“Do You Have A Question About Aortic Valve Surgery?” Asks Adam

Hi Dr. Roselli,

I am an energetic 45-year old female needing aortic valve replacement.

I am weighing my options and have become interested in the Ross procedure. I have read some good things as well as concerns about this operation. What is your experience with the Ross procedure? Do you think the benefits of a double valve replacement outweigh the risks?

Many thanks for your thoughts.

Tara

I am 69 years old – female, and I had an aortic valve replacement and one by-pass surgery on April 28, 2010. I am generally doing well; however, I have bothersome neuralgia in my chest. As clothes lightly rub my incision area I have pain. Is there anything I can do? Also, when can I begin to use Mederma on my incision? Thank you!

I had the Ross prosedure on May 7, 2009. I have completely recovered and resumed life to the fullest but my scar made a very tender and often painful keloid (raised, red and shiny in appearance) Do you suggest I return to the surgeon to explore my options or seek out a cosmetic surgeon’s opinion. I really don’t mind the appearance of the scar too much but the pain and itching are so uncomfortable.

My surgeon indicated to me the ROSS procedure was used some years ago but now with improved procedures and improved tissue valves the complications associated with the Ross procedure and the possible risks make it a less chosen procedure.

My question for Dr. Roselli “How many Ross procedures have you performed inthe past two years?

Had av mechanical replacement on 3/22/10. Recovered amazingly until Memorial Day weekend. Diagnosed at ER with P.E.. Spent six more days in C.O.U.. Had an echo on 6/22. They said everything looked good, but, feel tired all the time and have back pain and low grade fever in the morning. When will this resolve? Your response will be most appreciated!

Dr. Rosseli,

I had a repair of the aortic valve in 2008 at the Cleveland Clinic and also a repair of a 5.3 cm aneurysm in the ascending aorta. I am physically active and I work out regularly in the gym. I cannot find a doctor where I live, that can tell me how high I should get my heart rate. For my age (57) the gym equipment recommends 130. My heart rate fluctuates from 106 to 122. I would like to know if 130 is too high or if that is just right?

Also, is there going to be a new procedure for aortic valve surgery in the near future?

Mary

My husband had successful aortic valve replacement in October (incl. maze procedure). However, once awake and out of ICU we noticed difficulty with his eyes and my husband complaining of double vision .When visiting our opthamologist we were told that this is Fourth Nerve damage from the anesthesia.While the situation has improved somewhat with time, will this ever go away completely and/or HOW could this have been prevented in the first place??

1. What is your opinion on the best TISSUE valve available today, in terms of longevity/reliability?

2. What are negative effects of using coumadin? Are there recent technologies that people are using to better cope with the daily measurements?

3. What is your opinion on the TRIFECTA valve? Is it worth waiting for, if we can wait for US approval?

4. I am a candidate for aortic valve + root replacement. If I have both done now, and need another surgery in my lifetime, will I be a candidate for less invasive surgery?

THANK YOU!!

Dear Dr Roselli,
What a great opportunity!
I am 57 years old and have a bicuspid valve with moderate stenosis, a 5.3 cm ascending aorta and a 4cm arch. All will have to be replaced fairly soon.
What are the complications specifically arising from arch surgery?
Would you know the comparative rates of complications arising from the (additional) arch surgery versus ‘straight’ valve/ascending aorta surgery?
Many thanks for your advice.
Toni

Dr. Roselli,

I am 50, in good health and weight, but due to radiation treatment for Hodgkins 30 years ago I had a triple by-pass in 2002 and will within the next couple years or so need a aortic valve replacement. the aortic valve is trileaflet and stenotic. The mean gradient is 31mmHg. Aortic valve area 0.8 cm2 consistent with severe aortic stenosis calculated based on LVOT diameter of 2.1 cm, aortic valve VTI of 0.8 and LVOT of 0.2. Estimated ejection fraction is still 60 to 65%. So far I have no real signs of problems that they are looking for that would indicate a need at this time for replacement. It will happen soon enough. We are hoping to hold out as long as possible due to not wanting to open chest again until totally necessary because of past by-passes.

My questions are with having been opened once how many times can or should that usually be done, and how well are they doing with replacement of aortic valve though other means rather than reopening the chest cavity.Will having the by-passes previously effect my chances of other means of replacement.

I really appreciate you taking the time.

Terry

Is there a time frame for when Aortic Valve replacement will be commonly minimally invasive?

I am two years past surgery but feel it may take three years to really fully recover to normal activities. Age 66.

What are the long term effects of taking COUMADIN? I AM HAVING JOINT AND MUSCLE PAIN.

How will Vitamin E effect my INR?

