ken taylor
Well-known member
As you know my surgery is May 26th , My question is , at what point do they replace the arotic root. I forgot to ask them . My last Eco said mild arotic root dialation.
Arotic root
- Thread starter ken taylor
- Start date
Help Support Valve Replacement Forums:
zztimeout
Well-known member
If u have a BAV they will remove all tissue of the root and will replace it... Anurysums usually start at the root with BAV patients.
I am having mine replaced tomorrow (19th May) here in Brisbane. Where is the scotch... Geez I need it !
I am having mine replaced tomorrow (19th May) here in Brisbane. Where is the scotch... Geez I need it !
Hold on there, timeout.
They do not necessarily remove the root in patients having bicuspid valves. They do careful measurements and evaluate the root and repair or replace the aorta or root as necessary. A significant portion of us BAV'ers have only the valve anomaly without involvement of the aorta, myself included.
There are checkpoints in the various measurements of the root. Maybe someone else can cite them, but I didn't pay that much attention to them once they did the MRI and declared my aorta and root "normal."
They do not necessarily remove the root in patients having bicuspid valves. They do careful measurements and evaluate the root and repair or replace the aorta or root as necessary. A significant portion of us BAV'ers have only the valve anomaly without involvement of the aorta, myself included.
There are checkpoints in the various measurements of the root. Maybe someone else can cite them, but I didn't pay that much attention to them once they did the MRI and declared my aorta and root "normal."
camgough
Well-known member
I am bicuspid and had valve sparing aortic root replacement surgery. Kept my bummer valve, replaced my 6.7cm ascending aorta aneurysm with a Dacron graft and replaced the root. Sounds like fun!
ken taylor
Well-known member
Well THANK YOU MY FAMILY, a little hope feels good right now.
I had my valve, root and ascending aorta replaced (aka Bentall procedure). If your root is normal but you have ascending aneurysm, they can replace the valve and the ascending aorta with a graft without replacing the root, which is a slightly less complicated procedure.
What has your surgeon said?
The "in network" local surgeon I talked was nervous about reattaching my coronary arteries to a graft so I decided to go to someone who wasn't.
What has your surgeon said?
The "in network" local surgeon I talked was nervous about reattaching my coronary arteries to a graft so I decided to go to someone who wasn't.
Jason
Always Assume Positive Intent
I am in the category of aortic valve replacement with a graft for the aortic aneurysm (5.5cm at replacement), while saving the root. My surgeon said that if the root looks good, she likes to keep it so there isn't the issue of reattaching the coronaries to a graft, and it reduces time on bypass. Do you know how dilated your root was, in numbers?
ken taylor
Well-known member
JASON, From my last ECO it says-mild arotic root dialation arotic sinus of valsava =3.7 cm also moderately dialation assending arota 4.4 cm with that what do you folks think?
I was told by a member of my surgical team that 4.5 was the measurement they used to determine whether to do aorta work while replacing the valve. But if it were me and I went into surgery with a 4.4 measurement, I would be adament about wanting the aorta work done as well. No reason to go through another surgery in a year or two (or ten) because a measurement comes up 1 millimeter short.
I too had the BAV replaced, but my root was not bad enough for replacement. Of the 3 surgeons I met with, 2 of them wanted to leave it alone and the one I went with offerred to wrap it with a dacron strip. He said the benefit is that it would preserve the native tissue while preventing it from getting any bigger.
Jason
Always Assume Positive Intent
My aortic root is mildly dilated like yours, and my ascending aorta was where the aneurysm was occuring. I had an ascending aortic measurement of 4.5 for about 10 years, and was under a watch. In the last year it (ascending aorta, not the root) went from 4.5 to 5.4, so I went in for surgery. They replaced the BAV at the same time even though by itself it wouldn't have required the surgery yet. It was better to get them both now rather than wait and have a guaranteed second surgery.
My particular surgeon said that 5cm was her point for recommending surgery, although I have seen recent references saying that for folks with BAV they are thinking that 4.5cm is a better target. The correlation of connective tissue disorder and BAV was cited as a reason to possibly move this recommendation downward. I think there is no hard and fast rule for when to repair or replace, and that it may depend on the surgeon and the patient's other circumstances, but if I were in your shoes I would be asking about a graft for the ascending aorta. I think at 3.7cm diameter in the root (may want to confirm this with a CT) you are only considered on the high side of normal, so they may not recommend replacement of that. But again, this is something to discuss with your surgeon's team, definitely.
My particular surgeon said that 5cm was her point for recommending surgery, although I have seen recent references saying that for folks with BAV they are thinking that 4.5cm is a better target. The correlation of connective tissue disorder and BAV was cited as a reason to possibly move this recommendation downward. I think there is no hard and fast rule for when to repair or replace, and that it may depend on the surgeon and the patient's other circumstances, but if I were in your shoes I would be asking about a graft for the ascending aorta. I think at 3.7cm diameter in the root (may want to confirm this with a CT) you are only considered on the high side of normal, so they may not recommend replacement of that. But again, this is something to discuss with your surgeon's team, definitely.
camgough
Well-known member
It's interesting that when the root is replaced like mine was, it can be more complicated because the coronary arteries are re-attached. After I was sewn up my chest tubes filled from an interior bleed. i was re-opened up and the surgeon could not find the bleed. Eventually it was found that a coronary artery had not been attached properly and was bleeding. They tried to fix it without going back on the bypass, but no luck. Put back on the heart/ lung bypass and sewn up for the second time. 7 1/2 units of blood later. Over the next day I developed acute respitory distress syndrome, asperation pnemonia and acute kidney failure. I had to be re-ventilated and spent almost 2 weeks in the ICU. I believe this is all a result of being on bypass for so long, and the numerous blood transfusions.
Once my lungs cleared up I started to heal and feel better quite quickly. Quite a gong show considering all the surgeons said it would be a snap since I was young and healthy.
On another note, it was one year ago today that a cardio told me I had a bicuspid aortic valve with the 6.7 cm aneurysm and needed open heart surgery promptly. WHAT A YEAR, HAPPY TO BE HERE!!
Once my lungs cleared up I started to heal and feel better quite quickly. Quite a gong show considering all the surgeons said it would be a snap since I was young and healthy.
On another note, it was one year ago today that a cardio told me I had a bicuspid aortic valve with the 6.7 cm aneurysm and needed open heart surgery promptly. WHAT A YEAR, HAPPY TO BE HERE!!
Cam - I got that "young and healthy" lecture, too. I often wonder where I would now be if I wasn't so "young and healthy." I'll agree - WHAT A YEAR, HAPPY TO BE HERE!
