Hi Harvey, not sure I can add much to what has already been stated, but in June of 2001 I had an ascending aneursym repaired. The valve was a judgment call on the surgeon as the first choice was to leave the original or repair, if possible. But, he thought my enlarged aorta had stretched the valve too much to take a chance, so the second choice was a homograft (tissue valve from a human). The thought was that it was going to last 15 or 20 years. Since I was 45 at the time, that seemed ok to me. The homograft comes with a piece of aorta for the root and then they added some dacron to that to replace the anuerysm. They had been monitoring me for about 10 years and when I got to the 5.5 stage, they started talking about surgery. My time on the pump was extended because they decided that the upper end of the repair was too close to the aortic arch to handle without freezing me to death basically. They bring your body temperature down until the brain signals are gone and then they do the repair and warm you back up. I think that added some time.
My replacement valve developed a leak after 18 months and I just had a valve replacement in January of 2003. Because we weren't sure why the tissue valve had failed and to try and avoid another surgery, we used a St. Judes mechanical this time. I like the fact that I hopefully won't have to have another valve surgery, but I also wish the tissue had lasted. It didn't require the meds and didn't click. I've only had it a couple of months and they tell me I will get used to it, but it is noticable to me. But, I'm sensitive to noises anyway. They had to use a different drug on the pump as I developed a reaction to the Hepron they use on the bypass. But, that worked out fine and recovery from both surgeries was not too bad. Praising God for those blessings. The biggest problem from the first surgery was that I developed a blood clot in my leg from the Hepron reaction. That set me back a couple of weeks on rehap.
Unless they have a reason not to do it, I think it would be a good idea to have the aneursym/dilation/enlargement (whichever term you hear). I was told that most surgeries are done between 5 and 6 CM. My surgeon thought that the 5.5 range was the best risk to benefit and recovery range. I think mine was like 6.4 when we actually did the surgery. But, I'm not real sure that was an accurate measurement. I would be concerned that it wouldn't be that far down the road before they would have to operate on the aneursym. But, you'll have to see how they want to proceed. If they decide they need to wait, subsequent surgeries are not that bad (less is still better).
I don't think that having an aneursysm requires a difference in valve selection, probably does add time on the pump, I don't think it would affect recovery, does make the surgery more complex, but mine went well. I didn't have the stenosis.
I've got to quit writing these long replies.
