Surgeons valve choice along with an aorta graft

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bdryer

Well-known member
Joined
Oct 22, 2010
Messages
429
Location
Canada
Good day

My surgeon recommended a MAV to go along with my ascending aorta graft. Those who have or are having a replacement aorta valve and ascending aorta graft, what was your surgeons recommendation for the composition of the aorta valve?
 
Thx, oldmanemu,please allow me to clarify.

Either tissue or mechanical, with or without the factory installed graft.

I would presume that surgeons would prefer to use the factory installed graft. Out of the St. Jude brand I only found the masters series to come preinstalled with the factory installed graft. Have not as yet found an On-X valve with the factory installed graft. As for me I do not want a masters series valve. I would prefer the Regent or an On-X.

I would appreciate reading what others have found or were told.
 
I was expecting to get a replacement Aortic Root, a Dacron graft, added to my porky-pig Hancock II AV. When they examined my AR, they decided it was only very slightly distended, and that the tissue looked good, so they just took a "tuck" to make it totally normal size (presumably a snug fit to the 2.7mm AVR I got), so I got stitched up without the AR graft.

I was never told that the need for an AR graft had any bearing on my preference for one general kind of valve over another, e.g., mechanical vs. tissue. I've since learned that there are a number of tissue valves that come with tissue Ascending Aortas still attached (e.g., from the pig). Many of the so-called "stentless" valves work that way, I believe. They often have the best hemodynamics (more important if your Aorta and AV are small), and are considered trickier to install properly by many CV surgeons.

(I was happy to make my surgeon uncomfortable with challenging patient-from-Hell questions, but when it came down to his choice of tools and techniques and valves and such, I decided I wanted him in the middle of his Comfort Zone.)

I thought that some of the MVs also came with AR sleeves pre-attached, but I may be remembering wrong.
 
I went with the valve my surgeon recommended even though it didn't have a pre-installed at the factory graph. I wanted mechanical to hopefully avoid a 3rd surgery and Dr. Miller went into surgery with the idea of using the TopHat valve due to my small annulus would have limited me to a 23 mm valve. The TopHat allowed a 27mm valve which Dr. Miller thought would be a better fit for me. The backup plan was a St. Jude.

I don't think it's a big deal to sew the graph on the valve, so I'd get whatever valve you and your surgeon are comforatble with whether it has a pre-installed graph or not. Otherwise your choices are definetely limited.
 
I have discussed this with my surgeon as this is what my redo will eventually require.
He doesn't have preference regarding the graft being attached or not, as he can make one in a few minutes, with this being his area of specialty.
As for tissue or mechanical he recommends mechanical valves for younger patients however will install whatever the patient chooses.
My cardio on the other hand prefers tissue valves, for patients in their 40's and 50's.
 
My son's valve replaced his his pulmonary not aorta, but he has a conduit that is basically the same thing. It really isn't a problem for most experienced surgeons to sew the graft on the valve and usually only adds a couple min, some surgeons DO prefer to use a valve with the graft already attatched, but many others don't prefer either way.. Justin has had a few different kinds of conduits, a couple of them were completely made in the OR (not just a ready made tube sewn on) Right now, because of his unique issues, he actually has a section of conduit going from his heart to the valve, then another section from his valve to his pulmonary artery. When we were dicussing the plan before surgery, his surgeon said it wouldn't add much time at all to sew 2 conduits to the valve.

Currently the ON-X valve does not have on with the graft available.
 
It was only seven and a half years ago but I consulted with three surgeons and got (basically two) different opinions. And as it turned out for me, I didn't need a graft or aortic sleeve.

Edit - Let me clarify that, I didn't need a graft on the ascending aorta with the valve replacement. I do have a (Dacron) graft from my first surgery over 30 years ago but it's on the descending aorta.
 
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Graft Options

Graft Options

After a couple of lengthy discussions with my surgeon regarding valve choice and graft options, I opted for a St. Jude Master's Series with the factory attached dacron conduit. While doing the graft attachment on a valve's sewing cuff is a quick job for a good surgeon, I wanted to get off the heart-lung machine as quickly as possible and I wanted one less stitched together area in the entire assembly.

My original plan was to get an On-X, but opted out because the valve is unavailable with a factory attached conduit.

-Philip
 
Hey Brother BDryer---whatever valve assembly you choose will be the right combination because you put a lot of thought into it and you make the final choice.Got a date yet for the jump?
 
Hey gang

Thx for the input. It's interesting that the surgeon recommends a MAV to go with the ascending aorta graft. Lot's of folks here have a tissue AV implant along with the ascending aorta graft. I'm still pushing for an On-X or St.Jude Regent. This especially after "robthatsme" suffered from pannus overgrowth of his St. Jude Masters series. He may be a exception, but knowledge is power.

Brother bigsidster, I've got the CT scan Jan 2 and angiogram Jan 4. Pre-op clinic is Jan 11. D day TBA.

It finally happened, Got a bloody cold before the ball starts rolling.
 
On-X with aortic graft

On-X with aortic graft

For my second surgery I wanted a mechanical valve and new I would need an aortic graft. My surgeon was very comfortable with assembly in the operating room a little more than a year ago.

I thought though that On-X was going to have a pre-assembled valve/graft by now?
 
I hear ya normofthenorth, I just wish it was the surgery I was getting over and not a virus. I'm concerned about sneezing and hacking during the CT scan causing blurred pictures. I can also envision me coughing during the angiogram, causing the Doc to pierce something. OK thinking happy thoughts!

Hey Bob, I'm thinking valves pre-assembled with an aorta graft aren't the rage, as from what I have learned, it only takes the surgeon a couple of minutes to do their own graft.

How is the On-X AV working for you? Do you hear much noise?
 
On-X is working on an attached graft that I believe they hope to release "soon".
(I'm not sure what their target date is).
 
bdryer. I am feeling just great. Interestingly, I am feeling better and have better heart function now than with the previous homograft. I van hear the On-x in a quiet setting like when I am trying to go to sleep. You get used to it. Sometimes I use it to keep track of time as my pulse is almost always 60 :) Like having your own personal metronome.
 
On-X Advantage

On-X Advantage

On-X does seem to have a definite advantage over many other mechanical valves because research indicates that its leaf design does less damage to red blood cells when the leaflets close.

I considered the red blood cell damage issue prior to having my St. Jude Masters Series implanted, but like often happens with many of us, got focused on other issues related to the surgery. I really was obsessed with getting off the heart-lung machine as quickly as possible.

-Philip
 
Thx Philip

Had the pre surgery angiogram on Jan 4. The Dr accomplishing the procedure warned me not to push the surgeon into doing any procedure that they are both unfamiliar or not comfortable with.

The physicians to date have not installed an On-X AV. They are current with St Judes and CarboMedics. I have let both the Canadian On-X tech rep and the physician know that an On-X tech rep must be in the OR, if my surgeon is to install the valve and he has no prior experience with the On-X. Otherwise, I'm requesting the Regent.
 
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