Late Complications of Aortic Graft?

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Humboldtgrrl

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At a routine one year post-OHS review {for ascending aortic graft repair + AVR with a tissue valve}, my sister just learned that the grafted area has problems. The graft itself seems fine, but the native aorta at each end of the graft has expanded, so there are now two new aneurysms. She has had no symptoms, so this is unexpected & of course unwelcome news.

A re-work of the ascending section will now involve the coronary arteries. Nothing said yet if the lower aneurysm repair will involve rework of the 1 year old artificial valve, which is doing fine. There are additional consults scheduled with both her cardiologist & her surgeon, so many things are still unclear. She is an otherwise healthy 68 y/o; HWP; completed the hospital-based 3 month outpatient rehab program with flying colors; & has had a good diet/walking program for years. There is a family history of AVR.

Has anyone here had a late graft complication similar to this? (my Search of previous threads on this board did not find anything very similar.) How was it resolved? Google search indicates some ascending aortic (first-time) grafts are now done with endovascular technique, but did not see any graft re-works using endovascular. Where/with Whom was the OHS #2 done?

Thanks in advance for any sign posts or direct experience shares from this special community. Unclear how to address to All, so please feel free to share.

Sherry on the Prairie (USA)
 

pellicle

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Hey, sorry to read this. With my own surgery they were concerned about aneurysm growth at the arch end, however it was impossible for it to grow at the valve end because I got a graft that was preattached to the valve. Did she not have this done?

Is surgery planned or is it just on a watch list now?
 

toadhall

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Hey, sorry to read this. With my own surgery they were concerned about aneurysm growth at the arch end, however it was impossible for it to grow at the valve end because I got a graft that was preattached to the valve. Did she not have this done?

Is surgery planned or is it just on a watch list now?
I’m the patient (sister posted with my okay) to the best of my understanding the graft not attached to the valve. They also inserted a tissue Inspiris Resilia that seems to have healed fine. I wasn’t sure what to ask original surgeon and assume I am in waiting mode of aneurysm as my next appt is in August.
My understanding is that the new less invasive endovascular aneurysm repair is for descending rather than ascending - if anyone has info or suggestions regarding this ascending repair situation I would appreciate it.
The thought of cracking my 68 y/o chest open again with the feeling undead/unliving and the following long rehab plus the physical/mental changes that follows really is disheartening in so many ways.
I have a cardiology appt later in June, am making list of questions and will ask his recommendation (if I should go to different hospital/surgeon/city).
 

ATHENS1964

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I’m the patient (sister posted with my okay) to the best of my understanding the graft not attached to the valve. They also inserted a tissue Inspiris Resilia that seems to have healed fine. I wasn’t sure what to ask original surgeon and assume I am in waiting mode of aneurysm as my next appt is in August.
My understanding is that the new less invasive endovascular aneurysm repair is for descending rather than ascending - if anyone has info or suggestions regarding this ascending repair situation I would appreciate it.
The thought of cracking my 68 y/o chest open again with the feeling undead/unliving and the following long rehab plus the physical/mental changes that follows really is disheartening in so many ways.
I have a cardiology appt later in June, am making list of questions and will ask his recommendation (if I should go to different hospital/surgeon/city).

I would ask the surgeon why he did not put this implant that had the valve before
 

pellicle

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Hi

I’m the patient (sister posted with my okay) to the best of my understanding the graft not attached to the valve.

well I do see the strangest things here ... I have totally no idea why you would do that and prolong the surgical duration (with the attendant risk the the patient - you)

I would be asking (not agressively) and just sit back and listen to the reason. Note it and report it back here (if so inclined).

They also inserted a tissue Inspiris Resilia that seems to have healed fine. I wasn’t sure what to ask original surgeon and assume I am in waiting mode of aneurysm as my next appt is in August.

excellent and I'm glad to hear that. As I mentioned there was concern about my own aneurysm growing (which would have been "very bad" for reasons I won't go into here), but it stabilised as a bulge and has remained unchanged in the last 8 years (and surgery was ten years ago).

My understanding is that the new less invasive endovascular aneurysm repair is for descending rather than ascending

this is not my understanding, although I confess I don't understand what you mean by invasive because the invasive stuff is cutting into the thoracic cavity.


