“A New Trend To Aortic Vave Repair Surgery?” with Dr. Bavaria

By Adam Pick on April 19, 2013

In the past, I’ve filled this blog with hundreds of stories about mitral valve repair procedures. However, over the past 12 months, I have started to hear and report about aortic valve repair surgery — from patients and physicians.

To learn more about this new trend to aortic valve repair surgery, I met with Dr. Joseph Bavaria. So you know, Doctor Bavaria is the Vice Chief, Division of Cardiovascular Surgery and the Director of the Thoracic Aortic Surgery Program at Penn Medicine. In addition, Dr. Bavaria has performed successful surgery on many members of our community including Rebecca Roberts, Hubert Karreman and Craig Fisher.

 

 

I hope this video helped you learn more about the rising use of aortic valve repair operations for patients experiencing aortic regurgitation (leaky valves). Many thanks to Dr. Joseph Bavaria for sharing his clinical expertise and research with our community.

Keep on tickin!
Adam

P.S. A written transcript of this video is provided below:

Dr. Joseph E. Bavaria: Hi. I am the Vice Chair of the Department of Cardiac Surgery at University of Pennsylvania. I practice in Philadelphia, Pennsylvania. I am the director of the Thoracic Aortic Surgery program. I have been in practice as an attending cardiac surgeon for approximately 20 years. I have done about 6,000 open heart operations of which 4,000 are cardiac valve related.

Adam Pick: Can you tell us what attracted you to the field of cardiac surgery?

Doctor Bavaria: My next door neighbor actually was a vascular surgeon and that’s what got me into the surgical field and maybe the vascular surgical field very early on my career. Fundamentally, I was a chemical engineer and I went to medical school after chemical engineering. One of my early mentors was a cardiac surgeon. Based on the clinical aspects of cardiac surgery and the biophysics aspects of cardiac surgery — that is what got me hooked right away.

Adam Pick:  Do you specialize in a particular type of valve surgery?

Joseph Bavaria, MD: Yes, most of the valve surgeries that I do are aortic valve related. Sometimes that is at the aortic root level which is more of a complex aortic valve operation. I do a lot of those — maybe 200 to 225 a year.

Adam Pick: In our patient community, we hear a lot about mitral valve repair, however we almost never hear about aortic valve repair. Why is that?

Dr. Joseph E. Bavaria: Well, aortic valve repair is simply not mature. The actual fundamentals of the conceptual background to understanding how to repair an aortic valve was not really developed until recently. The big difference between aortic valve repair and a mitral valve repair conceptually is that aortic valve surgery is in three dimensions and not two dimensions. The aortic valve is  three dimensional valve — as opposed to mitral valve which is a two dimensional valve. We just did not understand the valve quite as much but now we are starting to understand it a lot. We are in the third dimension and we are able to repair these valves on the X, Y and Z plane. We are at the level now for those of us who do a lot of these, that we can repair almost any valve that is fundamentally leaky — in other words an insufficient aortic valve. If it does not have a lot of calcification on it, we can almost repair every one of those valves, as long as the valve leaflets are somewhat intact.

Adam Pick: What type of patients are candidates for aortic valve repair?

Joseph E. Bavaria, MD: Well, the first criteria for candidacy for aortic valve repair is to have a valve that is fundamentally leaky or insufficient, and has only a minimum amount of calcium or no calcification. If it is too calcified, we cannot really repair the valve. The second thing which we can only tell once we get inside is, “Are the leaflets intact enough to actually take a repair stitch?”. But, if you have that, we can repair a lot of valves. Now, we can repair three cusp valves and we can repair bicuspid valves. We can repair both. Both type of valves as long as both criteria are satisfied. Again, not too much calcification, pure aortic valve insufficiency. You got those, we are in good shape.

Adam Pick:  Dr. Bavaria, what are the surgical outcomes for an aortic valve repair procedure?

Joseph Bavaria, M.D.: The results are excellent. They range from anywhere between 90 to 95% freedom from re-operation at ten years. In our series we have no reoperations yet. And, more importantly, with the more robust and kind of advanced techniques, we are getting a situation where we have 95% freedom from significant aortic valve insufficiency. So it is a very, very good operation for the patients who qualify.

Adam Pick: What is the number one piece of advice you would offer a patient who is considering aortic valve repair?

Dr. Joseph Bavaria: Well, the most important thing about someone who is effectively considering aortic valve repair is to go to surgeon who has the experience, the technical knowledge, and the conceptual depth to be able to do the procedure itself that requires a certain amount of experience, the number of cases that they have done — and maybe even a publishing record of some sort (so you can tell is this guy is really doing the operation, or really doing it well).


Written by Adam Pick
- Patient & Website Founder

Adam Pick is a heart valve patient and author of The Patient's Guide To Heart Valve Surgery. In 2006, Adam founded HeartValveSurgery.com to educate and empower patients. This award-winning website has helped over 10 million people fight heart valve disease. Adam has been featured by the American Heart Association and Medical News Today.

Adam Pick is a heart valve patient and author of The Patient's Guide To Heart Valve Surgery. In 2006, Adam founded HeartValveSurgery.com to educate and empower patients. This award-winning website has helped over 10 million people fight heart valve disease. Adam has been featured by the American Heart Association and Medical News Today.


zafar says on April 19th, 2013 at 2:24 pm

My son Aiortic valve was repaired in June 2009. Even after the repair there was mild AR. Now the leakage has again increased to Moderate and valve are also calcified. Is second repair possible for him? I will appreciate some guidance.



Erin says on April 20th, 2013 at 1:14 pm

I’m really glad you brought up this topic. I have mod-severe aortic insufficiency and moderate mitral regurgitation. Recently, I met with my surgeon (Dr. Starnes) to discuss options he mentioned that he will attempt to repair both my mitral valve and aortic valve. At first, I wasn’t sure if I had heard him correctly since I had the understanding that the aortic valve always had to be replaced. But, I know now that it is becoming much more common especially with surgeons of his caliber.



David Tanner says on April 23rd, 2013 at 11:04 am

I had a Pig valve operation on January 8th of this year along with a triple by-pass. Dr. Michael Wood is the surgeon here in Las Vegas. I am doing well and started my 7th week of cardiac rehab of the 12 weeks recommended. I am very thankful that I am still on the good side of the green as I will be 87 come July 1st. Your articles have been very helpful in my making a decision to go ahead and have the procedure as I did not have any symptoms of the heart blockage, but have been watching my valve gather more “crud” closing down the opening.
Thank you,
David Tanner



Kathryn Waymire says on May 2nd, 2013 at 11:57 pm

Is there a surgeon near Dayton Ohio who can do this and do it well?
Thank you very much!
Kathryn Waymire



;Ursula S. davis says on June 14th, 2014 at 2:57 am

I do not knowthat much about computers. I am 84 and have been diagnosed with calcification of the thoratic aorta. I am looking for s doctor in Las Vegas who has experience in this. Generally I am in good health. I have enough health insurance. Please reply. Thank you.
Ursula Davis



Willie Radl says on December 28th, 2017 at 9:21 pm

It has been a few years since this thread was posted, but in the last sentence from Dr. Bavaria he stated that some surgeons may publish their track records for Aortic Valve repair. Has anyone ever seen statistics like this for a specific surgeon? I would really like to investigate surgeons in my area that have performed this procedure with success.


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