Bentall's Procedure vs. Valve Sparing (David Procedure)

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Reddog

Reddog

Well-known member
Joined
Nov 29, 2008
Messages
55
Location
Seattle, WA
Hi All,

I have an 5.4cm aneurism of the ascending aorta with a bicuspid aortic valve, and I've been told that I should have surgery soon. Although the measurement hasn't changed since 2002, apparently the doctors have changed the surgery criteria for non-Marfans patients from 5.5cm to 5.0 cm.

The aortic valve is in pretty good shape, so the surgeon suggested that I might want to get a valve sparing aortic replacement. The valve is bicuspid, so I probably won't get more than 15-20 years before it needs replacement. The alternative seems to be a Bentall's Procedure with a mechanical valve, and then I'd need to take coumadin. I'm a 46 year old man, and I'm not looking forward to taking coumadin or having another surgery!

Have any of you made the choice between a Bentall's Procedure with a mechanical valve and a valve sparing operation (David Procedure)? If so, which did you choose and why?

Thanks!
Reddog
 
All I can say Reddog, is what my surgeon told me "I don't think you'd want to go through this surgery again. "If I can't repair it I'll place it with a mechanical" so therefore made the choice for me.
At the time I was unaware of having to take warfarin for the rest my days, but after almost 2 years of taking this med and having a black eye and stitches, life is no different. YES, one does have educate themselves about INR readings, but I haven't adjusted my diet because I'm on coumadin.
If and when I have a problem with my INR I come here for answers............my doc thinks I'm smart LOL.
I guess all I'm trying to say is to not panic about coumadin/warfarin. What you have heard or read could be lies.
 
Five years ago I had BAV with ascending aortic aneurysm and moderate regurgitation. My surgeon (Dr. Joseph Coselli in Houston) flatly stated aortic valve repair was not an option with BAV and when an ascending aortic aneurysm is present. Also in my opinion coumadin is not such a bad tradeoff versus another guaranteed surgery down the road.

All my best,
MrP
 
Hi Reddog,

I'm 48 and found myself in a similar situation as you in January. The surgeon gave me the option of repairing the valve or doing the Bentall procedure. He stated that it would be a difficult repair though and if it didn't go well he would put in a mechanical valve. He also stated that the likelihood of re surgery would be higher with the repaired valve. I decided to go for the Bentall procedure with the mechanical valve mainly due to the more complicated surgery and the chance of re-surgery later. I am now 5 weeks post op and do not regret my decision. I do not want to get through surgery again if I can avoid it. So far the 5 weeks of being on warfarin haven't been a problem. I am looking into self testing and self dosing. That could only make things better.
 
I had a David type repair in 2002 and thus far everything looks good, my doc thinks mine will last for life. I am 55 now. I had an ascending aortic aneurysm but an otherwise normal aortic valve, no BAV. I have read that some surgery centers are doing BAV repairs, and I think we may have a few here on VR. So my situation was a bit different. The BAV is a risk. If you go for it be sure your doc thinks he can get you a long term fix. Good luck to you.
 
Reddog
I am in your same shoes, but I have 5.6 anuerism (been that way since at least the late 80's) but now fits the "criteria" for surgery. My Doc is going to try and repair the valve, he thinks its a good option and if he cant, he will put in an biological valve, with a mechanical valve being option C. I am active and have no symptoms and the thoughts of post surgery and what is expected is much more scary than the surgery. Doc says if all goes well, I should have no limitations from what he does, recovery is up to me. I dont want anyhting to do with ACT; I have heard good and bad both ways, but it is a personal choice. After discussion with my Doc about options, and my decision, he feels I am making the best choise for me, and never tried to talk me out of it or "sell" me something different. What I am saying is the choice is yours to make, and I feel much more comfortable with mine, and I am not changing. Many threads you read will give you many different avenues and thoughts but its your heart and your life, go with what you feel you have educated yourself best on.
My "vacation" as they are calling it at work is April 7. Best of luck to you!
Tom
 
Just a couple of thoughts. I had a 6 cm ascending aortic aneursym but did not have BAV. I had a trileaflet aortic valve. I saw Dr. Coselli as MrP did. He impressed me with his expertise and felt in capable hands. He said quite clearly, that he did not feel that a repair is indicated. In other words, he was not impressed with repairs in general and I got the impression that he did not advocate them to anyone. That was just my interpetation and may not be true. I subsequently visited with Dr. Zehr who has done numerous repairs. I had a David procedure May 2007 and have done well. I really cannot speak to how a David procedure would hold up in individual with BAV. Whatever your choice, I hope you continue to do your homework and seek the most experienced surgeon you can find. No substitute for experience. God Bless.
 
I just had my aortic valve replaced and a Bentall procedure done. I won't ever go in for OHS again. I would say do it now, get it over, and don't even think about future surgeries. If I was told I had to have another surgery, I would say it's time to go see God.....never again.
 
I had the bentall procedure in November 06, my surgeon told me that was my best option and I would have less problems. I have a St Jude AHV, I also had a 6cm aneurysm. He did however wrap my natural root back around my graft. I don't know if that is standard or if it was special. I have a few problems with my INR but nothing to bad. I haven't had any major problems after my surgery or during my surgery. A little AFib few months after surgery because I caught a stomach virus. It is your choice, weigh out all you options and make your own decision. I never thought about anything like this until it happens! then you have to make a life long decision! God Bless and good luck.
 
lilteach3234 said:
I just had my aortic valve replaced and a Bentall procedure done. I won't ever go in for OHS again. I would say do it now, get it over, and don't even think about future surgeries. If I was told I had to have another surgery, I would say it's time to go see God.....never again.
Click to expand...

