aortic root aneursym. any thoughts?

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T

tcopel

VR.org Supporter
Supporting Member
Joined
Apr 25, 2007
Messages
179
Location
oklahoma city
Just wanted to say how grateful I am to this wonderful site. I am a newly registered member but have been reading this forum for several months and have found it very encouraging, educational and quite frankly, a source of strength.
I am 52 years old, reasonably active male, who found out that I have 5.5cm to 6.0 cm aortic root aneursym. The ever ongoing debate about mechanical valve or not has been source of many sleepless nights for me regarding my aortic valve. Ultimately, I have finally opted for the aortic valve sparing procedure by a cardiothoracic surgeon in Pittsburgh on May 14th.
I suppose it is only natural to wonder if one is making the right decision but it would nice to get input from those who have been there. Thanks.
 
This is a great site...wish I'd have found it prior to my surgery. Sorry you need surgery, but welcome!
With regards to repair of your native aortic valve when one has an aortic aneurysm as large as yours, I am skeptical and think replacing with tissue or mechanical will be more lasting and successful. I'm assuming you have a bicuspid aortic valve with regurgitation, as well as stenosis. Replacement represents less risk of another surgery, and most surgeons will recommend this approach for bicuspid aortic valve patients....for good reason. While there are probably some good success stories out there, seems to me one has to make a decision based upon probability of best outcome long term.
All my best,
MrP
 
Welcome to our family...you will get tons of great advice form all our experiences...

At 41 I opted for the St JUdes mechanical valve with the dacron Ascending aorta attatched for the same reasons MrP states...to try avoid further surgeries on my delicate tissues...I didnt really want a dodgy valve left there just because it still had a few good years left. It is made out of the same faulty tissue and was going to need replacing oneday anyway. I was not offered the vave-sparring option and I dont think I would have taken it.

Are you a Bicuspid Aortic valver or a Marfan ?...as both these types have a connective tissue disorder which is something you probably should consider.
 
Welcome to the VR community. Sorry you're facing OHS but glad you found us and decided to introduce yourself. I had a mitral valve repair so can't help you with valve choice. However, there's lots of knowledge and insights on the subject here. Best wishes with your surgery and for a speedy, uneventful, recovery.
 
Welcome and I'm so glad you decided to register. I put you on the calendar for May 14th so we can cheer you over the mountain. Best wishes to you.
Phyllis
 
MrP said:
This is a great site...wish I'd have found it prior to my surgery. Sorry you need surgery, but welcome!
With regards to repair of your native aortic valve when one has an aortic aneurysm as large as yours, I am skeptical and think replacing with tissue or mechanical will be more lasting and successful. I'm assuming you have a bicuspid aortic valve with regurgitation, as well as stenosis. Replacement represents less risk of another surgery, and most surgeons will recommend this approach for bicuspid aortic valve patients....for good reason. While there are probably some good success stories out there, seems to me one has to make a decision based upon probability of best outcome long term.
All my best,
MrP
Click to expand...

Thanks to all. You guys were quick to respond. MrP, as I understand it, I have a normal 3 leaflet valve. Its stretched out a bit due to the aortic root being dilated from the aneurysm. The procedure is called the David surgery, after Dr. T. David (same fella who did Wayne GN). The aneursym is replaced with dacron and the valve is tweaked and inserted in the graft. The down side is that nobody knows how long lasting it is as it has only been around for a few years. Maybe 5 years, maybe 50 years..geez...decisions, decisions.....
Again, thanks for your thoughts.
 
Good luck on your surgery! I can only give you my own experience in this matter. At age 38 I had a valve sparing root replacement procedure done. This was caused by Marfans desease. Now a year and a half later on 5/9/07 I will be getting the valve replaced that they tried to spare.Learned some time after the procedure that about half of these procedures result in having to replace the valve within approx. 5 years anyway.Had I known this my desicion may have been different? Only you can make this decision. Hope this helps
 
Originally Posted by tcopel
The procedure is called the David surgery, after Dr. T. David....
Click to expand...
I seemed to recall that Tom F. had the "David Surgery" so I checked his profile in the members list and sure enough he had the "David-V Valve Sparing Aorta Replacement". If that's what you're having maybe you could PM Tom F. directly and ask him about it. As I recall he's mentioned it in several posts very positively. Good luck.

