Questions posted in the Heart Forum have been answered by doctors from The Cleveland Clinic Foundation.

Subject: Re: Aortic Valve Replacement
Forum: The Heart Forum
Topic Area: Stenosis
Posted by CCF CARDIO MD - MTR on March 21, 1999 at 10:56:11:
In Reply to: Aortic Valve Replacement posted by Ted Cottrell on March 17, 1999 at 17:47:08:


I am 53 yrs old and have severe aortic stenosis caused by a bicuspid valve... the area of my valve is slightly below 1 centimeter at the last checkup. My doctor in FT Collins Colo believes that I will need replacement within a couple years.
My symptoms are very small now.. shortness of breath with strenuous excercise. I have taken very good care of myself and am in excellent condition otherwise. have never smoked.. eat a low fat diet etc.. and excercise daily. I recently made and appt
in Phoenix for a second opinion.. They have scheduled me for an angiogram. In your opinion is this necessary ? I realize that more information can be obtained from this than just echocardiograms but given the possible problems .would your hosp do this test
as the next step also.. I have read of your hospital and am interested in looking into it further..I was wondering about the type of valve that would be best for me. they use porcine valves only in Phoenix and I am not sure that I dont want a homograph..

Not sure at all about the longivity of these valves??could you tell me.. and also wondering about minimaly invasive surgery. your hospital appears to me to offer more options.. I would very much appreciate a response to these questions...before I decide
to do something I don't feel comfortable with..
because I am in excellent health otherwise >> I do not want to be doing heart surgery every 8 or 10 yrs.. that is real scarey to me.


Thank you very much

Ted Cottrell


Dear Ted, thank you for your question. I agree that it's time to start planning for you to have an aortic valve replacement. An angiogram is necessary to rule out coronary artery blockages because if these are present, then you would need bypass surgery as well as a valve replacement. I doubt you have blockages, but an echocardiogram cannot determine this. The severity of aortic stenosis can also be assessed during an angiogram, but an echocardiogram can also determine that information. I've listed the options for aortic valve replacement below, but I can't tell you what the best option is for you. Our cardiac surgeons have pioneered minimally invasive valve replacement surgeries and we would be happy to evaluate you for such a surgery. To arrange an evaluation at the Cleveland Clinic, please call 1-800-CCF-CARE during business hours and ask to speak with Cathy (pager 24774) who works for the cardiac surgery department.

Aortic Valve Replacment Options:

There are four basic options for aortic valve replacement (AVR). First, a mechanical AVR involves a prosthetic valve (usually a St. Jude's or Carbomedics valve) that has excellent long-term durability but requires coumadin - a blood thinner. Coumadin can be harmful to fetal development so women who expect to become pregnant after an AVR should investigate options that do not require coumadin. Second, a bioprosthetic AVR is made from porcine tissue and doesn't require coumadin. However, a bioprosthetic valve only lasts 10-15 years so it's not appropriate for a young person. Third, an aortic valve homograft is a cryopreserved cadaveric aortic valve that is self-contained in the overlapping aortic tissues and is inserted as a whole conduit. The native coronary arteries are reimplanted just above the valve. While homografts have only been used for 10-15 years, results are good and coumadin is not needed. However, there are unanswered questions regarding long-term durability with homografts. Fourth, there is a unique form of AVR called the Ross Procedure that involves switching the native pulmonic valve to the aortic position and replacing the pulmonic valve with an aortic homograft. This surgery is very technically demanding and should only be done by a surgeon with good experience since there is a high rate of perioperative and postpoerative complications. The benefit of a successful procedure is, however, no need for coumadin and probably the most durable aortic valve prosthesis that doesn't require coumadin. There is a website for the Ross Procedure and the URL is http://www1.primenet.com/~carym/. Finally, AVR can be performed via a minimally invasive approach with a 4-5 inch incision and postoperative pain and recuperation are reduced.


I hope you find this information useful. Information provided in the heart forum is for general purposes only. Only your physician can provide specific diagnoses and therapies. Please feel free to write back with additional questions. Good luck.

If you would like to make an appointment at the Cleveland Clinic Heart Center, please call 1-800-CCF-CARE or inquire online by using the Heart Center website at www.ccf.org/heartcenter. The Heart Center website contains a directory of the cardiology staff that can be used to select the physician best suited to address your cardiac problem.

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