect at your valve and then in your ascednign aorta, its possible, i will say probable that the same defect is in your tissue at the root, which is in the middle of the other defects. not saying what to do aboyut it other than be aware of it.

typically the defect affects the entire ascedning aorta up to the arch, although not typical it affects some people in to the arch and then rare past the arch.

i cant remember a normal range for the root but i think it is 2-3. it expands in everyone as we age.

 

[temp69]

Magic:

I was faced with the same problems, I had a bicuspid from birth, never even learned of it until I was in my 40's (now 55) and had normal measurements. But over time, the valve tightened up, as it usually does, and I developed an aneurism which was at 4.2...then a little bigger and bigger each couple of years.

I decided I would just have the "package" done. I had a new mechanical valve put in, the aneurysm fixed, and a bypass -- because while they're in there, they might as well fix whatever they can.

So, that's my experience. Good luck to you. Just know that you might not want to have to go back in for any additional work.