{"id":4908,"date":"2024-09-18T16:38:26","date_gmt":"2024-09-18T16:38:26","guid":{"rendered":"https:\/\/www.heart-valve-surgery.com\/learning\/?page_id=4908"},"modified":"2024-09-26T13:41:58","modified_gmt":"2024-09-26T13:41:58","slug":"aortic-valves-aneurysms-interactions","status":"publish","type":"page","link":"https:\/\/www.heart-valve-surgery.com\/learning\/aortic-valves-aneurysms-interactions\/","title":{"rendered":"Surgeon Roundtable: Aortic Valve and Aortic Aneurysm Interaction and Treatment"},"content":{"rendered":"<p>The aortic valve is the gateway for oxygenated blood to leave the heart and circulate throughout the body. That said, the aortic valve is a complex and vital component of human life.<\/p>\n<p>&nbsp;<\/p>\n<p><img loading=\"lazy\" decoding=\"async\" class=\"size-full wp-image-4922 aligncenter\" src=\"https:\/\/www.heart-valve-surgery.com\/learning\/..\/Images\/aortic-valve-inside-aorta-2.jpg\" alt=\"Inside Structure of the Aortic Valve\" width=\"650\" height=\"363\" \/><\/p>\n<p>&nbsp;<\/p>\n<p>Unfortunately, several problems are related aortic valve function, including aortic stenosis and regurgitation. Additionally, since the aortic valve structure is part of the aorta, when the valve doesn\u2019t work correctly, it can create complications including an aortic aneurysm, which can be life-threatening.<\/p>\n<p>At HeartValveSurgery.com, we receive several questions about aortic valve disease from our community considering (i) aortic valve defects are the most common type of heart valve disease and (ii) there are many different treatment options available to patients from standard aortic valve replacement and aneurysm repair to complex valve-sparing aortic root replacement.<\/p>\n<p>To learn more these two associated aortic diseases, we sat down with two highly skilled heart surgeons from the Cleveland Clinic. <a href=\"https:\/\/www.heart-valve-surgery.com\/surgeons\/dr-Eric-Roselli-Cleveland-Ohio.php\">Dr. Eric Roselli<\/a> is the Chief of Adult Cardiac Surgery and Director of the Aortic Center. <a href=\"https:\/\/www.heart-valve-surgery.com\/surgeons\/dr-Xiaoying-Lou-Cleveland-Ohio.php\">Dr. Xiaoying Lou<\/a> is an expert cardiac surgeon with extensive experience managing and treating aortic valve disease and aneurysms.<\/p>\n<p>&nbsp;<\/p>\n<p style=\"text-align: center;\"><iframe loading=\"lazy\" title=\"YouTube video player\" src=\"https:\/\/www.youtube.com\/embed\/ok1exvQBhaU?rel=0\" width=\"560\" height=\"315\" frameborder=\"0\" allowfullscreen=\"allowfullscreen\"><span data-mce-type=\"bookmark\" style=\"display: inline-block; width: 0px; overflow: hidden; line-height: 0;\" class=\"mce_SELRES_start\">\ufeff<\/span><span data-mce-type=\"bookmark\" style=\"display: inline-block; width: 0px; overflow: hidden; line-height: 0;\" class=\"mce_SELRES_start\">\ufeff<\/span><span data-mce-type=\"bookmark\" style=\"display: inline-block; width: 0px; overflow: hidden; line-height: 0;\" class=\"mce_SELRES_start\">\ufeff<\/span><\/iframe><\/p>\n<p>&nbsp;<\/p>\n<h2>Key Patient Insights About Aortic Valves and Aortic Aneurysms<\/h2>\n<p>Here are key insights shared by Dr. Roselli and Dr. Lou during the surgeon roundtable:<\/p>\n<p>&nbsp;<\/p>\n<p><strong>The structure, the complexity and the embryology of the aortic valve<\/strong><\/p>\n<p>Dr. Roselli stated, \u201cThe aortic valve is a really complex structure, and embryologically, it develops in unison with the aorta. And the aortic structure is critical to the way the aortic valve works. As I\u2019ve been staring at so many thousands of aortic valves over the years, I think I\u2019ve gained a better appreciation of how that works and the embryologic development and the subtleties of how the valve forms probably have a bigger impact than we ever realized on the later dysfunction of that valve. It has to open and close a hundred thousand times a day. Over a lifetime, it could be like three billion cycles of wear and tear.