More on "Relative" Aortic Size - Email From Study Author

[Equusz]

Hi all:

In reference to this thread about an article on relative aortic size compared to risk of rupture: the article cited this study done by Yale in 2005. I was curious as to whether the "4% annual risk" for the low-risk group was cumulative or not. I emailed one of the authors of the study, Dr. Michael Coady, and he responded thusly:

"Hi - the risk of rupture would be 4% per year. So, over a 10-year period, the cumulative risk over this period is 40%. Hope this makes sense."

He goes on to say:

"I'm sure you're going to be completely fine. Aneurysms eventually enlarge -- and we operate on the ascending aorta when it gets to about 5-5.5 cm or if the aortic valve starts leaking severely when the aneurysm is smaller.

"Dr. Miller is a master surgeon - probably the best in the United States. I know, because he trained me in aortic surgery! Keep me posted -- and very best of luck. You'll be in great hands. --Michael"

I guess that means that surgery is definitely in my future and that my 4.5cm ascending aorta (which hasn't moved for at least 3 years) will likely start to enlarge and/or become symptomatic and that will be the signal to schedule surgery.

Just thought I'd share since I've seen the question raised in another thread.

--Equusz

 

[Duffey]

Thanks for taking the time to email Dr. Coady and post his reply. The issue is one I think most with BAVD have questions about.

 

[Lynlw]

The "relative" aorta size makes sense to me in a way, because most of my experience was with kids hearts and all the criteria is so much different since there are no really cut and dry numbers, but all depend on the kids age, size ect

 

[DavesMom]

Thanks for this.

Well, if the aneurysm will eventually enlarge and need to be repaired then I would much rather have the surgery now while I'm younger and healthier. I think my age and lack of other health problems is why I did well with my other surgeries.

Then again, maybe I'm just too much of worrier.

Cheers,
Michelle

 

[skeptic49]

Well, if the aneurysm will eventually enlarge and need to be repaired then I would much rather have the surgery now while I'm younger and healthier. I think my age and lack of other health problems is why I did well with my other surgeries.

I hear you, Michelle. I feel that way too. However, the Docs seem to want you to hold on to what you have as long as possible, which in the case of the aorta, means that you have to wait until it gets >5cm.

Jim

 

[Lynlw]

I hear you, Michelle. I feel that way too. However, the Docs seem to want you to hold on to what you have as long as possible, which in the case of the aorta, means that you have to wait until it gets >5cm.

Jim

Justin doesn't have an annuerism (well he DOES have a root of 4.3 and ascending 3.6) I think also previous surgeries (like Michelle) plays a role in when you operate. Especially IF there is a chance the problem will happen again after surgery, the longer you can safely hold off surgery the better until the risk/benefit of rupture vs surgery risk change

 

[Lionheart]

Hi all:
"Hi - the risk of rupture would be 4% per year. So, over a 10-year period, the cumulative risk over this period is 40%. Hope this makes sense."

Hi Equusz,
Good research but one thing bothered me and that was the interpolation of percentages over several years. This may be considered trivial and it's really not a big deal, but I'm not sure that you can take an annual percentage risk and multiply that by the number of years to get the cumulative risk for that time period. Maybe we can get a mathematician or statistician to chime in.

The actual risk over a 10-year period would be a little bit less than 40%. Here's my example:
If you start with 100 people and assume the worst case (4% rupture/ year) then over a 10 year period, 34 or 34% would have ruptured, not 40%.
Its important to apply the annual risk to the remaining population (i.e. those that have not had a rupture) and that number declines each year.

I tried it in a spreadsheet. Start with (100 X 4% = 4 ruptures) in year 1, then for year 2 you apply the percentage only to the remaining people that have not had a rupture (96 X 4% = 3.8 ruptures). The number of people left to get ruptures gets smaller each year, even if you round to the nearest whole number. If you do this for 10 years then the cumulative number of ruptures equals 34 not 40.

This probably doesn't really affect your decisions, but I often see the misuse of percentage risk, especially when applied to the annual risk of failure related to tissue valves, of which I have one. Just trying to keep everyone honest.

Here is my attempt to show a table with the year on the left and the number on the right is the cumulative number of ruptures at the end of that year.

Year------cumulative
----------# that have ruptured
---------at the end of each year

1-----------4
2-----------8
3----------12
4----------15
5----------18
6----------22
7----------25
8----------28
9----------31
10---------34

Take care,
John

 

[Equusz]

Good point. It's been awhile since I took stats.

But, that's 34% chance in 10 years, and 78% chance before I'm 60 (20 years). Don't like them pickles.

 

[Lynlw]

Good point. It's been awhile since I took stats.

But, that's 34% chance in 10 years, and 78% chance before I'm 60 (20 years). Don't like them pickles.

TRUE, BUT chances are it would grow and you would have surgery before you were 60

 

[Equusz]

Yeah, that's what Dr. Coady seemed to be saying.

I'm gettin' cut, I think that's inevitable. Just a matter of when.

I need more information about my condition, that's for sure, in particular, what's up with my valve.

Gonna go sulk for awhile.

 

[DavesMom]

Justin doesn't have an annuerism (well he DOES have a root of 4.3 and ascending 3.6) I think also previous surgeries (like Michelle) plays a role in when you operate. Especially IF there is a chance the problem will happen again after surgery, the longer you can safely hold off surgery the better until the risk/benefit of rupture vs surgery risk change

Good point, Lyn. I'd hate to get a surgery now and then have another aneurysm pop up in a few years. As I've mentioned in other threads, a third surgery will be risky for me because of scar tissue problems and another one after that? EEK!

Still, I'll admit that I truly fear dissection or rupture which is why I would like it gone.

Take care.

Cheers,
Michelle

 

[DavesMom]

I hear you, Michelle. I feel that way too. However, the Docs seem to want you to hold on to what you have as long as possible, which in the case of the aorta, means that you have to wait until it gets >5cm.

Jim

Yeah, well, the stress of worrying about the aneurysm sure doesn't help matters any, does it?

Maybe I need to go on valium.

Cheers,
Michelle

 

[Lynlw]

Good point, Lyn. I'd hate to get a surgery now and then have another aneurysm pop up in a few years. As I've mentioned in other threads, a third surgery will be risky for me because of scar tissue problems and another one after that? EEK!

Still, I'll admit that I truly fear dissection or rupture which is why I would like it gone.

Take care.

Cheers,
Michelle

OH Believe me I understand Justin already had issues with his heart being fused to his sternum before his last 2 surgeries and he's only 21, I can't imagine how many more he will need..

 

[MrP]

Dr. Michael Coady called me in 2004 after I emailed the Yale study authors with a list of questions, and based upon my moderate-severe BAV regurgitation, ascending aortic aneurysm at 5.1cm, and most importantly, my sharp chest pain, he recommended surgery at that time and also reassured me that I was in the best of hands with Dr. Joseph Coselli. He took time out of his busy day to answer all my questions and was extremely helpful. I can't tell you how much his call meant to me then and how grateful I still am for his caring nature.

All my best,
MrP

 

[Equusz]

Hi MrP:

Yes I was quite impressed that he emailed me, twice even. Very nice guy.

I was wondering if you could elaborate on the pain you were having. Specifically, how many days/weeks/months/years you had it before your surgery, how severe it was, and where it was located/radiated to. How were you able to determine it was aortic in origin?

Thanks!

--Equusz