Aortic Valve vs. Aortic Root Replacement Endocarditis Risk

[Jason2012]

Hi Guys and Gals,

I recently became a candiate for aortic valve replacement after doctors finally saw my valve turn to crud during a bike echo (I only have mild regurgitation when at rest, but severe when I am symptomatic).

Originally they were only talking about doing the valve, saying my aorta wouldn't need work right now (it is dilated, mildy to moderate, I don't know the exact number atm, I want to say 3.6 cm, but honestly I don't have the records on hand). After reading about consequential ascending aortic issues (dilation/anuerysm) in people with BAV, I asked the surgeon about whether or not this might be an issue later. First, he offered to dacron tape it. Then, when he realized that the dilation is closer to the root, he offered to do an aortic root replacement (synthetic) in my case (with an embedded On-X valve) instead of taping anything. To me, this sounds good. I can probably avoid future ascending aorta issues going this route.

My question is about endocarditis risk. I am curious about endocarditis risk with full aortic root replacemement vs. just having the valve done (and then having to monitor the aorta forever). In other words, I can't seem to find good information about whether having "more" synthetic material (the root and valve vs. just the valve) will make me at much higher risk for endocarditis or not.

I am in a strange situation. My aortic valve leaks randomly, usually with exertion or positional changes (like squatting to work on something). In theory I could prob. take it easy and live a long time. But quality of life isn't the best at age 32 when you have to rest all the time/manage your activity so much. Sometimes I have days where I have no symptoms, even with moderate activity. And I've got at least one family member telling me this surgery is very dangerous, why can't I wait, etc. (luckily it's not my wife who is saying this, this person is a doctor (an allergist however).

Right when I came to terms with the operational risks and the lifelong coumadin therapy... I heard about the endocarditis risks. Because my valve isn't so hot right now, I'm prob. at risk for that right now anyway.

Man... heh.

Thanks for any Information/Thoughts,
Jason

 

[escargome]

Hi Jason and welcome.
I'm not too well versed in endocarditis, but as I understand it, you are no more at risk of endo with a valve/root replacement than you would be with just valve replacement. As I understand since I have never had endocarditis, most times the bacteria can enter your system through routine dental care but not always. I'm sure others who have more knowledge regarding this infection will speak up soon. As to the valve only versus valve with root replacement, if it were I, I would get it all done at once. As to the dangerous part of the surgery, the way I see it is that it is only dangerous if you don't have the surgery. I wouldn't wait if you feel confident and your doctor says now is a good time. They do this type of surgery a lot and the survival rates are pretty good. I selected a tissue valve when it was my time and I know I will likely have to do the OHS again at least once, but I was so confident with both my surgeon and the hospital and staff that I can't foresee a problem when the redo time comes also. Good Luck as you begin to travel this road to a new lease on life.

 

[camgough]

Re: Aortic Valve vs. Aortic Root Replacement Endocarditis Risk

Hey Jason, I'm also 32 and at 30 I had valve sparing aortic root replacement. That means my root and ascending aorta were replaced with a dacron graft, and my BAV left in. It was my aortic aneurysm that needed repair before the valve. Yearly tests show my valve still leaks, but I am managing it. It is likely I will need it replaced down the road. Like you, I would get an on-x mechanical if available.

If I were in your shoes, I would have the whole root replaced along with the valve. This may prevent future surgery. This surgery is more complicated, but as mentioned before, has great outcomes with an experienced surgeon.

What are your symptoms?

Cam


Sent from my GT-I9100M using Tapatalk 2

 

[pellicle]

Hi

Hi Guys and Gals,
My question is about endocarditis risk. I am curious about endocarditis risk with full aortic root replacemement vs. just having the valve done (and then having to monitor the aorta forever).

I am not a doctor, but to my mind not really. The valve itself is where the infections most commonly take. I sincerely recommend asking your doctors that exact question

In other words, I can't seem to find good information about whether having "more" synthetic material (the root and valve vs. just the valve) will make me at much higher risk for endocarditis or not.

not to my understanding

And I've got at least one family member telling me this surgery is very dangerous, why can't I wait, etc. (luckily it's not my wife who is saying this, this person is a doctor (an allergist however).

that's (just my HO) just BS ... I would ask them if they would prefer you died from the thing that the surgery is designed to save you from? Sure the surgery is risky, but FAR FAR less so than not having it.

Right when I came to terms with the operational risks and the lifelong coumadin therapy... I heard about the endocarditis risks. Because my valve isn't so hot right now, I'm prob. at risk for that right now anyway.

I agree with your summary.

