AVR and AAA at the same time? Always?

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M

Motox-z

I have been watching this site for the past year in anticipation of my own surgery, and have gained very valuable information that will help me prepare for AVR and I hope AAA repair on March 14th at the Cleveland Clinic.

I am concerned that only the AVR will be completed and for some reason that they will wait to repair ~ 4.6cm AAA. I feel this way because at first they were not concerned about the size of my AAA and initially rejected the AVR, until the cardio I worked with at the Cleveland Clinic presented my case to the surgeon. Also, when the surgery scheduler called they mentioned minimally invasive surgery for the AVR and did not mention the AAA. I am fairly sure that the AAA can not be repaired with a minimally invasive technique. The frustrating part is every time I ask for surgery approval specifics, the nurse says I will have to talk to the surgeon during my consultation on May 12th (test planned for May 11th ? 12th). I can not get the test completed early as I am traveling to the CCF from Colorado. Has anyone planned for AVR with a a similar sized AAA not had both completed at the same time? I am probably thinking about it to much, but I am worried to travel to Cleveland and then not get both procedures done.

Any advice on travel? I have read most the post on this and came to the conclusion of ?
Planning to stay 8 days post surgery in Cleveland
Wife will be with me for the entire time
Have an opened ended return flight

Finally, what recommendations / experience do people have with having surgery at a far away location and then working through issues when they return home? Does your Cardio help you or should you find another surgeon?
 
Welcome to the site; glad you have benefited from the information. There are several members here who have traveled quite some distance for their valve surgeries and I'm sure they'll post their helpful experiences once they see your thread. I just wanted to tell you "hi" and I hope everything goes well for you. Take care and post again.
 
Glad you came forward Motox-z, we've got EXACTLY what you need to see. Get comfortable, it was a Long Journey but worth the effort.

Our member "Harleygirl528" had an Aortic Aneurism and BAV, went through all kinds of hoops 'trying' to be evaluated at CC, finally gave up and went to see Dr. Raissi in Los Angeles.

To find her Threads, which began in Oct 2007, click on "Members List", find 'Harleygirl528', click on "Threads started by Harleygirl 528" (or Threads started by member - I forgot the exact wording), and get ready for a Long Read.

Bottom Line: YES, it makes sense to fix Both an Aortic Aneurism and Aortic Valve at the Same Time but sometimes you have to 'nudge' the surgeon, especially if your aneurism doesn't meet the usual guidelines (at his hospital).

If you are willing to consider other Surgeons and/or Hospitals, be sure to seek out an Aortic Specialist. I believe a few were mentioned in Lorie's (Harleygirl528) threads.

Feel free to come back with more questions as they arise. Hopefully Lorie will see your post and respond also (or you could contact her through a Private Mail (PM) message or e-mail.

'AL Capshaw'
 
Welcome Motox-z. I will put you on the calendar for March 14th and hope that in the meantime you find many of your questions answered here. The usual procedure when having surgery "out of town" is to have a local cardio who will take care of you after you return home with one visit post-op to see the surgeon again- usually around 6 weeks. Best wishes to you.
 
Hey Motox-Z

We are in the same boat and if you are going in March, I'm about 10 days ahead of you at the Cleveland Clinic. I went in last week for my pre-sugical consult and my AVR surgery is scheduled next week (March 4th). My Asending Aorta (AA) was measured at 4.5 cm^2 and the cardio suggested it was borderline based on my large (tall) size, but the guidelines?, he called them rules, suggested that was the upper limit and it should be replaced. See my post in the Pre-Surgery forum. My surgeon said he would probably repair the AA if the tissue was in good condition and only replace it if necessary. For me minimally invasive was not an option because of the need for AA repair. Regardless, I would totally trust the MDs at CC, especially the surgeons. The scheduling nurses are very helpful but until they do your evaluation nothing is certain.

When I went to CC they did a Cat scan that identified my AAA, interesting because the local surgeon here in CO did not even think a CTA was necessary. CC also did an amazingly thorough echo cardiogram. So trust that they will know what is best once you are evaluated.

Housing at CC is expensive on Campus but there are other options.
I am not far from you and will send a PM for you to call or email me and we can compare notes. I would be glad to talk to you.
John
 
Hi there,

Sorry to hear that you are dealing with all of this but it is great that you are on this site. I can't tell you how much encouragement and practical advice I received from the members here. In fact, I was referred to the surgeon I eventually chose by a member here!

Al is right, I have dealt with the same situation you are in from dealing with Cleveland Clinic, traveling for surgery and having both valve and aneurysm issues.

I have sent you a personal message with my thoughts and also my phone number if you want to call me ~ I know I found it extremely encouraging to talk to people who had gone through similar situation and would be more than happy to chat with you.

I totally, wholeheartedly agree with the recommendation to deal with the aneurysm NOW while you are doing the valve...I have given you details in my PM as to why I feel this way and I am sure Ross will be around soon to share his situation because he is one who didn't make it to 5 cm...and he was a big part of the reason I didn't wait to deal with mine. Several doctors told me I could wait and watch but it just didn't make sense to me...why take a chance with my life when surgical outcomes and mortality is extremely low....about 1%? It was absolutely the right choice and I feel like I have a new lease on life, literally! Walking around with that aneurysm made me feel like I had a ticking time bomb in my chest and now I really feel such a tremendous amount of relief and my anxiety level and quality of life is sooo much better.
We're here for you....hang in there and don't hesitate to call me if you want!
 