Is there any possibility that a re-do aorta valve replacement can be done minimally invasive or does the scar tissue prevent this ? And which valve would you recommend for a 65 year old male, who is in good health ? Are there any new mechanical valves now being used that are considered superior to the older valves, like the St Judes valve ? And can the drug plavix be used in place of coumadin ?

Thanks, Don

Dear Doc
One of my friend is diagonised with a biscupid aortic valve,thickened.With a 2D Echo Test, the findings are Mild AS + Mild AR,Lv dilated contracting well LVEF 72%, aortic flow 2.7 m/sec gradeint 30 mm/Hg, aorta 2.8 cm ALS-1.9 cm.
Mitral Valve : DE-0.82 EF – 3.25 EPPS 2.11 ; LVOT gradient 34 mm/Hg , no veg/clots, No MR/TR. Currently,he is 40years old.
Does the above condition call for a surgery.If yes, when would be the best time? Are there any ways to improve this condition without surgery? What type of surgery will be required,if need be? Currently,what are the precautions or medicines to be taken to keep the condition stable?
Awaiting your kind revert..Thank You in advance.

I am a 41 year old female who had aortic valve replacement in December, 2009. In March of this year I was diagnosed with post-operative peracarditis, and I am still having complications from it. Is this a common condition after valve replacement, how long will it last, and what would be the best course of treatment?

what does mild TI seen PG =26mm Hg mean? Must I worry about it and what can I do?

Not having been able to “get on top of it” since the aortic valve replacement 1-1/2 year ago, exhibiting “being tired all the time” symptoms.
The heart scans checked out okay.
I think I’ve since discovered it is the blood pressure medicine, the “LoPressor”, that is robbing me of my endurance.
1/2 hour after taking it in the morning, I can feel my energy sapping away.
The doctor tried me on a different type, which just made my heartbeat go crazy, so put me back on the LoPressor.
Am I “doomed” to this lack of energy and being tired climbing just walking up a hill because my heartbeat never gets above 80pbm.
I am able to do a 1 1/2 hour workout at the gym twice a week, but it’s tough.
The cardologist and doctor both say “this is normal”.
Is there something else one can check or do to overcome this problem?

My husband is scheduled to have a liner placed in his ascending aorta later this week. He had a Ross procedure (13 years ago) that failed 3 days later and then was given a St. Judes’ mechanical valve and has been on coumidin ever since. He had a bicupisid aortic valve and was only 44 at the time of this valve replacement. The problems with this genetic defect apparently now are impacting his aorta.

Since the aorta is at now 4.9/5.0 cm. they have determined that the aorta needs this dacron liner. The heart surgeon has said that a cow valve would be a good option to his current mechanical valve as they have improved and has a possible 20 year time frame before replacement again. It could be inserted at the same time when they are reinforcing the aorta. He also said in 20 years the valve may be able to be replaced through a leg vein (?) artery (?) rather than the complete opening of the chest. My husband (now 57) will be 77 years old in 20 years.
The cardiologist has reservations about this cow valve and actual length of time before needing another surgery.

What is your information on the cow (bovine) valves vs. keeping ST. Jude valve? My husband is really tired of the bruising, limiting activities, etc. with the coumidin but he is worried about facing another chest surgery with a tissue valve.

He will be at work Wed. and cannot participate in the live session but would greatly appreciate any input on the cow valves you can give. Please email your response. His heart cath is scheduled for this Thursday and Friday is the surgery.
Thanks,
Gail Bender, Lincoln, Nebraska

am an 80 year old male diagnosed with severe aortic stenosis. 0.6
am asymptomatic except that I can no longer run road races although I can
compete in indoor rowing. Do I need the operation? thank you

1-muscle pain and twitch 24hours 2- my left hand shakes from the shoulder sometimes with noumness 3- pulses in abdominal area 4- head pain ( not headach ) . 5- chest pain . 6- strong palpitation untill my head and hands shakes .am taking now beta blocker . are these related to aortic valve regurgitation ? what are the possible chances fix mild thickend aortic valve ?
what is the best for 34 year old mechanical or tissue valve ?

Kelly – weird my husband also 41, also had aortic valve replacement in Dec. 2009, has been dealing with pericarditis now for 3 months. He has been on all sorts of medicines, including steroids and nothing seems to work.

Anyone else out there with similar condition?

Tina

I am a 44 years old male and need an aortic valve replacement very soon.
Very active and asymptomatic.
I am weighing biological valve.

1- Can we expect a complete normal life after heart valve surgery with a biological valve ?

2- Second surgery is so terrible as our French cardiologists say ?