P.S....I've got nothing but confidence in Dr. David. He's one of the best and one of the most innovative heart surgeons around.
 
Hi and welcome!
I'd try to get a second opinion at the Cleveland Clinic. Repairing the old valve would be great if it's sturdy enough but I would want to make sure that I would not have to go through OHS again soon. I had my ascending aorta replaced with a graft and my valve replaced with a mechanical valve. And my aneurysm was only 5.2 cm. When I had surgery they told me that they would fix the valve if they could but might have to replace it. I woke up with a new one. The surgery wasn't nearly as bad as I expected.
Good luck! I'll keep you in my prayers.
 
As one of the few that had there aortic valve repaired, I think you'd be better off opting for either tissue or mechanical valve. My repair lasted about 7 years, then it had to be replaced. I was 39 when it was replaced, so I opted for a mechanical valve. The key here is to never have to go through surgery again. Sure it can be done, but it doesn't mean it should. I just don't want to see you going in time and time again, plus each time recovery is harder and there's more scar tissue to deal with.
 
Yes, I did in fact have a David type valve sparing procedure done at Rush University Hospital on December 20, 2002. Thus far my fix has held up well, and my cardiologist commented not long ago that he believed that I am not likely to require another surgery. So my results have been great.

I would further comment that both before my surgery and afterward I continue to monitor articles available online that discuss the David procedure, and for the most part, this procedure seems to hold up well over time. I would urge you to spend some time in Google and read for yourself. The one cautionary note that I have seen is that those with Marfan's should think long and hard before having it. But others whose aneurysm has been caused by trauma or hypertension and who do not present with Marfan's seem to do quite well. Please feel free to contact me directly at [email protected] if you wish to talk more. Good luck to you, I am sure all will be fine.
 
If you are sure you do not have Marfans, they most likely discover when they open you up a bicuspid valve, at times it can be difficult to diagnose w/ echo.

Most important-if going w/ valve sparing, have a backup plan, meaning tisue or mechanical and type.

If the valve is in good working order and the surgeon expects a long life for valve, I like the valve sparing procedure. With that said, I dislike repairs becasue of risk of going back so it depends what shape valve is in.

My valve looked great on film but when they got in thier the tissue in the valve was as thin as the arotic root and so they used my backup plan of st. jude

Also, if you are thinking of tissue, may be worth the risk to have your original valve as you may need another surgery anyway in 15 years.

I think its may be a little backwards, seems acepted practive to replace valve when replacing aorta but i think it should be replacing aortic root when replacing bicuspid valve, just my opinion.
 
j3brawny said:
Good luck on your surgery! I can only give you my own experience in this matter. At age 38 I had a valve sparing root replacement procedure done. This was caused by Marfans desease. Now a year and a half later on 5/9/07 I will be getting the valve replaced that they tried to spare.Learned some time after the procedure that about half of these procedures result in having to replace the valve within approx. 5 years anyway.Had I known this my desicion may have been different? Only you can make this decision. Hope this helps
Click to expand...

J3brawny..I wish you all the best in your repeat OHS. Where did you do your first surgery and where are you going on 5/9. I didn't realize that half of these procedures fail. I truly will keep you and your family in my prayers.
 
Had first procedure at Columbia Presbyterian Hosp in New York ( Manhattan).Will be having the next one there also by the same Doctor ( Alan Stewart).Let me add that my circumstance was a bit diff from yours due to the fact that I do have Marfans. Dont want to scare you into getting a new valve.Just wanted to give you my experiance with the same procedure.If you would like to talk to me more about this let me know and I will give you my e-mail address or even phone # if you wish. Take care and keep us posted on your progress. God bless and good luck.
 