\u201d<\/p>\n<p>&nbsp;<\/p>\n<p style=\"text-align: center;\"><a href=\"https:\/\/www.heart-valve-surgery.com\/surgeons\/dr-Eric-Roselli-Cleveland-Ohio.php\"><img loading=\"lazy\" decoding=\"async\" class=\"aligncenter\" src=\"https:\/\/www.heart-valve-surgery.com\/profileImages\/71_129_161.jpg\" alt=\"Dr. Eric Roselli\" width=\"129\" height=\"161\" \/><\/a><a href=\"https:\/\/www.heart-valve-surgery.com\/surgeons\/dr-Eric-Roselli-Cleveland-Ohio.php\">Dr. Eric Roselli (Cleveland Clinic)<\/a><\/p>\n<p>&nbsp;<\/p>\n<p><strong>How to think about the aorta when a patient is told they have a bicuspid aortic valve that needs to be addressed<\/strong><\/p>\n<p>Dr. Roselli said that since more and more treatment options are available, they can appreciate the interaction between the aorta and the aortic valve. \u201cI think one of the most common things we see is a bicuspid aortic valve, or what gets lumped into a bicuspid aortic valve, which is really a malformed valve,\u201d he said.<\/p>\n<p>Dr. Lou said that although statistics show that about two to three percent of the population have a bicuspid valve, that number is only based on people who come in for treatment and have a confirmed diagnosis. \u201cSo, I bet the prevalence of the bicuspid valve is a little higher than that,\u201d she said. \u201cPatients who have a bicuspid valve are born with it.\u201d<\/p>\n<p>&nbsp;<\/p>\n<p><img loading=\"lazy\" decoding=\"async\" class=\"size-full wp-image-4924 aligncenter\" src=\"https:\/\/www.heart-valve-surgery.com\/learning\/..\/Images\/bicuspid-aortic-valve-drawing.png\" alt=\"bicuspid aortic valve drawing\" width=\"650\" height=\"358\" \/><\/p>\n<p>&nbsp;<\/p>\n<p>She explained that a normal aortic valve has three leaflets, but there can be different forms of bicuspid valves which have just two leaflets. \u201cThere can be these raphe that form and are either completely bicuspid, or they can have different leaflets that are fused. Based on different fusion patterns of those bicuspid valves, there are different associations with aortas that can develop abnormally.\u201d<\/p>\n<p>Dr. Lou continued, \u201cI think the debate is still out whether it\u2019s because of the bicuspid valve and these associated aortopathies, these aneurysms that grow in association with the bicuspid valves, or whether it\u2019s because of the valve getting stenosed that causes some of these hemodynamic pressure issues in the aorta that\u2019s also causing those aortas to get bigger.\u201d<\/p>\n<p>&nbsp;<\/p>\n<p style=\"text-align: center;\"><a href=\"https:\/\/www.heart-valve-surgery.com\/surgeons\/dr-Xiaoying-Lou-Cleveland-Ohio.php\"><img loading=\"lazy\" decoding=\"async\" class=\"alignnone size-full\" src=\"https:\/\/www.heart-valve-surgery.com\/profileImages\/479_129_164.jpg\" alt=\"Dr. Xiaying Lou Heart Surgeon\" width=\"129\" height=\"164\" \/><\/a><br \/>\n<a href=\"https:\/\/www.heart-valve-surgery.com\/surgeons\/dr-Xiaoying-Lou-Cleveland-Ohio.php\">Dr. Xiaoying Lou (Cleveland Clinic)<\/a><\/p>\n<p>&nbsp;<\/p>\n<p>Dr. Lou explained that when a patient is diagnosed with a bicuspid valve, medical teams should also check their aortas because a bicuspid valve is often associated with aneurysms at the aortic root level, ascending aorta, or aortic arch. She also said, \u201cThey also have things inside the heart that may be malformed as well. There are a lot of other things we need to look at to diagnose that patient.\u201d<\/p>\n<p>Dr. Roselli explained that a bicuspid valve presents a constellation of problems in many different patterns. \u201cThe estimate is that at least a third and probably half of people with a bicuspid valve diagnosis are prone to develop an aneurysm. We did a study where we looked at unicuspid valves, another kind of malformed valve, which should be lumped into the same space, and they also had about the same incidence of aortic aneurysms. Sometimes, we see it involves the root and sometimes the ascending aorta. So, there is a lot of complex decision making, not just about what we do with the valve, but what we do with the aorta, including whether we deal with the root or we extend into the arch.\u201d<\/p>\n<p>&nbsp;<\/p>\n<p><strong>Aortic valve repair versus replacement when addressing an aneurysm<\/strong><\/p>\n<p>Dr. Lou said that she\u2019s seen a lot of bicuspid valve repairs since coming to the Cleveland Clinic under her fellowship with Dr. Roselli. She recognized that while not everyone is repairing bicuspid aortic valves, Dr. Roselli has built a huge practice of doing them.<\/p>\n<p>&nbsp;<\/p>\n<p><img loading=\"lazy\" decoding=\"async\" class=\"size-full wp-image-4926 aligncenter\" src=\"https:\/\/www.heart-valve-surgery.com\/learning\/..