{"id":36988,"date":"2023-05-12T12:25:37","date_gmt":"2023-05-12T17:25:37","guid":{"rendered":"https:\/\/www.heart-valve-surgery.com\/heart-surgery-blog\/?p=36988"},"modified":"2025-11-24T18:45:20","modified_gmt":"2025-11-24T23:45:20","slug":"aortic-valve-reoperations-roselli","status":"publish","type":"post","link":"https:\/\/www.heart-valve-surgery.com\/heart-surgery-blog\/2023\/05\/12\/aortic-valve-reoperations-roselli\/","title":{"rendered":"Surgeon Insights: Advanced Surgical Techniques for Aortic Valve Reoperations with Dr. Roselli"},"content":{"rendered":"<p>The idea of a &#8220;one-and-done&#8221; 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.<\/p>\n<p>To learn the advanced techniques that world-renowned surgeons use to best position aortic valve patients for multiple operations, I interviewed <a href=\"https:\/\/www.heart-valve-surgery.com\/surgeons\/dr-Eric-Roselli-Cleveland-Ohio.php\">Dr. Eric Roselli<\/a>, 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.<\/p>\n<p>&nbsp;<\/p>\n<p style=\"text-align: center;\"><iframe data-src=\"https:\/\/www.youtube.com\/embed\/nVu7DEJ0FPU?rel=0\" loading=\"lazy\" title=\"YouTube video player\" src=\"https:\/\/www.youtube.com\/embed\/nVu7DEJ0FPU?rel=0\" width=\"560\" height=\"315\" frameborder=\"0\" allowfullscreen=\"allowfullscreen\"><\/iframe><\/p>\n<p>&nbsp;<br \/>\n<!--more--><\/p>\n<h2>Key Learnings from Dr. Roselli<\/h2>\n<p>Here are important findings from my discussion with Dr. Roselli about advanced surgical techniques for aortic valve reoperations:<\/p>\n<ul>\n<li>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&#8217;s diseased aortic valve during primary operations, Dr. Roselli takes a big step back to consider the patient&#8217;s health and lifestyle now and in the future. &#8220;It really starts in the outpatient clinic first,&#8221; states Dr. Roselli. &#8220;I try to get a feel for what that the patient\u2019s 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\u2019s going to be for their long-term survival to protect their heart.&#8221;<\/li>\n<\/ul>\n<p>&nbsp;<\/p>\n<p style=\"text-align: center;\"><img loading=\"lazy\" decoding=\"async\" class=\"alignnone size-full aligncenter\" src=\"https:\/\/www.heart-valve-surgery.com\/profileImages\/71_129_161.jpg\" alt=\"Dr. Eric Roselli\" width=\"129\" height=\"161\" \/>Dr. Eric Roselli<\/p>\n<p>&nbsp;<\/p>\n<ul>\n<li>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.<\/li>\n<li>One technique that Dr. Roselli leverages is specific to aortic valve replacement sizing and selection. &#8220;Details like making the opening bigger to get a bigger valve in that\u2019s more efficient so it\u2019ll last longer and it\u2019s easier to address later on with another procedure,&#8221; states Dr. Roselli.<\/li>\n<li>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, &#8220;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.&#8221;<\/li>\n<\/ul>\n<p>&nbsp;<\/p>\n<p><img loading=\"lazy\" decoding=\"async\" class=\"aligncenter size-full wp-image-36994\" src=\"https:\/\/www.heart-valve-surgery.com\/heart-surgery-blog\/..\/Images\/aorta-aortic-root-roselli.jpg\" alt=\"Aortic Root Diagram\" width=\"650\" height=\"363\" \/><\/p>\n<p>&nbsp;<\/p>\n<ul>\n<li>Suture placement is a key consideration for Dr. Roselli during a primary aortic valve replacement in case the patient needs a reoperation. &#8220;[There are] granular details like the way we sew something in with the thought that maybe we\u2019ll be back cutting this out. So, we can simplify the way that we cut it out when we have to re-replace a valve.&#8221;<\/li>\n<li>Establishing a lifelong view of aortic valve disease from the patient and physician perspective is critical. &#8220;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,&#8221; states Dr. Roselli.\u00a0 &#8220;We can have this lifelong view of what\u2019s best for them as well as our understanding of what they want and what we can provide.&#8221;<\/li>\n<\/ul>\n<p>To contextualize the important points referenced above, here is the special patient success story of Ari Mintzer, a double aortic valve replacement patient.\u00a0 Unfortunately, Ari&#8217;s initial tissue aortic valve replacement wore out.\u00a0 Together, Ari and Dr. Roselli came up with a strategic plan to help Ari &#8220;get to 90 years of age&#8221; using a second surgical aortic valve replacement (SAVR) and a potential TAVR in the future.<\/p>\n<p>&nbsp;<\/p>\n<p style=\"text-align: center;\"><iframe loading=\"lazy\" title=\"YouTube video player\" src=\"https:\/\/www.youtube.com\/embed\/mbVTFGTOZjY\" width=\"560\" height=\"315\" frameborder=\"0\" allowfullscreen=\"allowfullscreen\"data-thumbnail=\"https:\/\/i.ytimg.com\/vi\/mbVTFGTOZjY\/0.jpg\"><\/iframe><\/p>\n<p>&nbsp;<\/p>\n<h2>Many Thanks Dr. Roselli and Cleveland Clinic!<\/h2>\n<p>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.