Surgeon Insights: Advanced Surgical Techniques for Aortic Valve Reoperations with Dr. Roselli
Written By: Adam Pick, Patient Advocate, Author & Website Founder
Medical Expert: Eric Roselli, MD, Chief of Adult Cardiac Surgery, Cleveland Clinic
Published: May 18, 2023
The idea of a “one-and-done” operation to fix heart valve disease is beyond attractive. However, the reality is that many patients with valvular defects may need two or more operations throughout their lifetime. For that reason, it is critical that patients and their medical teams establish a long-term plan for the management of valvular diseases including aortic stenosis and mitral regurgitation.
To learn the advanced techniques that world-renowned surgeons use to best position aortic valve patients for multiple operations, I interviewed Dr. Eric Roselli, the Chief of Adult Cardiac Surgery at the Cleveland Clinic. As you may know, Dr. Roselli is a wonderful supporter of HeartValveSurgery.com who has performed successful operations on many patients in our community including Pamela Gregory and Tim Traub.
Key Learnings from Dr. Roselli
Here are important findings from my discussion with Dr. Roselli about advanced surgical techniques for aortic valve reoperations:
- Dr. Roselli takes a holistic and broad view of patient care. Instead of simply considering how he is going to repair or replace the patient’s diseased aortic valve during primary operations, Dr. Roselli takes a big step back to consider the patient’s health and lifestyle now and in the future. “It really starts in the outpatient clinic first,” states Dr. Roselli. “I try to get a feel for what that the patient’s desires are, what their concerns are, and what their risks are for reoperation later on. Because regardless of the type of valve that you get, the more functional and the less resistance to flow that the heart has through that space, the better it’s going to be for their long-term survival to protect their heart.”
- There are several techniques that Dr. Roselli has developed, researched and deployed throughout his career that are designed to yield better durability of aortic valve replacements.
- One technique that Dr. Roselli leverages is specific to aortic valve replacement sizing and selection. “Details like making the opening bigger to get a bigger valve in that’s more efficient so it’ll last longer and it’s easier to address later on with another procedure,” states Dr. Roselli.
- Dr. Roselli focuses on the aortic root and associated coronaries during aortic valve procedures to prepare patients for future valve-in-valve procedures. Dr. Roselli states, “Maybe [I will be] more aggressive about the root so that the coronaries are mobilized in such a way that the person will be amenable to a transcatheter aortic valve replacement (TAVR) later on.”
- Suture placement is a key consideration for Dr. Roselli during a primary aortic valve replacement in case the patient needs a reoperation. “[There are] granular details like the way we sew something in with the thought that maybe we’ll be back cutting this out. So, we can simplify the way that we cut it out when we have to re-replace a valve.”
- Establishing a lifelong view of aortic valve disease from the patient and physician perspective is critical. “I think the cool thing is in treating aortic valve disease is that throughout the entire time when I meet a patient through the nitty gritty details of the operating room and even afterward,” states Dr. Roselli. “We can have this lifelong view of what’s best for them as well as our understanding of what they want and what we can provide.”
To contextualize the important points referenced above, here is the special patient success story of Ari Mintzer, a double aortic valve replacement patient. Unfortunately, Ari’s initial tissue aortic valve replacement wore out. Together, Ari and Dr. Roselli came up with a strategic plan to help Ari “get to 90 years of age” using a second surgical aortic valve replacement (SAVR) and a potential TAVR in the future.
Many Thanks Dr. Roselli and Cleveland Clinic!
On behalf of our patient community, many thanks to Dr. Roselli for sharing these unique insights about the surgical techniques used to best position patients for aortic valve reoperations. We also want to thank the entire Cleveland Clinic team for taking such great care of patients with heart valve disease.
Related Links:
- See Dr. Eric Roselli’s Interactive Surgeon Profile
- Heart Surgery Innovations: Bicuspid Aortic Valve & Aortic Aneurysms with Dr. Eric Roselli
- Explore the Cleveland Clinic Heart Valve Microsite
Keep on tickin!
Adam
P.S. For the deaf and hard of hearing members of our community, I have provided a written transcript of this video below.
Adam Pick: Hi, everybody. It’s Adam with heartvalvesurgery.com. We’re at the Society of Thoracic Surgeons conference. I am thrilled to be joined by Dr. Eric Roselli who is the chief of adult cardiac surgery at the Cleveland Clinic. Eric, it is great to see you.
Dr. Roselli: Always great to see you, man.
Adam Pick: Now, you and I have known each other for a long time. We first met in 1990 at the University of Michigan.
Dr. Roselli: Go Blue.
Adam Pick: Go Blue. Because we’ve known each other for a lot of our life, we’re going to talk about a very important topic in heart disease right now which is the lifetime management of heart valve disease. People are living longer lives. Valve disease, when you have it, correct me if I’m wrong, even if you get treated, it can go on for the rest of your life.
Dr. Roselli: For sure.
Adam Pick: Given that you are a specialist there at the Cleveland Clinic, I’m really curious to know. Is there anything that you’re doing when a first time patient comes to you, needs surgery, when you’re in the operating room, are there any techniques that you use that may be advantageous if a patient needs another operation?
Dr. Roselli: It really starts in the outpatient clinic first trying to get a feel for what that patient’s desires are, what their concerns are, and what their risks are for reoperation later on, because regardless of the type of valve that you get, the more functional and the less resistance to flow that the heart has through that space, the better it’s going to be for their long-term survival to protect their heart. Actually, it also translates to improve durability of those valves.
There’s things that we pay attention to do that include details like making the opening bigger to get a bigger valve in that’s more efficient so it’ll last longer and it’s easier to address later on with another procedure, maybe being more aggressive about the root so that the coronaries are mobilized in such a way that the person will be amenable to a transcatheter valve later on, or even I guess more granular details like the way we sew something in with the thought that maybe we’ll be back cutting this out so we can simplify the way that we cut it out when we have to re-replace a valve.
I think the cool thing is in treating aortic valve disease is that throughout the entire time when I meet a patient through the nitty gritty details of the operating room and even afterward, we can have this lifelong view of what’s best for them as well as our understanding of what they want and what we can provide.
Adam Pick: Eric, on behalf of all the patients at heartvalvesurgery.com, all the patients all over the world, thanks for everything that you are doing at the Cleveland Clinic. Thanks for being here and sharing all this great information.
Dr. Roselli: Thanks, Adam. Always great talking to you and all the great knowledge you provide patients, I see it personally in the office, I see people come in that aren’t afraid because they come in prepared from what you provide them beforehand. Really cool, keep up the good work man. Keep on ticking, right?
Adam Pick: Yeah, and this could be the longest handshake in the history of my life.
Written by Adam Pick
- Patient & Website Founder
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