The thought of cracking my 68 y/o chest open again with the feeling undead/unliving and the following long rehab plus the physical/mental changes that follows really is disheartening in so many ways.

this is a common reaction, but please keep in mind the following points:
  1. OHS (in the standard way) is one of the most (I thought the most, but lets leave that debate aside) successful treatment for a major life threatening complication which exists in the medical repertoire
  2. for various reasons modern people are less aware of what surgery is and what bodies can tolerate than our ancestors (more familiar with dealing with animals)
  3. attitude plays the biggest part in your recovery: so think good thoughts, do your rehab and don't focus on anything disheartening.

I have a cardiology appt later in June, am making list of questions and will ask his recommendation (if I should go to different hospital/surgeon/city).

that's exactly the spirit!! Although I'm a little lost about the last bit, as your surgery is now done why would you go to a different surgeon at this point?

Oh, and thanks for letting us know you age, that's a key criteria.

Best Wishes
 

pellicle

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I would ask the surgeon why he did not put this implant that had the valve before
looking at the date I'd suspect either he didn't know or was cautious of new ideas. But (to @toadhall ) this is exactly what I had done over ten years ago with my valve (which was an ATS mechanical).
 

Humboldtgrrl

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I would ask the surgeon why he did not put this implant that had the valve before
Thank you ATHENS1964 for the info on this device, a print out copy will go to the next appointment.
 

toadhall

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My OHS for the valve replacement and aneurysm repair was done April 8, 2021.

I see my cardiologist June 23, 2022 and hope to get some clarification regarding what my surgeon told him about the new aneurysm at both ends of graft. Since the surgeon told me to come back for CAT scan late August, I'm assuming that we are in a wait and see if this is a growing aneurysm.

The reason I mentioned possibly a different surgeon, city or hospital is out of concern for that if I need a 2nd surgery to repair the ascending aortic aneurysm bulging at both graft ends maybe i should find an aneurysm specialist - I really don't want to get into a situation of having OHS every couple of years.

Thank you to ATHENS1964 for the info regarding Edwards Konect Resilia Aortic Valve Conduit
 

pellicle

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Since the surgeon told me to come back for CAT scan late August, I'm assuming that we are in a wait and see if this is a growing aneurysm.
its normal to have a cat scan at intervals after the surgery just to check how everything is going

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knowledge is power and knowing sure beats wondering or worrying.

Best Wishes
 

Humboldtgrrl

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TEVAR: When I referenced endovascular technique being used with Ascending Aortic Aneurysm, I did not include any citation. Evidently endovascular technique (leaving the aneurysm intact & inserting an artificial tube inside the native aorta via a groin incision) has been used for some while for Descending A.A. (a straighter shot), but only more recently for the Ascending section (TEVAR). This cite is for a 2017 meta-analysis looking at several research papers, so is dated, but provides a starting point for looking at research. There are newer comments about custom made endovascular tubes that accommodate the coronary arteries & the arch shape for longer Ascending AA repairs. In general, the endovascular technique seems to be used for higher risk patients in order to avoid another OHS. The patient would have to be assessed as to whether TEVAR is appropriate for their specific situation. Hoping others on this board may know more on this. Endovascular stent grafting for ascending aorta diseases - PubMed
 

Humboldtgrrl

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Thank you ATHENS1964 for the info on this device, a print out copy will go to the next appointment.
I would ask the surgeon why he did not put this implant that had the valve before
Thank you once again, Athens 1964. My sister now has this stented valve, surgically implanted by Coselli at Houston's Baylor St. Lukes. The fact that we had this photo-page at the pre-surgery meeting made Coselli physically startle & remark that "we had done our homework". Surgery went well, tho there were aftercare adventures detailed in my recent reply to Vitdoc, & she is doing well. Wishing you a happy Harvest Festival of your choice.
 

ATHENS1964

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Thank you once again, Athens 1964. My sister now has this stented valve, surgically implanted by Coselli at Houston's Baylor St. Lukes. The fact that we had this photo-page at the pre-surgery meeting made Coselli physically startle & remark that "we had done our homework". Surgery went well, tho there were aftercare adventures detailed in my recent reply to Vitdoc, & she is doing well. Wishing you a happy Harvest Festival of your choice.
Thank you for the kind words I'm glad that I was useful, we are a team here and we help each other as much as we can, we learn from the members. Wishes for the best .
 
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