Aortic Aneurysm & Heart Valve Disease Treatment: 9 Important Facts
Written By: Adam Pick, Patient Advocate & Author
Medical Expert: Joseph Bavaria, MD, Vice Chief of Cardiovascular Surgery at Penn Medicine Heart & Vascular Institute
Page last updated: June 10, 2021
For patients, the diagnosis of aortic valve disease can be dislocating, confusing and isolating. However, if patients are diagnosed with an aortic aneurysm – in addition to a valve disorder – anxiety levels can skyrocket.
As we have learned in our community, patients often consider an aortic aneurysm a “ticking time bomb” as a bursting of the aorta, which is the largest artery in the human body, can lead to a sudden, life-threatening situation. Unfortunately, it was an aortic aneurysm that took the life of John Ritter, the wonderful comedian best known for his starring role in Three’s Company.
To help patients better understand the realities of diagnosing, managing and treating aortic aneurysms and aortic valve disease, I met with Dr. Joseph Bavaria. A past-President of The Society of Thoracic Surgeons and the Vice Chief of the Division of Cardiovascular Surgery at Penn Medicine Heart & Vascular Institute, Dr. Bavaria has performed 9,000+ cardiac procedures of which 6,000+ operations included heart valve repairs and/or replacements. It should be noted that Dr. Bavaria is an aortic valve and aortic aneurysm specialist who has successfully treated many patients in our community including Mark Siedlecki, Diane Mowery and Eileen Garton.
Key Learnings from Dr. Bavaria
Dr. Bavaria shared several insights in this video. Here are key learnings for patients to consider:
- Dr. Bavaria’s interest in cardiac surgery began with his passion for becoming a doctor as a way to help people. After studying engineering in college, Dr. Bavaria’s attraction to physiology led him to medical school and then a specific focus on cardiac surgery.
- In his clinic at Penn Medicine, Dr. Bavaria sees many patients with both aortic valve disease and aortic aneurysms. Dr. Bavaria states, “The combination of aortic valve disease and aortic aneurysms is unbelievably common.”
- Specific to disease development and progression, an aortic valve disorder can cause an aortic aneurysm. At the same time, an aortic aneurysm can cause an aortic valve disorder. “It goes both ways,” states Dr. Bavaria, “For example, in bicuspid aortic valves, it’s these flow patterns that a lot of times will cause aneurysms… In three-cusp aortic valves, it’s the aorta that’s causing the valve problem. The two are intimately connected.”
- Both aortic valve disease AND aortic aneurysms are life-threatening conditions. However, the timeline of severity for each condition is unique. An aneurysm becomes very serious if a rupture or dissection occurs. Aortic valve disease, on the other hand, is a slow but progressive cause of heart failure. It is critical to repair or replace defective aortic valves prior to the onset of heart failure.
- Patients can undergo a single operation known as an aortic root procedure to address both aortic valve disease and aortic aneurysms. The operation is done frequently and is very safe at cardiac centers that specialize in aorta and heart valve surgery.
- Specific to the aortic valve, Dr. Bavaria can repair, replace of even “spare” the aortic valve. Valve-sparing procedures involve fixing the aortic aneurysm without any treatment to the aortic valve. The benefits of aortic valve repair and valve-sparing root procedures is that the patient can retain his/her own tissue which can lead to long-term durability and no lifelong use of blood thinners.
- For aortic valves that are leaking, also known as aortic regurgitation, Dr. Bavaria will typically repair those valves during an aortic root procedure. Alternatively, aortic valves that are stenotic typically need to be replaced.
- Given the data currently available, Dr. Bavaria does not believe that a tissue valve replacement placed in a Dacron graft will lead to better, long-term durability. However, there can be decreased complications (infection, thrombus, stroke) as a result of Dacron graft utility.
- Dr. Bavaria’s number one piece of advice for patients with aortic valve disease and aortic aneurysms is to find a cardiac center that specializes in aortic root procedures and performs these operations regularly.
Many Thanks Dr. Bavaria & Penn Medicine!!!
On behalf of our community, I want to thank Dr. Bavaria for taking the time to share his clinical experiences and research with our patient community. Dr. Bavaria’s commitment and dedication to advancing therapies for patients with aortic valve disease and aneurysms is extraordinary.
I also want to thank the entire Penn Medicine team for taking such great care of our patients!!!
Keep on tickin!
P.S. For the hearing impaired members of our community, we have provided a written transcript of this video below.
Adam Pick: Hi, everybody. It’s Adam with heartvalvesurgery.com, and this is a special question and answer session all about aortic valves and aortic aneurysms. I am thrilled to be joined by Dr. Joseph Bavaria, who’s the Vice Chief of the Division of Cardiovascular Surgery at Penn Medicine, and he’s also the director of the Thoracic Aortic Surgery Program there in Philadelphia. During his extraordinary career, Dr. Bavaria has been a president of the Society of Thoracic Surgeons, and he has performed over 9000 cardiac procedures of which 6000 have included heart valve therapies. Dr. Bavaria, it’s great to have you with us. Are you there?
Dr. Bavaria: Thank you very much, Adam. I’m here. It’s a pleasure.
Adam: Thanks so much, Dr. Bavaria for taking time away from your very busy practice. Before we get talking about your specialties, I’m really curious to know. Why did you want to become a cardiac surgeon?