\/Images\/aortic-aneurysm-drawing.jpg\" alt=\"aortic aneurysm drawing\" width=\"650\" height=\"363\" \/><\/p>\n<p>&nbsp;<\/p>\n<p>\u201cThere are different repair techniques, but we do a lot of valve-sparing root replacements here where, if that valve does not have a lot of calcium with it or fenestrations or isn\u2019t otherwise damaged and has pretty pliable leaflets, they can be reconstructed in a way where we can save that valve. It offers really good durability for that patient long-term without the need to replace the valve and no need for anticoagulation if they\u2019re a young patient not getting a mechanical valve. And that has been a really good adjunct procedure to a valve-sparing root replacement, for instance, if the aneurysm has been the main issue for that patient.\u201d<\/p>\n<p>Dr. Roselli said, \u201cThe idea of keeping a living valve is going to be better than replacing one. I think it\u2019s important for people to know that if you go down that pathway, you still have a bicuspid valve. We want to have a lifelong view of things, so it\u2019s important to continue to follow that.\u201d<\/p>\n<p>He went on to say that the hope is that some of the patients in their 20s or 30s who need a valve-sparing procedure may reduce the number of lifetime operations.<\/p>\n<p>\u201cWe also have other choices for dealing with it as well,\u201d he said. \u201cCertainly, the Ross operation is something we\u2019ve been doing more of, and we\u2019re going to see better artificial and prosthetic valves, both biologic and mechanical. And I think one of the things that\u2019s important to remind the patients is that although we don\u2019t have the perfect options, we have a lot of really good options and can tailor them to the patients. And I think it\u2019s important to be at a center that offers all those different options.\u201d<\/p>\n<p>&nbsp;<\/p>\n<p><strong>What about transcatheter aortic valve replacements explants, pacemaker rates and calcium removal?<\/strong><\/p>\n<p>Dr. Roselli said, \u201cI think it\u2019s reasonable in older patients where the risk of that transcatheter valve matches the risk of a surgical valve or maybe reduces the risk compared to a surgical valve. But of course, there\u2019s a lot of excitement when people think, \u2018Oh, I can have this taken care of without opening my chest.\u2019 But there are definitely some downsides to that.\u201d<\/p>\n<p>Dr. Lou said, \u201cIt\u2019s a great option for patients who are in the higher risk category and there are many studies out there also suggesting this is non-inferior to a surgical valve replacement in lower risk patients.\u201d Dr. Lou points out, however, that while they always have a heart team approach at the Cleveland Clinic when evaluating patients for a transcatheter versus a surgical valve option, they favor doing open surgery on a patient who is young and otherwise healthy. \u201cWe still don\u2019t have great durability data, and certainly the number of TAVR explants and the people who need TAVR explants has increased over the years, and we\u2019re seeing more of those getting infected, and we have to explant those. The paravalvular leak rate for TAVR valves is getting a lot better, and the pacemaker rates are way better, but they\u2019re still there. The difference is we can\u2019t remove all of the calcium in a transcatheter valve, but we can do that in an open valve. I do think, especially for patients with bicuspid valves, you get in there and see how calcified it is, and I think if it were my valve, I would want it out, and I\u2019d want it debrided and have a new valve put in place of it.\u201d<\/p>\n<p>\u201cIt\u2019s nice to put a valve in a clean space,\u201d said Dr. Roselli. \u201cBut also, if you have some potential risks for aneurysm, a TAVR will not address that. We\u2019ve seen some pretty bad problems where people have pushed that technology into that abnormal space.<\/p>\n<p>&nbsp;<\/p>\n<p><strong>What about safety and overall outcomes?<\/strong><\/p>\n<p>Dr. Roselli said, \u201cI think it\u2019s also essential for people to understand how safely we can do these operations. Everybody is afraid of having an incision in their chest, and I get that; why wouldn\u2019t you be? But our outcomes are outstanding, and we just presented all of our annual outcomes recently. They\u2019re pretty great.