BAV repair vs replacement

[a4wanman]

Of those who have had aortic valve surgery, did the surgeon indicate they would try to save/repair the valve. If the valve was repaired, how long did the repair last before replacement was necessary?

My surgeon indicated there is a change to repair my BAV, but he will not know until I'm on the table. I think echos have indicated my valve has stenosis and I've read stenoic valve are not repairable.


Scott

 

[Mentu]

Scott, as I understand this issue, repair vs. replacement is often something a surgeon can only determine once he sees the valve. If the valve is stenotic due to calcification, there would seem to be little likelihood of repair. These are questions, however, you need to address to your surgeon as he is probably the only one who can answer them. It is important that you have confidence in your surgeon since he is going to be making this decision. Talking with him again or one of his team members would be a good idea, especially, concerning your options if replacement is required.

Larry

 

[Ross]

I'm torn on this issue. I had my aortic valve repaired and it lasted 7 years before needing replaced. I'm of the faith that if you can avoid another surgery, just get it replaced. The other half says, hang on to native as long as possible. Surgery was hell for me and I never want to go through it again, which is why I say just replace it and get it over with.

 

[MarkU]

My surgeon discussed both doing a repair on my valve or a minimally invasive procedure, but told me that based on my test results and his experience we were better off just going through the front and doing a replacement.
That was recommendation was validated once they had me opened up and discovered that my valve was in much worse shape than they thought.

Mark

 

[nngbwh]

I always though the surgeon can tell if valve needed repair or replacement by the echo result and CT scan.

 

[worship.dr]

My surgeon also thought from my echo that the valve might be spared by a Ross procedure. My echo appeared to show that the calcification was not attached to the leaflets He did tell me that he would not be sure until he was in there. Sure enough, he got in there and the calcification was actually larger and more damaging than the echo showed. I had already chosen my replacement valve if needed so the replacement was made.

Only your surgeon will know what your situation calls for. That was mine. They were going in anyway because of my Ascending Anurysm and replacing my BAV was part of the package. My choice going in was to keep my native valve as long as possible if it could have been reasonably saved for a significant amount of time. My surgeon said the repaired valve would have only lasted a couple of years at best so replacement was the only option.

I am only 9 weeks out now so everything is still fresh. Good Luck.

 

[traveler]

It's tough call.

Repairs are nice and they don't change your life or require special attention after you recover from surgery. That said they are temporary fixes and temporary can mean much sooner than you thought. I had a repair of a aortic valve and an aneurysm repair at Mayo. The surgeon was great and upfront about the risk. And I'm good at accepting a lot of risk. But 3 years later, I'm wondering if this is the year for my next surgery. My primary care physician thinks I should have gone with replacement. But I'd go with the repair again. It's a little like digging for gold or winning the lottery -- you might get 10-20 years but it's more likely that you'll 4-7 years and you could get less (right now I'd be ecstatic about making it 7, and satisfied if I made it to 5). But for me a few years of no change in my life style is worth it.

The surgeon said a tissue valve might offer some of the same advantages, but that it would wear out too, thought that there more concerns about infections (based on my current understanding I'm not sure this is true), and hoped that the repair would offer a better deal.

I should note I travel a lot and accept more risk than most people would be comfortable with. And it was important for me to be able to do that. I'm currently in West Africa visiting a series of small villages (~500 people) who are being affected by a local gold rush. What that means is that local sanitation is even worse than usual and lots of people are sick (some young men have died in the past couple of weeks digging for gold), the food and water are questionable, and I'll spend much of the next week living in the villages without electricity, running water, or access to medical care (or the internet)- eating the food and sleeping in a mud hut with dirt floor. Based on this the surgeon thought repair (if possible) was the best choice.

Just my thoughts, it's probably worth it --- but you (with your doctor's advice) are the best judge of that.

 

[thenewmarket]

My husband had BAV repair and aneurysm repair in September 2007. Before surgery, the surgeon did not feel a repair was in our future. We made our valve choice and proceeded with surgery. Once the surgeon was "in" he determined that my husband's native tissue was in excellent condition and he opted to repair the valve instead of replace it. My husband's aneurysm was found through a routine chest x-ray and we truly felt the hand of God was leading us from the beginning of this journey. We haven't questioned the surgeon's decision to repair......we just continue to trust. We are approaching three years in September and so far.......so good. I tell my husband all the time that since this surgery isn't considered "routine"......he is contributing to the learning curve for the future in BAV repair.

 

[ottagal]

Prior to my surgery, I was told that my stenotic aortic valve would be replaced. However, I was told after the surgery (by my surgeon) that he had attempted to repair it first, but the valve was too calcified; hence, he felt I would not have been satisfied with the repair as it would not have lasted very long. So...I ended up with the replacement valve after all, but I did appreciate his attempts at a repair.

 

[Luana]

I'm not a BAV person but I had severe aortic regurgitation and moderate/severe stenosis. Replacement was the only option.

 

[james]

I had a repair in 1980 that was only supposed to get me to age 18 or so. I then had my replacement 30 years later at age 39.