<\/p>\n<p>Related Links:<\/p>\n<ul>\n<li><a href=\"https:\/\/www.heart-valve-surgery.com\/surgeons\/dr-Eric-Roselli-Cleveland-Ohio.php\">See Dr. Eric Roselli\u2019s Interactive Surgeon Profile<\/a><\/li>\n<li><a href=\"https:\/\/www.heart-valve-surgery.com\/bicuspid-aneurysm-modified-david-procedure.php\">Heart Surgery Innovations: Bicuspid Aortic Valve &amp; Aortic Aneurysms with Dr. Eric Roselli<\/a><\/li>\n<li><a href=\"https:\/\/www.heart-valve-surgery.com\/hospital\/cleveland-clinic-microsite\">Explore the Cleveland Clinic Heart Valve Microsite<\/a><\/li>\n<\/ul>\n<p>Keep on tickin!<br \/>\nAdam<\/p>\n<p>P.S. For the deaf and hard of hearing members of our community, I have provided a written transcript of this video below.<\/p>\n<p>Adam Pick: Hi, everybody. It\u2019s Adam with heartvalvesurgery.com. We\u2019re 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.<\/p>\n<p>Dr. Roselli: Always great to see you, man.<\/p>\n<p>Adam Pick: Now, you and I have known each other for a long time. We first met in 1990 at the University of Michigan.<\/p>\n<p>Dr. Roselli: Go Blue.<\/p>\n<p>Adam Pick: Go Blue. Because we\u2019ve known each other for a lot of our life, we\u2019re 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\u2019m wrong, even if you get treated, it can go on for the rest of your life.<\/p>\n<p>Dr. Roselli: For sure.<\/p>\n<p>Adam Pick: Given that you are a specialist there at the Cleveland Clinic, I\u2019m really curious to know. Is there anything that you\u2019re doing when a first time patient comes to you, needs surgery, when you\u2019re in the operating room, are there any techniques that you use that may be advantageous if a patient needs another operation?<\/p>\n<p>Dr. Roselli: It really starts in the outpatient clinic first trying to get a feel for what that patient\u2019s 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\u2019s going to be for their long-term survival to protect their heart. Actually, it also translates to improve durability of those valves.<\/p>\n<p>There\u2019s things that we pay attention to do that include details like making the opening bigger to get a bigger valve in that\u2019s more efficient so it\u2019ll last longer and it\u2019s 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\u2019ll be back cutting this out so we can simplify the way that we cut it out when we have to re-replace a valve.<\/p>\n<p>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\u2019s best for them as well as our understanding of what they want and what we can provide.<\/p>\n<p>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.<\/p>\n<p>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\u2019t afraid because they come in prepared from what you provide them beforehand. Really cool, keep up the good work man. Keep on ticking, right?<\/p>\n<p>Adam Pick: Yeah, and this could be the longest handshake in the history of my life.<\/p>\n","protected":false},"excerpt":{"rendered":"","protected":false},"author":1,"featured_media":36997,"comment_status":"open","ping_status":"open","sticky":false,"template":"","format":"standard","meta":{"_acf_changed":false,"footnotes":""},"categories":[28],"tags":[],"class_list":["post-36988","post","type-post","status-publish","format-standard","has-post-thumbnail","hentry","category-aortic-valve-replacement"],"acf":[],"aioseo_notices":[],"_links":{"self":[{"href":"https:\/\/www.heart-valve-surgery.com\/heart-surgery-blog\/wp-json\/wp\/v2\/posts\/36988","targetHints":{"allow":["GET"]}}],"collection":[{"href":"https:\/\/www.heart-valve-surgery.com\/heart-surgery-blog\/wp-json\/wp\/v2\/posts"}],"about":[{"href":"https:\/\/www.heart-valve-surgery.com\/heart-surgery-blog\/wp-json\/wp\/v2\/types\/post"}],"author":[{"embeddable":true,"href":"https:\/\/www.heart-valve-surgery.com\/heart-surgery-blog\/wp-json\/wp\/v2\/users\/1"}],"replies":[{"embeddable":true,"href":"https:\/\/www.heart-valve-surgery.com\/heart-surgery-blog\/wp-json\/wp\/v2\/comments?post=36988"}],"version-history":[{"count":3,"href":"https:\/\/www.heart-valve-surgery.com\/heart-surgery-blog\/wp-json\/wp\/v2\/posts\/36988\/revisions"}],"predecessor-version":[{"id":43031,"href":"https:\/\/www.heart-valve-surgery.com\/heart-surgery-blog\/wp-json\/wp\/v2\/posts\/36988\/revisions\/43031"}],"wp:featuredmedia":[{"embeddable":true,"href":"https:\/\/www.heart-valve-surgery.com\/heart-surgery-blog\/wp-json\/wp\/v2\/media\/36997"}],"wp:attachment":[{"href":"https:\/\/www.heart-valve-surgery.com\/heart-surgery-blog\/wp-json\/wp\/v2\/media?parent=36988"}],"wp:term":[{"taxonomy":"category","embeddable":true,"href":"https:\/\/www.heart-valve-surgery.com\/heart-surgery-blog\/wp-json\/wp\/v2\/categories?post=36988"},{"taxonomy":"post_tag","embeddable":true,"href":"https:\/\/www.heart-valve-surgery.com\/heart-surgery-blog\/wp-json\/wp\/v2\/tags?post=36988"}],"curies":[{"name":"wp","href":"https:\/\/api.w.org\/{rel}","templated":true}]}}