I was thinking in a similar way after two consecutive OHS's last year. But the funny thing is that these things go away with time. I can't say that I would look forward to it now... If I knew that a new surgery would take away my pounding heart sensation for instance, I would probably actually do it.

(I will do a non-invasive procedure with a remaining contraction in a few weeks that I hope can help here though).

::g
 
Reddog said:
Hi All,

Have any of you made the choice between a Bentall's Procedure with a mechanical valve and a valve sparing operation (David Procedure)? If so, which did you choose and why?
Click to expand...

Yes. I only had a few minutes to decide while they disinfected me (emergency surgery) but I chose David procedure. The main reason was the Coumadin issue and that a repaired valve still have a chance of working for a substantial time or even possibly forever (no one really knows if that can be possible it seems). I had moderate regurgitation but now it is almost too tight.

::g
 
Hello, I ended up signing a consent for valve sparing but when the surgeon got in there, as the cath indicated previously, my aortic valve (previously a pulmonic valve put in aortic position for the Ross procedure) was "shredded" and the valve sparing was not to be. Got a St. Jude mechanical. No choice. Coumadin sucks and I am only 47 myself so I understand your pain. Others on this site tell me coumadin's not so bad if your doc lets you self test with a home monitor, but mine wont let me because he likes to rake in the big copays I pay every week. Sorry if I sound like a bad attitude but I have been 'thru the mill'.
 
Choosing Bentall over David procedure.

Choosing Bentall over David procedure.

FYI: This is my first posting. I also have an aneurysm of the ascending aorta and a bicuspid aortic valve.

My BAV has extensive calcification with severe regurgitation and mild stenosis. My aorta measures 5.6cm.

Surgery is scheduled for October 6th 2010 in Ottawa and I am choosing to have the Bentall at this time using St. Jude valve with the aortic graft attached. I would have preferred an On-X valve but they won't have a graft approved in Canada (where I live) until the end of the year and that is too long for me.

I had the option for repair as well, though I didn't think stenotic aortic valves could be repaired going into my meeting with the surgeon. However, my surgeon was confident that he could perform a repair despite my calcified valve. Talking to others he is equally talented as David himself at this and I could be confident in the repair. However, my primary concern was the inevitable requirement of re-operation when a mechanical would last a lifetime (for most folks). Although I am only 35 years old, I think the risks of Coumadin seem low relative to a re-operation.

I can still change my mind until my surgery on October 6th 2010, so if anyone has found any evidence of a repair being better I certainly would love to hear.
 
Aaron,
Your choice sounds good to me. I know you've been a member for some time, so I assume you've been reading various accounts from other members who have the BAV and enlarged aorta.
Best wishes on the 10th!

By the way, the 10th is a Sunday. Is the surgery on the 11th or are you scheduled for the 10th? I'm going to put the date on the calendar; that's the reason for my question.
 
Aaron BAV said:
FYI: This is my first posting. I also have an aneurysm of the ascending aorta and a bicuspid aortic valve.

My BAV has extensive calcification with severe regurgitation and mild stenosis. My aorta measures 5.6cm.


I had the option for repair as well, though I didn't think stenotic aortic valves could be repaired going into my meeting with the surgeon. However, my surgeon was confident that he could perform a repair despite my calcified valve. Talking to others he is equally talented as David himself at this and I could be confident in the repair. However, my primary concern was the inevitable requirement of re-operation when a mechanical would last a lifetime (for most folks). Although I am only 35 years old, I think the risks of Coumadin seem low relative to a re-operation.
Click to expand...
Hello and wishing a fellow Canadian a very warm welcome,

I have limited knowledge of the Bentall procedure (I had a straight AVR), but my understanding is that regurgant aortic valves (also called aortic insufficiency) may be able to be repaired. From my limited reading, strictly stenotic valves are very difficult to repair.

I am sure others with chime in with more informed answers. Wishing you all the very best,
 
Hello. Aaron I sent you a PM. I am 30 yr old male who in May learned I had a bicuspid aortic valve, and an aneurysm at 6.7cm in my ascending aorta. I met a surgeon in Kingston who suggested the valve-sparing aortic root replacement. I then had a consult at the Ottawa Heart Institute where the surgeon's there agreed. I had the David type procedure on July 9 in Ottawa. I pretty much had evey complication during, and after surgery but made it out OK in the end. I was in hospital for over 3 weeks and needed a pacemaker put in July 29. Currently in cardio rehab, but finding recovery slower than expected. My last echo showed valve was working well after being re-shaped by the surgeon. I am hoping that if I need a new valve later on, it can be done by less invasive surgery. I am really happy that I do not need blood thinners, or any meds for that fact. My backup plan was a mechanical valve if mine could not have been spared. In my personal opinion, if a surgeon is confident that your native valve is functioning well and can be repaired/ reshaped then it makes sense to keep it in there. Not a fun decision.
 
I had a Bentall procedure with a bovine tissue valve 14 months ago. It's a fairly humbling recovery, but I can say now that I feel better than I have in many years. I certainly wouldn't hesitate to have more surgery (the surgeon thinks there will be a less invasive procedure by the time I get to replacing this valve in 10-14 years). But if I had the chance to do it once, for good, I would. Although repair was never suggested to me, I'd say get it over with and get on with your life!
 
Hi all,

I had a normally functioning/operating aortic vavle (No BAV), with an aortic root and ascending aortic aneurysm. I had the valve sparing procedure done almost 7 months ago, and am doing great so far.

My surgeon studied/worked with Dr. David in Toronto, and had a lot of experience with the valve sparing procedure.
But going into the surgery, he wanted me to have a 'plan B', in case when on the table, things didn't look '100%' for going forward with the David procedure.

It's certainly an individual decision, so best of luck and thanks to all on the forum for their experiences and information !

Jazzman
 
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