Aneurysm question.....(posting for someone else)

[Keithf]

Hi Kate,

Yes, I have not heard anyone claim that the valve will last 60 years either, but what other conclusion should I draw? The valve does not wear out, as such, but calcifies. If thermofix makes the calcification problem go away (by a factor of 4 or 5), then what else should I think?

From
http://www.edwards.com/products/heartvalves/thermafixfaqpdf.htm

As the only tissue treatment to extract both major calcium binding sites, theproprietary ThermaFix advanced tissue process reduced calcium uptake by up to 81% over glutaraldehyde controls in small animal studies.5Edwards

I do know that it will take a long time to find out for sure how long these valves last, but meanwhile you would think that someone could put together an educated guess (without waranty).

 

[MrP]

Extrapolation of results of a study on small animals to humans is a big leap....not to mention a single study.

 

[Keithf]

This is a bit off-topic, but let's talk about it anyway.
You are right, extrapolation is a very error-prone mathematical tool.
But at the end of the day, what are you going to do? You have valve A with its datapoints and you have valve B with its datapoints and you have to pick one or the other. Whether you like it or not you are guessing at which one is better by deciding on a probable number for each.

And it is a very expensive guess, given the cost and risk of an OHS operation.

So what I am saying is that as a consumer of these expensive heart valve products, I would like to have as much information and analysis as is possible... not conservative estimates and hedging of bets for legal protection.

There is very little difference among mechanical valves, but big differences between tissue valves. It seems to me that most of us are reduced to selecting between heart valves in a process that is similar to buying a house after being shown a few pictures of some nearby houses.

 

[MrP]

Keith,
I'm no expert on differences between tissue valves (or mechanical valves), and so I relied upon advice and wisdom of those I considered experts and extremely experienced in this area.
Given the expense and risk of OHS, I think being conservative and trusting the very best and most experienced is not such a bad way to go. At least this is better than relying on flimsy datapoints from marketing blurbs of various products or deriving probabilities of success from limited information and knowledge.
Good luck....pick a strong house that will last a lifetime.
MrP

 

[Susan BAV]

Select an excellent surgeon, and one you are comfortable with, and ask him what he recommends or would choose for himself. I went to mine and explained who I was and what I wanted and why, and told him I was leaning toward some Edwards bovine valve that I had read about here over three years ago, he smiled pleasantly and told me about the Medtronics porcine. I like pork as well as beef, so why not?

 

[Keithf]

Hi Keith!
I just wanted to respond to the Cleveland Clinic portion of your orginal question. I had my aortic valve replaced and a 4.8cm ascending aortic aneurysm fixed there about a year and a half ago. I can't say enough about how fabulous the care I received was!

Hi Kate!

A question, please. Did you go in to get your valve replaced or to get your aneurysm fixed?

In other words, was the decision to operate made because of your aneurysm was getting large, or was it because you valve was starting to have a lower ejection fraction and you had shortness of breath etc? I guess I'm trying to get some insight into when they at the CCF think it's time to operate on an aneurism.

Thanks!

 

[Kate]

Hi Keith,
Although my valve was looking bad and would likely have needed to be replaced within a year anyway, it was my aneurysm that prompted surgery at the time I had it. However, normally, CCF would not recommend surgery at 4.8cm, so you shouldn't really use this as a guideline. The only reason they did with me is because I'm a relatively small person (5'3") and managed to find an article written by Dr. Svennson, recommending earlier intervention with people my size based on the relative size of aneurysm. My cardiologist was actually recommending that I wait another six months, but I insisted. In my opinion, if the risk of dissection is 5% and the risk of dying during surgery is under 2%, it makes no sense to wait around. Kate

 

[MrP]