Thank you

I had mitrial valve repair 5 months ago. Di Vinchi method. my Echo is very good, and the heart shows near full recovery. However, I have symptoms for a month now, the mimick a valve infection. Fever (high 103.3), chills (low 93), unbelievable night sweats. I lost 20 lbs already and have no energy or drive. The hospital did a blood and a urine culture. Both negative. They gave me the 5 day antibiotics. A week later, my Cardiologist then did 4 + blood cultures, all negative. He then took me off amedirone, as the side affects could be said to be the cause. Nothing is working. My normal BP 110-70 with pulse 75-80. (Recently, at 101 degress, I had a 100 pulse, and 80/57 BP). My body temp at night moves between between 93 and 96 degrees. I am on Warfarin 4 mg, and Metoprolol 50 mg. I am going to my internst Thursday. Any suggestions on what to ask him, any thoughts on a diagnosis? I really don’t even want to sleep anymore, and I cannot hydrate enough to make up for the sweat loss at night. I am fine when I am awake, absent sometimes I have a fever.

I am an active 53 year old male Grand Canyon riverguide who was diagnosed with an ascending aortic anurysm 8 1/2 years ago. I had a congenital bicuspid aortic valve which I didn’t know about until I was 44 years old. I had a porcine valve and root along with a double bypass. Both of my parents have heart disease as well.

Two years ago I was hospitalized with endocarditis and was told that it may do damage to my valve. Since the endocarditis, I have monthly IVIG treatments and also am on a bipap machine which was prescribed do to an A-fib problem a few months ago. I am in good physical condition, work out 4 to 5 days a week and am not overweight.

My echo in Jan. 2010 showed a slight leakage which has now progressed to a moderate leakage. I was told by my cardiologist that I will most likely have to have a redo replacement within the next year or so, although my last echo, in June showed no change from my previous echo 6 months earlier. The surgeon referered to me by my cardiologist, thought that a valve within my valve would be the preferred procedure rather than replacing the root and valve, which he said would be a much more significant surgery. They would also do an ablation procedure and hopefully not another bypass… (My current porcine valve is 27). I want to do another porcine valve because I do not want to be on coumidin do to my lifestyle.

My question is: Is a valve within a valve a common and successfully performed procedure? I was also hoping I could get away with a less invasive surgery, but was told I will have my chest split open again. I will get another opinion soon, but would appreciate your input.

Thanks,
Marty Mathis

I have been diagnosed with severe aortic stenosis. I’m 68, 6′, 185lbs, and fairly active. I’ve been reading about the trans catheter aortic valve replacement being placed in older non ambulatory people. I understand this procedure has been used in other parts of our world for about eight years now. I realize this is still considered experimental medicine here in the U.S. but when will they start using younger ambulatory subjects for these clinical trials?
Gary Vice

Is the Laser Angioplasty Excimer Laser Coronary Angioplasty being used routinely in US Hospitals? If so are there any surgeons in the Columbus, Ohio area ? Do you feel that this is a safer procedure and one that should be used if at all possible for the patient?

I am active 27yrs old female. I had my arotic valve replacement surgery one year agoand rheumatic heart problem from last 10 yrs. They had put prosthetic valve. I am on medication asprin, lopressor, pencillin and spironolactone . At the time of surgery I had been told that I don’t have to take any medicine, but I am taking it from last one year. how long I have to take the medicine.

What is the average time for surgical repair of 3 valves. Mitral, Pulmonary, Tricuspid. They are leaky:mild to moderate. Also the cost?

Hi Janet,

Thanks for your question.

However, the chat with Dr. Roselli was last week. If you would like to review the transcript, please visit this link:

http://www.heart-valve-surgery.com/heart-surgery-blog/2010/07/10/eric-roselli-chat-transcript-aortic-valve-cleveland-clinic/

I hope that helps!

Keep on tickin!
Adam

I have two valves calcified (Aortic and Pulmonic) in need of replacement. I am 62. I had radiation when I was 1 yr. old on my left shoulder and side of neck for a tumor. My left shoulder and neck are growth stunted
My files have been sent to Dr. Roseli . Is this a possible surgery

My husband had aortic valve replacement surgery and single bypass on Aug. 3. I understand his pain, which is unbearable without pain medication, but what concerns me is the fluid retention. His hands and arms are extremely swollen. The nurse doesn’t seem to be concerned, but I just want to know if this is expected after this kind of surgery. He did not have a minimally invasive procedure; his chest was opened. I would appreciate your getting back to me soon.

my age is 75 years and my MR ,TR ,AR valve is defective can it be replaced? plz reply

Should I do an angioplasty proceedure before I do an aortic valve replacement surgery?? I feel wesk dizzy and out of breath sometimes. I think an angioplast proceedure will get me health enough to recover faster after aortic valve replacement surgery. I would appreciate you professional understanding in this matter. Thank you for taking the time to replay to my concerns.
Sincerely,
Joseph Handal