Hi tcopel - Lots of good experience offered here for you already. Glad you found the site; hope all goes well for you.
 
I cant tell you guys how reassuring this site. I tend to be fairly reserved and not express concerns or doubts to my family. So it's nice to be with those that have been there, done that and gone over the mountain and find that life goes on. To J3Brawny, I would appreciate the e-mail that you offered.
Ross, what problem did you have that you attempted a repair of the AV (bicuspid?). To Len, who posted earlier today, hang tough on your surgery and know that others are with you. Thanks everybody!
To any others who have thoughts on the aortic valve sparing procedure..give me shout-out. Decisions..decisions.
 
If my aorta were 5.5 - 6 cm, I would want to be sure my blood pressure was well controlled with medication, I would be very careful about lifting, and I would have the aneurysm removed as soon as possible.

I am also wondering why the size of the aneurysm has not been given with more precision? The difference between 5.5 and 6 cm is very significant.

No one knows exactly when an aneurysm will tear or break, but there is no debate about this size range needing surgery. Soon.

In the past when aneurysm surgery was higher risk, people were told to wait until 6 cm to have surgery. Half of them never got to choose their surgery date - they got into trouble first. Definitely not what anyone wants - an emergency with their aorta.

Best wishes for your upcoming surgery,
Arlyss
 
I have talked to surgeons who very strongly believe in the David Procedure and some who are very skeptical/pessimistic about it. I think that if you have a surgeon who is conservative about when he will apply the procedure that would be a good thing. You don't want a repair if it isn't going to hold up for more than 10 years. There have been many successes and some failurers in patients undergoing this procedure, just as with any valve operation. I think it will be important to get a diagnosis as to the underlying cause of your aortic aneurysm. Is it due to a connective tissue disorder? If so then valve-sparing probably isn't the best idea, but if it is simply due to trauma it may be a good option. It is a tough decision, I wish you the best of luck in making it.

I have had two aortic valve replacements in the past 7 years. My latest one was just 5 months ago -- I am currently playing softball, tennis and table tennis five days a week. I feel completely back to normal -- and that is after my 2nd OHS! Recovery can be hard both mentally and physically, but in the long run when you look back at your life recovery will likely seem like a blink of the eye. I don't even remember the weeks following my first surgery and the ones following my second surgery are beginning to fade as well because they just weren't that traumatic. Boring - yes. Exhuasting - yes. But bearable? Very much so. I regret all the worrying and mental anguish that I went through leading up to both surgeries.

Mr. P has a quote from the Beatles song in his signature that I feel is very apt.
O bla di, O bla da, life goes on
Lala how the life goes on

I have to say that these lyrics describe my surgery experience better than any I have seen. And when I find myself sitting at my computer concentrating on work or out on the court playing tennis, sometimes I think to myself how little has changed. Life just keeps on moving. I know not everyone has had such an easy time as myself, but I believe it is becoming more common place to live an active normal life even after 2 OHS.

Good luck and keep in touch,

Brad
 
Tom F. said:
Yes, I did in fact have a David type valve sparing procedure done at Rush University Hospital on December 20, 2002. Thus far my fix has held up well, and my cardiologist commented not long ago that he believed that I am not likely to require another surgery. So my results have been great.

I would further comment that both before my surgery and afterward I continue to monitor articles available online that discuss the David procedure, and for the most part, this procedure seems to hold up well over time. I would urge you to spend some time in Google and read for yourself. The one cautionary note that I have seen is that those with Marfan's should think long and hard before having it. But others whose aneurysm has been caused by trauma or hypertension and who do not present with Marfan's seem to do quite well. Please feel free to contact me directly at [email protected] if you wish to talk more. Good luck to you, I am sure all will be fine.
Click to expand...

Thanks Bradley. That helps. To Tom F. Did you get my e-mail?
 
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