Dr. Bavaria: First I – it’s about becoming a physician, and I had some exposure for various reasons as a youngster when I was in high school and determined at that point that I wanted to become a physician. Then a little bit later while I was in medical school – in the early part of medical school – I was exposed to – for various areas to cardiac surgery, and it captured my imagination, and I was an engineer, actually, in undergraduate, and I think it was the physiology as well that captured my imagination regarding my pursuit of cardiac surgery.
Adam: I’m glad that pursuit happened because I know many of your patients, and you’ve done some incredible work over the years helping them and so many other people there at Penn Medicine. I’m going to start with a really specific question about your specialty. It’s all about the prevalence of aortic valve disease and aneurysms together. Is this a common condition for patients out there?
Dr. Bavaria: Yeah, the combination of aortic valve disease and aneurysmal disease is unbelievably common, okay? They work in concert together. The aortic valve really is part of the aorta, and the aorta itself is very dependent, I suppose, or is affected by the aortic valve in multiple domains, so yes, there – they are very much together, and they present from a disease standpoint together a lot, especially as you get younger.
Adam: Given your science and all the research you’ve done there at Penn Medicine, I’m curious to know, do we – and I mean you in the scientific community – know does the valve problem cause the aneurysm or is it the other way around?
Dr. Bavaria: That’s a good question, and it’s actually both. It goes both ways. For many of the more congenital or bicuspid aortic valve or some of the syndromes that occur in younger people such as Marfan’s or Loeys-Dietz or syndromic conditions, it’s probably – many of those a valve is actually a major part. For example, in bicuspid aortic valve, it’s these flow patterns that a lot of times will cause the aneurysms, or the aneurysms will be stressed because of the flow patterns, or the aortic wall will be stressed.
In three cusp valves, it’s also mostly – it’s probably the other way around. It’s usually related to the aorta, and then the aorta gets big, the valve gets stretched, the valve gets leaky, and it’s the aorta causing the valve issue. They are intimately connected. Sometimes the valve’s causing the aneurysm. Sometimes the aneurysm is causing the valve problem.
Adam: Dr. Bavaria, I’m sure if a patient is newly diagnosed with these conditions, they are probably wondering a very big and important question which is.. Is this a life threatening condition?
Dr. Bavaria: Absolutely. They’re both life threatening conditions, but they’re a little bit different in the way they present and the way they act. The aortic aneurysm is a very, very serious condition, but it’s not really serious until is ruptures, so it’s kind of what I call to my patients an A+/F- condition. You’re either fine or you’re in really bad shape, so it’s really important with aneurysms to fix them before they rupture or before they dissect. However, aneurysm – I mean valve disease is a slow but progressive cause of heart failure, so you have to catch the valves and replace and repair valves prior to the development of heart failure. That’s the key there.
Adam: Yeah, and so let’s talk about the work that you and your team are doing there at Penn Medicine because these are two different conditions. Are they treated in one operation, or do you need to have multiple procedures?
Dr. Bavaria: No, today we can treat these in one operation. We can repair and replace valves at the same time as repairing the aneurysm itself. This is called an aortic root procedure in many respects where you have the combination of the valve plus the aorta together, and we do these all the time. This is something that is now done in 2020. This is a – something that’s not dangerous.
Adam: Got it. If I remember right, I think I’ve seen some research potentially with you talking about valve sparing procedures. Can you share with the patients what that is?
Dr. Bavaria: Oh, yes. If your valve is fundamentally okay and/or it’s a bicuspid valve that is what I call physiologically normal or near normal – it looks fine, it is fine, but it may be leaky, but it’s not calcified and it’s not – doesn’t have any irreversibly damaged tissue, then we can repair these valves. We can either spare them, which means that we’re fixing the aneurysm around the valve, or we can actually repair the aneurysm and repair the valve as well at the same time. This is a little complicated. It’s a little sophisticated, but we can definitely repair and spare valves under certain conditions, especially regurgitant valves or valves that have insufficiency or leaks. Now, it’s a little harder if you have a stenotic valve with calcification.
Adam: Got it. Let’s talk about if you can’t spare or repair the valve about replacements. In particular, we’ve got a patient question, and the question is… Is a tissue valve more durable if it’s placed inside a Dacron graft?
Dr. Bavaria: That’s a great question, and the answer is we actually don’t know the answer to that. In my opinion looking at everything, I don’t think we have greater durability or greater longevity of the valve if it’s in a Dacron graft. However, we do have decreased complication rates, especially at the midterm, related to infection and/or thrombus and/or stroke because if you have the valve inside a Dacron graft, the connection zone between that valve and the heart is actually on the outside of the heart not on the inside, and so that makes some of the complications a little bit less common.
Adam: Dr. Bavaria, you have done just an incredible job there with the research and the science and the procedure, learning about aortic valves, how to treat them, when to treat them, the timing of the procedures. I’ve got to ask for all the patients out there who are thinking that a procedure is coming up for them, what is your number one piece of advice for them?
Dr. Bavaria: I think if you have the combination especially of a valve procedure and an aneurysm procedure, that’s a pretty significant operation. It’s a pretty significant disease process. My best piece of advice would be to go to a surgeon who does a lot of them and to an institution that does a lot of them.
Adam: It is really great advice. Dr. Bavaria, on behalf of all the patients in our community and all around the world who are going to see this, I want to thank you so much for taking time away from your very important practice there at Penn Medicine and sharing all of your great clinical experience and research with our patients. Thank you so much.
Dr. Bavaria: Thank you, Adam, and this is why we do this for our patients. Thank you.
Adam: Thanks so much, Joe. As we always say here, keep on ticking.
Dr. Bavaria: Keep on ticking.