Keith,
Many surgeons recommend elective surgery for ascending aortic aneurysms in BAV patients when the diameter reaches 5.0cm, and some recommend surgery at 4.5 cm in these patients to further reduce risks associated with rupture or dissection. Keep in mind the size criteria are based upon statistical analysis and measurements over a large sample of patients, and there is a margin of error associated with each measurement. Your individual measurement would vary if you were to have many measurements of your aortic size, and the differences between each measurement and the average would be attributed to the inherent margin of error or precision of each measurement. Comparison of ascending and proximal descending aortic diameters is also helpful to better understand how the aneurysmal dilatation compares with what is the "normal size" for you.
With respect to timing of surgery, as Kate points out the risks of rupture or dissection may be greater than the risks of surgery. And you will ultimately need surgery, so really the risks of surgery will exist nonetheless. Increased risks exist for rupture or dissection once the aortic size reaches 4.5 to 5.0cm, and these risks only increase the longer you postpone surgery.
Make no mistake, this surgery is major and will alter the lifestyle of all who unfortunately undergo it. Best to have this surgery in advance of an emergency situation, however. Once rupture or dissection occurs and assuming you survive an emergency surgery, your long term survival will be less than one who elects to pre-emptively have surgery in a non-ER situation.
All my best,
MrP

 

[wildcat fan]

hello everyone ,

Brand new to this site and came across post and I just had a 5.2cm Ascending Aortic Aneruysm and Aortic Valve replacement done 3 months ago. What is scary is that this a very common problem. When I had been diagnosed with the Aneruysm it was Sept.2005. I waited till Nov.7th 2006 and I had my surgery done at Baptist Hospital East in Louisville,Ky and my surgery went smooth as silk. The only problem I encountered was the Recovery staff was trying to get me off the Ventilator and my heart went into Atrial Fib so they had to put me back to sleep to try and get my heart to slow down enough to where I could come off the Vent. The rest of my recovery has been smooth and to everyone surprise is how well I have done with this of operation . I will be going to back to work in about 2 more weeks. All I can say is please listen to the Nurses and don't be afraid to ask for the pain meds( that was plainly stated to me before and after surgery .)
My heart doc was Dr. Sam Pollock and he is an excellent surgeon I have seen operate in the middle of night and be done in under 4 hours start to finish. I work for the hospital I mentioned and it is in the OR area I work in . I trust and pray that everyone is doing good and in good health.

P.S. the location of the Aneruysm was located near the Sinuses area of the Aortic root that if had ruptured it would have killed me instantly.
surving with an ATS Mech.Valve and taken care of Aneruysm.

 

[Wise]

hello everyone ,

Brand new to this site and came across post and I just had a 5.2cm Ascending Aortic Aneruysm and Aortic Valve replacement done 3 months ago. What is scary is that this a very common problem. When I had been diagnosed with the Aneruysm it was Sept.2005. I waited till Nov.7th 2006 and I had my surgery done at Baptist Hospital East in Louisville,Ky and my surgery went smooth as silk. The only problem I encountered was the Recovery staff was trying to get me off the Ventilator and my heart went into Atrial Fib so they had to put me back to sleep to try and get my heart to slow down enough to where I could come off the Vent. The rest of my recovery has been smooth and to everyone surprise is how well I have done with this of operation . I will be going to back to work in about 2 more weeks. All I can say is please listen to the Nurses and don't be afraid to ask for the pain meds( that was plainly stated to me before and after surgery .)
My heart doc was Dr. Sam Pollock and he is an excellent surgeon I have seen operate in the middle of night and be done in under 4 hours start to finish. I work for the hospital I mentioned and it is in the OR area I work in . I trust and pray that everyone is doing good and in good health.

P.S. the location of the Aneruysm was located near the Sinuses area of the Aortic root that if had ruptured it would have killed me instantly.
surving with an ATS Mech.Valve and taken care of Aneruysm.

Welcome, to one Wildcat Fan from another. Glad you are doing well after your surgery. You'll receive a lot of help here. It is also good to know of an excellent surgeon in this region. My wife and I live in Frankfort; if I'm ever a surgical candidate, I will remember the name Dr. Sam Pollock. I used to work for a Sam Pollock, so I'll just imagine him dressed up as a surgeon (and laugh, frankly). Anyway, welcome and best wishes.

Wise