Have the Aneurysm repaired at same time....if not, you are virtually guaranteed of another OHS and an increased risk, it could be in as little as a few years. You will not want to go throguh it again when they could ahve done it before.

5cm is the normal threshold for surgery but every one is different, dont mess with it. Rememver the risk of not doing it, it dissects, rupture and you leave planet earth.
 
Look at my son's info below and you will see why I wholeheartedly recommend dealing with an aneurysm in a timely fashion. That being said, I understand that sometimes an enlarged aorta is due to the faulty valve and that it goes away after valve surgery. If this is the case, then I think you can avoid the aorta repair, otherwise, I say do it now.

Just my 2 cents worth.
 
I also agree that both should be fixed at the same time...my aortic valve wasnt as urgently in need of repair as my aneurysm when I had surgery so my Cardio had a bit of a "timing dilemma" for awhile. On the other hand my surgeon was keen to get me fixed before a disaster happened.

In reality I sacrificed a few more years of life out of my bicuspid aortic valve in an effort to avoid another OHS. It didnt quite work out (the avoiding more surgery bit) due to unforseen complications but at least we tried and I have no regrets and I wont need another OHS in a few years to replace my worn out valve 'cos its already been done.
 
Thanks for the posts and valued information. Each day I am more prepared for this challenge.

This Site is GREAT>>>
 
Mike C said:
Have the Aneurysm repaired at same time....if not, you are virtually guaranteed of another OHS and an increased risk, it could be in as little as a few years. .
Click to expand...

Absolutely well put - excepting I would stress that it could easily be as little as a few months, and could be only days.

It's not uncommon for the valve replacement surgery to encourage a tissue change in the ascending aorta, if it's already headed that way. Sometimes it seems to be from the actual sewing and valve placement. Another possible contributor is that when you're hooked up with your new valve, everything also goes back to full pressure. Except that you still have an enlarged, over-muscled left ventricle from when your valve wasn't cooperating, so its output is higher than normal, healing and drugs or or not.

It's hard to see where they might be doing you a favor by holding off. It's not likely to stop expanding or stabilize. You will almost surely have to have it surgically corrected later - an extra surgery that didn't need to happen by my reckoning. Were it me at 4.6, I would insist it be done, and would switch surgeons and facilities if necessary to ensure it. Of course, not everyone would agree with my ferociously patient-centric opinion.

Best wishes,
 
I just want to double check, when you speak of AAA are you talking about an Abdominal Aortic Anuerysm? that is a pretty big surgery.
 
Ascending Aortic Anuerysm. I am prepared to walk away from the surgery if both procedures are not done at the same time. However, I am also more confident that both will be completed, I will no for sure on March 12th.
 
yes

yes

Circ J. 2005 Apr;69(4):392-6.Related Articles, Links
Natural history of a dilated ascending aorta after aortic valve replacement.

Matsuyama K, Usui A, Akita T, Yoshikawa M, Murayama M, Yano T, Takenaka H, Katou W, Toyama M, Okada M, Sawaki M, Ueda Y.

Nagoya University Graduate School of Medicine, Department of Cardio-Thoracic Surgery, Nagoya, Japan. [email protected]

BACKGROUND: Little information is available regarding the incidence of aortic dissection or rupture in patients with a dilated ascending aorta after aortic valve replacement (AVR). The present clinical study aimed to demonstrate the incidence of aortic complications after AVR in patients with a dilated ascending aorta and to clarify those risk factors associated with the progression of a dilated ascending aorta or late aortic events. METHODS AND RESULTS: A total of 35 patients with a dilated ascending aorta at the time of AVR were enrolled. A dilated ascending aorta was defined as 40 mm or greater in diameter by preoperative computed tomography or operative findings. The baseline ascending aorta diameter ranged from 40 to 55 mm with a mean of 44.8+/-4.4 mm. There was a high frequency of bicuspid valve disease in patients with a dilated ascending aorta (57%). The mean follow-up interval was 8.1+/-3.5 years (range: 2.3-13). Aortic events occurred in 5 patients (aortic dissection in 1, rupture in 2, reoperation in 2) during the follow-up. One aortic dissection developed at a baseline aortic size of 42 mm, whereas 2 aortic ruptures occurred at baseline aortic sizes of 47 mm and 50 mm. There was no statistically significant univariate association between any of the patient clinical characteristics and late aortic events or ascending aortic progression. CONCLUSION: Although the clinical course of patients with a dilated ascending aorta is unpredictable, aortic events may occur even in patients with a baseline aortic diameter of <50 mm. Therefore, preventive aortic surgery at the time of AVR should be considered to prevent aortic dissection or rupture in patients with an even slightly dilated ascending aorta with a diameter of 40 to 50 mm, unless the patient has a high operative risk or older age.
 
I had bicuspid valve replacement and ascending aortic aneurysm repair with graft at the same time in Cleveland in November. Once I got to Cleveland, everyone was extremely helpful answering all my questions, and I had many.

I would highly recommend Cleveland Clinic and I traveled like you will. do you know who your surgeon will be? I would really trust the surgeon and go in with all your questions and concerns, and expect for them to be addressed during the consultation one way or the other. I can not recommend what to do about your size aneurysm, but would really try to be open to the advice of the surgeon at Cleveland.

As far as traveling, I stayed two extra nights after surgery, and then got on two planes home to the Southwest. Traveling was fine, but an extra day might have been nice. Feel free to ask any other questions, and it's great you found us here on this site.

All the best, Betsy
 
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