Aortic Valve Bypass

[Bill B]

I saw this a while back when I was looking for alternatives to traditional valve replacement for my now severely stenotic BAV. I don't see it mentioned here. I gather this is not entirely new, but it appears to be a refined version with a new apparatus. Right now it is investigational and only used in patients who would not tolerate AVR. Perhaps it will be a good solution for me should I choose to go with a bio AVR next month and need re-operation in 20 years. Anyway, here is a description from the University of Maryland.

http://www.umm.edu/heart/avb.htm

 

[Lynlw]

Interesting, so basically you would be having blood go thru 2 different "aortic valves". Since all of the work is done out side your heart, I can see where it would be easier/no stopping heart /bypass pump, but I'm not sure the long term advantage, over other things they have in trials, it will be interesting to watch.

 

[tobagotwo]

I posted a question this morning to the doctor through the university website. I'll be interested to hear the response.

Thank you for posting the link.

Best wishes,

 

[Bill B]

Bob:

Let us know what you hear back. For future reference, I'm wondering if this bypass can be grafted onto a Dacron aorta.

Bill

 

[tobagotwo]

Bill, most dacron aorta sections are parts of the ascending aorta (including the root). My understanding was that this bypass attaches to the descending aorta. While there are some folks who have that in vellour as well, it's much less common.

I haven't seen anything to indicate a response yet, but as it's an educational institution, I'm not going to hold my breath waiting for a speedy reply...

Best wishes,

 

[Bill B]

Ah, I missed that it was descending aorta. I would have expected ascending, but I gather the retrograde flow feeds the arch well. Great. That avoids my issue.

 

[TXWildflower]

That was an interesting read. I too am counting on advances in technology to be a possible alternative when it comes re-op time (should I choose a bio valve which I am almost sure I will). This might not be the answer for someone with connective tissue disorders as well, but since I fortunately fall in the plain old AVR only category (and hope I remain so) this really gives me hope that I could have something like this available for my re-op.

This little video is definitely not new to the forum as I saw it in someone else's post awhile back. One thing I need to discuss with my surgeon is how feasible this really is and whether you must have a specific type of valve in the first op to perhaps use this procedure in a re-op.

http://abcnews.go.com/GMA/OnCall/story?id=6589797&page=1

Rhena

 

[tobagotwo]

My understanding was that the original aortic opening would still feed the ascending aorta. I don't think retrograde flow would serve the brain and heart adequately. This quote from that brief article would tend to bear this thought out:

blood flow across the substitute valve (where clots can form) never reaches the brain.

That, in fact, was the basis of my question to him: was this not more of a holding action than a resolution, as the original aortic valve would continue to stenose, eventually becoming inadequate to feed the ascending aorta sufficiently for the brain and heart?

As such, it would work for those of advanced age, but not for folks who would outlive the final calcification of the valve.

Of course, I could be missing a point somewhere in this.

If I get a reply, I will share it. So far, it hasn't shown up on his Q&A website, and I've not gotten a reply.

Best wishes,

 

[Lynlw]

My understanding was that the original aortic opening would still feed the ascending aorta. I don't think retrograde flow would serve the brain and heart adequately. This quote from that brief article would tend to bear this thought out:
That, in fact, was the basis of my question to him: was this not more of a holding action than a resolution, as the original aortic valve would continue to stenose, eventually becoming inadequate to feed tha ascending aorta sufficiently for the brain and heart?

As such, it would work for those of advanced age, but not for folks who would outlive the final calcification of the valve.

Of course, I could be missing a point somewhere in this.

If I get a reply, I will share it. So far, it hasn't shown up on his Q&A website, and I've not gotten a reply.

Best wishes,

That was my thoughts too. Since it bypasses the arch and you are relying on your origonal valve/ascending aorta to feed the brain ect, what happens as it gets worse and worse.
Also since it is a surgery, even tho you don't need to be on bypass, what is the big advantage over either tradional AVR or if you are talking about the future, over percutaneous replacements.

Ps it reminds me of the BT shunt Justin and many other CHD kids have to help them grow big enough to handle the big complex surgery

 

[Bill B]

My understanding was that the original aortic opening would still feed the ascending aorta. I don't think retrograde flow would serve the brain and heart adequately. This quote from that brief article would tend to bear this thought out:
That, in fact, was the basis of my question to him: was this not more of a holding action than a resolution, as the original aortic valve would continue to stenose, eventually becoming inadequate to feed the ascending aorta sufficiently for the brain and heart?

As such, it would work for those of advanced age, but not for folks who would outlive the final calcification of the valve.

Of course, I could be missing a point somewhere in this.

If I get a reply, I will share it. So far, it hasn't shown up on his Q&A website, and I've not gotten a reply.

Best wishes,

Yes, another good pick up. Funny, I did see that part about the flow from the bypass would not reach the brain, but when you brought up the descending aorta, which I missed, I forgot about reading the former. So, yes, it appears they are counting on the aortic valve still being somewhat competent.

 

[Bill B]

Here's a link to a paper by the Baltimore group.

http://circ.ahajournals.org/cgi/reprint/118/14/1460.pdf

Here's a discussion/interview with the author. You may have to join this service (free) to view this.
http://www.theheart.org/article/907725.do

 

[ShezaGirlie]

Welcome to the forum Bill and all the best.

 

[pamela]

I sent some information to our friend Dawn-Marie about this surgery. The one I inquired about was where the new valve actually joined before the arch, I thought and the department replied that even though the heart doesn't go on bypass, it is stopped very briefly and the patient is intubated and on a respirator (which didn't serve Dawn's purposes).

I'd count more on having a percutaneous valve replacement before I'd expect a valve bypass to be the favoured technology in 20 years. If there's capability to have AVR surgery traditionally or minimally invasive then my personal choice would be to have that procedure over any other less familiar ones.