\u201d<\/p>\n<p>\u201cYes,\u201d said Dr. Lou. \u201cI don\u2019t have the valve data, but I have the root replacement data in elective cases.\u201d She explained that the mortality rate for the root replacement data is only 0.5%.<\/p>\n<p>\u201cPretty awesome,\u201d said Dr. Roselli. \u201cAlso, these patients can get back to normal life afterward. I have patients who are competitive athletes after they go through all of this, and I think that\u2019s something that people need to appreciate.\u201d<\/p>\n<p>&nbsp;<\/p>\n<p><strong>Patients can make decisions for themselves with good support and education<\/strong><\/p>\n<p>Dr. Roselli said, \u201cThat\u2019s one of the beauties of the HeartValveSurgery.com website: patients talking to patients, and they share their stories, and they reassure each other that, even though this is a scary ordeal, there\u2019s a really good chance you\u2019ll get through it safely and get back to a high quality of life.\u201d<\/p>\n<p>He explained that the new technology they\u2019ve been working on at the Cleveland Clinic has made operations for aortic valve and aortic disease safer and easier. \u201cMore importantly, we are providing people good, high quality, lifelong care. We are here to help educate people about that so patients can make the best decisions for themselves in a precise way with all the options at hand.\u201d<\/p>\n<p>&nbsp;<\/p>\n<h1>Thanks Dr. Roselli, Dr. Lou and the Cleveland Clinic!<\/h1>\n<p>On behalf of the HeartValveSurgery.com patient community, thank you, <a href=\"https:\/\/www.heart-valve-surgery.com\/surgeons\/dr-Eric-Roselli-Cleveland-Ohio.php\">Dr. Roselli <\/a>and <a href=\"https:\/\/www.heart-valve-surgery.com\/surgeons\/dr-Xiaoying-Lou-Cleveland-Ohio.php\">Dr. Lou<\/a>, for helping us understand more about the aorta and aortic valve and the treatments that are now available. We would also like to thank the Cleveland Clinic for continuing to care for heart valve patients and keep them informed!<\/p>\n<p>Related Links:<\/p>\n<ul>\n<li><a href=\"https:\/\/www.heart-valve-surgery.com\/heart-surgery-blog\/2023\/05\/12\/aortic-valve-reoperations-roselli\/\">Surgeon Q&amp;A: Advanced Aortic Valve Techniques with Dr. Roselli<\/a><\/li>\n<li><a href=\"https:\/\/www.heart-valve-surgery.com\/learning\/shared-decision-making-dr-eric-roselli\/\">Patient Success Story: Ari &amp; Dr. Roselli Aortic Valve Reoperation<\/a><\/li>\n<li><a href=\"https:\/\/www.heart-valve-surgery.com\/learning\/bicuspid-aortic-valve-valve-sparing-root-replacement\/\">Bicuspid Aortic Valve &amp; Valve-Sparing Root Replacement: Top 8 Facts<\/a><\/li>\n<\/ul>\n<p>Keep on tickin,<br \/>\nAdam<\/p>\n","protected":false},"excerpt":{"rendered":"","protected":false},"author":4,"featured_media":0,"parent":0,"menu_order":0,"comment_status":"closed","ping_status":"closed","template":"cms.php","meta":{"_acf_changed":false,"footnotes":""},"categories":[3],"class_list":["post-4908","page","type-page","status-publish","hentry","category-aneurysms"],"acf":[],"aioseo_notices":[],"_links":{"self":[{"href":"https:\/\/www.heart-valve-surgery.com\/learning\/wp-json\/wp\/v2\/pages\/4908","targetHints":{"allow":["GET"]}}],"collection":[{"href":"https:\/\/www.heart-valve-surgery.com\/learning\/wp-json\/wp\/v2\/pages"}],"about":[{"href":"https:\/\/www.heart-valve-surgery.com\/learning\/wp-json\/wp\/v2\/types\/page"}],"author":[{"embeddable":true,"href":"https:\/\/www.heart-valve-surgery.com\/learning\/wp-json\/wp\/v2\/users\/4"}],"replies":[{"embeddable":true,"href":"https:\/\/www.heart-valve-surgery.com\/learning\/wp-json\/wp\/v2\/comments?post=4908"}],"version-history":[{"count":20,"href":"https:\/\/www.heart-valve-surgery.com\/learning\/wp-json\/wp\/v2\/pages\/4908\/revisions"}],"predecessor-version":[{"id":4939,"href":"https:\/\/www.heart-valve-surgery.com\/learning\/wp-json\/wp\/v2\/pages\/4908\/revisions\/4939"}],"wp:attachment":[{"href":"https:\/\/www.heart-valve-surgery.com\/learning\/wp-json\/wp\/v2\/media?parent=4908"}],"wp:term":[{"taxonomy":"category","embeddable":true,"href":"https:\/\/www.heart-valve-surgery.com\/learning\/wp-json\/wp\/v2\/categories?post=4908"}],"curies":[{"name":"wp","href":"https:\/\/api.w.org\/{rel}","templated":true}]}}