I had a valve replaced and an ascending aorta done at the same time. It was a pre-stitched unit. Both On-X and ATS make them, although I thought ATS had a longer history of them being produced. Either are good valves.

I personally would far rather have one surgery and recover from that than have a surgery again just as I had recovered a normal life (as happened to me).

Now I have to struggle again to regain where I once was.

Warfarin is not so bad (the name Coumadin is a trade name for a product, Marevan is another Wikipedia). I used to be worried about it too, but I am of the view now that with more information coming to my vision of things its not the dark horse that I once thought it was. Search some of the threads here where I have commented about Warfarin.

Thanks for any Information/Thoughts,

you're welcome

 

[ski girl]

Jason-

I had endocarditis in 2011, 11 months after having my native valve replaced with a bovine one. I had a massive infection that came very close to killing me - I was given a 30% chance of surviving and had to have a second OHS to replace my relatively new bovine valve. So I feel reasonably qualified to speak about endocarditis!

It's the valve that the bacteria set up shop on, for reasons to do with hemodynamics and also because artificial parts don't have any internal blood supply so the immune system can't get to anything foreign. The risk of endocardititis is tiny though, and any increased risk you might be at from having work done on your aorta is so miniscule as to not be worth considering. If your aorta needs some work done, you're at massively more risk if you DON'T have it fixed!!

One of the most important things you can do to avoid endocarditis is to be very careful with your oral hygiene, as mouth bacteria are a common cause. I was told (after I got endocarditis, thanks guys) to always rinse with an antiseptic mouthwash before I brush my teeth, then wait a couple minutes before brushing so that as many bacteria as possible are killed off. And floss with tape floss, not the string.

As for this surgery being dangerous - there is about a 1-3% chance of something serious going wrong. Ask your allergist mate what the chances are of something going wrong in a person with an undiagnosed allergy . . . HEAPS higher! You'll be fine. Good luck!

 

[pellicle]

Jason-

I had endocarditis in 2011, 11 months after having my native valve replaced with a bovine one. I had a massive infection that came very close to killing me - I was given a 30% chance of surviving and had to have a second OHS to replace my relatively new bovine valve. So I feel reasonably qualified to speak about endocarditis!

It's the valve that the bacteria set up shop on, for reasons to do with hemodynamics and also because artificial parts don't have any internal blood supply so the immune system can't get to anything foreign.

Interesting research topic:
Are tissue prosthetics more prone to endocarditis than mechanical ones?

 

[ski girl]

Pellicle I've done some digging around on this and I can't find anything definitive. I wondered if perhaps the tissue was more 'edible' for bacteria but the companies treat it with so many chemicals that IMHO a tissue valve isn't edible at all. The nutrition comes from the blood, and the bacteria can keep growing as the immune system isn't attacking them like it would if the bugs were camping out on a native valve.

However, I didn't find any studies showing a relationship or lack thereof with endocarditis and valve type . . .

 

[ElectLive]

Interesting research topic:
Are tissue prosthetics more prone to endocarditis than mechanical ones?

Historically they are in fact equal, although very often thought not to be. This article is about much larger issues, but illustrates the point: http://ats.ctsnetjournals.org/cgi/reprint/82/3/776.

 

[pellicle]

Historically they are in fact equal, although very often thought not to be. This article is about much larger issues, but illustrates the point: http://ats.ctsnetjournals.org/cgi/reprint/82/3/776.

Thanks

Will check that link when I'm on a network which can access it

 

[Jason2012]

Thanks for the great replies everyone. I want to reply to the individual posts soon (and will), I just haven't had time to yet, hence me vanishing for over a day. I have a 1.5 year old who is a blast -- he does tire me out however, and I'm off to bed for some Z's.

 

[Gail in Ca]

After I was treated with 6 wks of IV antibiotics and oral as well, I still had to have surgery to find out why my hematocrit was staying so low. My cardio and surgeon decided the bacteria had done damage to my leaking natural mitral valve, and also affected my 8 yr old mechanical valve, or the tissue surrounding it, to be more specific. When they got in there, they found my natural mitral had little holes in the leaflets, and they also decided to replace my mechanical valve and existing 20 yr old dacron graft with a mechanical valve inside a hemashield graft. The surgeon moved the mechanical valve up along the aorta to avoid the suspect tissue damage.
He told me later that this valve inside graft should help me avoid endocarditis. He mentioned that the stitching is on the inside, so less problem with bacteria setting up shop on the sewing ring of the valve.
But, he just repaired the mitral, because he found no evidence of lingering bacteria. I was told by the infectious disease doc that my risk of getting endocarditis again was only 1% higher than it was when I originally got it the first time.