 

[aussigal]

If you have a BAV I think you have to remember that this is a Connective Tissue Disorder and therefore all your connective tissue is likely affected/faulty. This is why I am firmly of the opinion that you do not repair them, you replace them. I sacrificed a few more years with my BAV to have my valve and aneurysm fixed/replaced in the one surgery (Bentall's procedure). When they did the testing on my tissue sample it came back that it was affected by the connective tissue disorder I have...(myxmatous) was the term used to describe the tissue samples from my BAV.

 

[Lily]

I found this question interesting, having previously heard that bicuspid valves don't repair well but having also heard of some who had aortic valves repaired well -- though perhaps that's related to whether they're stenotic or regurgative, and of course they're sometimes both. Anyway, I looked up Ton's word and found something interesting (to me) about the possibility of "connective tissue" issues, because I, in my ignorance, don't recall hearing the "connective tissue" terminology used related to mitral valve prolapse, but only bicuspid valves:

"Myxomatous degeneration -- From Wikipedia, the free encyclopedia

Micrograph demonstrating thickening of the spongiosa layer (blue) in myxomatous degeneration of the aortic valve. Movat's stain.Myxomatous degeneration refers to a pathological weakening of connective tissue. The term is most often used in the context of mitral valve prolapse, which is known more technically as "primary form of myxomatous degeneration of the mitral valve."

The degeneration occurs in conjunction with an accumulation of dermatan sulfate, a glycosaminoglycan, within the connective tissue matrix of the valve. The exact mechanism is unknown.

In many cases, the degeneration is limited to the mitral valve and follows a benign course. When associated with systemic diseases, like Marfan syndrome, the degeneration is more extensive and involves other heart valves. The valves can become sufficiently distorted to cause insufficiency and regurgitation. Myxomatous degeneration is, in fact, the most common cause of pure mitral valve insufficiency."

 

[ALCapshaw2]

My impression from reading this website for many years is that the Mitral Valve is a better candidate for Repair than the Aortic Valve and that Aorta Repairs are less common (and typically less successful?). As always, it is best to find a surgeon with Considerable Experience doing the procedure.

Another factor to consider is that Connective Tissue Disorder(s) have a high correlation with BAV. I'm guessing that Repair of a BAV in a patient with connective tissue disorder would NOT be wise (or durable). Again, it is best to find a Surgeon with Considerable Experience dealing with BAV and the Knowledge and Experience to properly Diagnose and Treat Connective Tissue Disorders.

One common sign of Connective Tissue Disorders is an Aortic Aneurism. The Gold Standard for checking for Aortic Aneurisms is a Chest CT or MRI. Without one of those tests, the surgeon will likely NOT know the condition of the entire aorta. IF there is an Aortic Aneurism, then it is wise to find a Surgeon with Considerable Experience doing Aorta Surgery which is another Step Above 'Mere Valve Replacement Surgery'. Dr. Chen at Emory University Hospital in Atlanta is often considered to be the 'go to guy' for Surgery of the Aorta in the SouthEast.

Personally, I would NOT go to a "Local Heart Hospital" for a complex Heart Surgery which is not frequently performed by their Surgeon(s) and staff.

'AL C'

 

[BarbJean]

My surgeon also thought from my echo that the valve might be spared by a Ross procedure.

I am still trying to educate myself on all of this. What is the difference between the Ross procedure and the David procedure to repair the valve. My 24 year old son, with Marfan Syndrome, needs surgery soon. I have been praying he would be able to have a repair rather than a replacement. He is so careless that I just don't know how he would be with checking levels for Coumadin. After reading some of these posts, I am wondering if a repair is what I should be wishing for. It does seem like they are doing more for Marfan patients though.

 

[Lynlw]

I am still trying to educate myself on all of this. What is the difference between the Ross procedure and the David procedure to repair the valve. My 24 year old son, with Marfan Syndrome, needs surgery soon. I have been praying he would be able to have a repair rather than a replacement. He is so careless that I just don't know how he would be with checking levels for Coumadin. After reading some of these posts, I am wondering if a repair is what I should be wishing for. It does seem like they are doing more for Marfan patients though.

The Ross procedure they take your own pulmonary valve and use that for your aortic valve, then use a tissue valve to replace the pulmonary one.
The David they keep your aortic valve

 

[karen14]

... Surgery was hell for me and I never want to go through it again, which is why I say just replace it and get it over with.

I agree with Ross's statement here, that to avoid another surgery is better. It was hell for me too and I may be facing another. So I'd go with the replacement. Think you'll be glad you did.

 

[COLLEEN S]

spared by a Ross procedure. My echo appeared to show that the calcification was not attached to the leaflets He did tell me that he would not be sure until he was in there


To correct: A Ross procedure does not spare a valve. It actually makes a person into a double valve patient by taking the persons own pulm valve and putting it in the aortic position and giving the patient a cadaver (tissue) valve in the pulm position. A valve sparing procedure is what the OP refers to. Valve sparing is a technique where the surgeon determines whether or not the valve can be "saved".

 

[COLLEEN S]

My surgeon had me sign for repair and or replacement. Once in, he found it to be "shredded" (his words) and not salvageable. So it just depends on what they see when they get in there. I was hoping it would be a candidate for "valve sparing", but it was not to be.

 

[a4wanman]

Just to update since I started this thread: Surgery was Monday, April 26

Surgeon determined my valve was not sufficient enough to repair so I received a St. Jude mech valve. He said if a repair was performed, the valve would not last long.


Scott