David's Journal

Marie Myers  Was wondering how you decided on a mechanical valve vs bioprosthetic ? I am wrestling with that decision now myself.

David Knight  Marie. Dr Svensson said I had mild calcium on my valve (via CT scan) and my hemodynamics across my valve were a bit high. When he repairs aortic valves the repair itself increases the hemodynamics across the valve also. As a result he isn't comfortable my repair would last long enough.

Marie Myers  I was wondering how you chose the mechanical valve over the tissue valve. Am assuming it is the shorter life span of the tissue valve. I hope everything goes perfectly for you I surgery.

Jan Persico  David, I am scheduled for an aortic valve replacement at Cleveland Clinic on the 13th. My surgeon is Dr. Douglas Johnston. The cardiologist who was to clear me for surgery wasn't sure I needed it at this time. Yet in September 2016, it was like the end of the world.....that valve must be replaced, so said the same cardiologist. We almost cancelled a trip that had been planned for over a year. I met with Dr. Johnston and he was very sure my valve needs to be replaced. Meet with your surgeon, let him look at the tests and make the decision. The surgeons are the experts.....trust them! Would love to meet up with you in the clinic!!
Stay strong!

Catie B  I agree with Jan. I hope you have an appt with a surgeon. Surgeons and cardiologists can see these things very differently. In Cleveland in September, 2 days before my surgery I somehow ended up with a heart failure cardiologist doing my pre-op appt. She spent 45 min. telling me why I didn't need my aortic valve replaced, that it wasn't yet time. I told her my aortic aneurysm was driving the timing and that two surgeons already told me I'd need the severely stenotic valve replaced while they operated on my aorta. Surgeons rule in these matters. Rely on a surgeon's opinion.

Judy Paul  I will be having a AVR redo at Cleveland Clinic on March 7. Dr. Svennson is performing the surgery. I had a situation similar to the one David described at UPenn in September. I was told that the valve that was installed in May of 2012 ( I had been suffering from aortic stenosis due to a native bicuspid aortic valve) was leaking severely. After a TEE and several other tests at UPenn the surgeon told me that I needed to have the valve replaced. The surgery was scheduled for Sept. 26. I had all the pre-op testing done on Sept. 6, and after waiting for two hours for the pre-surgery conference with my surgeon, he came into the exam room and told me that I really didn't need the surgery on the 26th, that I could wait and be monitored every 4 months! Or, if I was too emotional, I could proceed with the surgery on the 26th. The decision was mine. WTF!! My decision was to go to Cleveland Clinic for a second opinion. After a day of testing at CC, a meeting with a cardiologist, and the surgeon, Dr. Svennson, it was decided that the surgery to replace the leaking valve was best scheduled for now rather than later, that the leak was not going to get better, and that I was only going to become symptomatic ( I am feeling fine now, no serious symptoms, perhaps a bit dizzy at times - which is a symptom according to the surgeon) So I will be going to Cleveland Clinic ( a 7 hour drive from Philly) on March 4 for a day of pre-op testing on March , and the surgery ( another OHS!) on March 7. I am trusting that the staff at CC have my best interests at heart ( no pun intended!). It has been an emotional, confusing time for me and my family for the past year. I am eager to have the surgery and begin the healing process. No more indecision, no more conflicting opinions.

Adam Pick  Hi David, Here's some info and patient stories to help you and everybody else learn about aortic valve repair.

David Knight  Thank you Adam. I've been reading the literature on results of aortic valve repair. The success rate seems somewhat controversial as to what to expect as far as reoperation. I've seen Dr Svensson's video and read his results of 91% at 10 years free from reoperation. Seems like most other centres have had less success for reoperation rate. What is your understanding since you go to most of the current meetings discussing repairs vs replacement for aortic valves?

Steve Farthing  These videos really show how useful it can be to spend some time to find out if there are additional options available whenever valve replacement is suggested. Sometimes that means visiting another surgeon - or two. Many surgeons will only mention procedures they know how to perform. If the surgeon across town can offer a viable alternative option, you may not be told unless you seek that out.

Marie Myers  This is exactly what I am researching now. I need more info on the possibility of repairing the bicuspid AV rather than replacing it...

Phil Gerber  I had a successful aortic valve repair done 9 months ago and feel like I am back to normal now. I actually didn't have any symptoms prior to surgery. My surgeon explained that they wouldn't do a repair if they didn't feel that they could get at least 10 years out of it. For me it was my first choice since I am active in sports (including hockey) and would prefer to not be on blood thinners at this point in my life.

Phil Gerber  Yes, it is a bicuspid aortic valve also. I replied to your guest book post as well with some more detail.