Plication of Ascending Aorta????

[savysmommy]

Hello Everyone,
Today I got my Pre Operative cardiac surgery directions in the mail. I was reviewing it and under Surgery, it says AVR & Plication of Ascending Aorta. My cardiologist and surgeon had talked to me briefly about It. And to my understanding, they are just going to close up the aorta a little tighter. I wasnt really concerned about any of that until now, probably because my surgery is very soon!

Anyway, the more I read about BAV the more it freaks me out. If BAV is more of a connective tissue disorder, then would doing this plication thing impact the aorta? I realize you have to go through the aorta anyway, but what I am concerned about is that if the tissue doensnt have the normal elasticity, which they say is common of patients with BAV disease, right?? How would it respond to being sewn up tighter? Would that make your aorta more fragile.. more likely to disect later..?

Sorry if these questions seem silly..or just plain dumb! I looked online and couldnt seem to find much on this procedure. I also did a search here and nothing came up.

Thanks for your help..

 

[Arlyss]

Hello Everyone,
Today I got my Pre Operative cardiac surgery directions in the mail. I was reviewing it and under Surgery, it says AVR & Plication of Ascending Aorta. My cardiologist and surgeon had talked to me briefly about It. And to my understanding, they are just going to close up the aorta a little tighter. I wasnt really concerned about any of that until now, probably because my surgery is very soon!

Anyway, the more I read about BAV the more it freaks me out. If BAV is more of a connective tissue disorder, then would doing this plication thing impact the aorta? I realize you have to go through the aorta anyway, but what I am concerned about is that if the tissue doensnt have the normal elasticity, which they say is common of patients with BAV disease, right?? How would it respond to being sewn up tighter? Would that make your aorta more fragile.. more likely to disect later..?

Sorry if these questions seem silly..or just plain dumb! I looked online and couldnt seem to find much on this procedure. I also did a search here and nothing came up.

Thanks for your help..

Hi,
These questions are not silly. They are very important. Dealing with the aorta and potentially fragile tissue requires very exacting skill in order to have the best possible results in both the short and long term.

Do you know how large your aorta is? Was anything said that might indicate they are talking about wrapping your aorta to reinforce it?

I will list some links here that may help you.

http://www.slrctsurgery.com/Thoracic aortic aneurysms.htm
http://www.cedars-sinai.edu/aorta
http://www.bicuspidfoundation.com

Please feel free to send me an email or private message.

Best Wishes,
Arlyss

 

[Arlyss]

Hi,
These questions are not silly. They are very important. Dealing with the aorta and potentially fragile tissue requires very exacting skill in order to have the best possible results in both the short and long term.

Do you know how large your aorta is? Was anything said that might indicate they are talking about wrapping your aorta to reinforce it?

I will list some links here that may help you.

http://www.slrctsurgery.com/Thoracic aortic aneurysms.htm
http://www.cedars-sinai.edu/aorta
http://www.bicuspidfoundation.com

Please feel free to send me an email or private message.

Best Wishes,
Arlyss

Here is a little further detail about aortic plication. Apparently this approach was used in the early days of aortic surgery, before there were well developed techniques for removing the aneurysm. The bulging tissue can be folded and then stitches are run along that part of the aorta in order to reduce its size. Or some tissue can actually be cut out of the aneurysmal area and the stitches are run along the cut edges to seal it. I'm not sure this is a clear description, but anyone who does any sewing can probably imagine this!

Taking fragile, aortic tissue that is already stretched and weak, and trying to handle it this way, let alone hoping the line of stitches will hold up, is extremely high risk. Anyone proposing to do this should provide statistics regarding how many of these procedures they personally do each year, how many deaths and how many injuries (morbidity rate) occur within 30 days, and what the long term results are (without requiring further aortic surgery).

As the links I previously listed indicate, today aortic surgery involves removing the aneurysmal aorta completely, and replacing it with a Dacron graft. (In some special circumstances, the aorta may be wrapped, but that is a very individual situation and a judgment call.)

It is often said that the last decade has seen great advancements in aortic surgery. As different ones share their experience here, we see people not only surviving, but leaving the hospital in just a few days. Aortic surgery had to come a long way to make that happen! That means using state of the art techniques. Plication is not one of them. From what I can tell, on the timeline of aortic surgery, it is a very old idea/approach now replaced by much better techniques.

Arlyss

 

[savysmommy]

Great info. Thanks Arlyss. I am going into the hospital tomorrow for pre-op chest x-ray. I dont know if my surgeon will be there or not. I am going to call there in the morning and see if I can talk to him or leave a message regarding this. I also just emailed my aunt who is a nurse in the cath lab. Maybe she can talk to a few docs tomorrow too.

My aneurysm is small, 4.0 ascending. But still.. its got me freaked. That website you sent me, http://www.slrctsurgery.com/Thoracic aortic aneurysms.htm, says that if there is any dialation the aorta should be replaced. I am also going to bring this up to him tomorrow.

Thanks again, I will let you know what they say.

Shannon