AORTA STENOSIS

[CHARMAINE-PULON]

  78 YR. OLD FEMALE DIAGNOSISED WITH AORTA STENOSIS. NEED AORTA VALVE REPLACEMENT ,BUT CONSIDERED HIGH RISK.  I HAVE UNCONTROLABLE HIGH BLOOD PRESSURE     COPD, ASTHMA, AND EMPHASEMA     THE SURGEON GIVES ME A 50% SURVIVAL RATE IF I OPT TO HAVE THE SURGERY.  HE ALSO ADVISED ME I WOULD DIE IF I DO NOT HAVE THE SURGERY.  WHAT IS YOUR ADVISE?  PLEASE GIVE ME SOME ADVISE AS I AM VERY UPSET WITH MY PROGNOSIS.  I ALSO HAVE A HUSBAND WHO HAS JUST BEEN RECENTLY DIAGNOSISED WITH LIVER CANCER AND THIS IS VERY UPSETTING FOR ME.  NONE OF THIS IS HELPING ME COPE WITH MY OWN HEART PROBLEMS.  IF I DO OPT TO HAVE THE SURGERY AND SINCE I AM A HIGH RISK PATIENT, WHO IS THE VERY BEST SURGERON IN THE USA TO DO THIS SORT OF SURGERY?  THANK YOU FOR YOUR QUICK RESPONSE.

[CCF Cardio MD-SGM]

Dear Charmaine,
Stenosis of the aortic valve is not an unusual problem, especially in older patients.  Typically the mortality risk of such a surgery is less than 5 percent.  However, the problems of lung disease that you mentioned will increase this risk.  Specific estimates depend on your degree of lung disease and the status of other body systems such as the kidneys, for example.  A surgical mortality risk of 50% is very high, and I agree that you should seek other options.
One option is to undergo aortic valvuloplasty, where a balloon is passed across the stenotic aortic valve.  There is risk associated with this procedure as well, but since it is non-surgical, involving a catheter in the artery of the groin,  the risk is substantially less than what you have been quoted.  However, aortic valvuloplasty is a palliative procedure, meaning that it helps the problem for a while, but within six months or so, the stenosis often returns, necessitating another procedure.  
Another option is to obtain a surgical consultation at another institution.  We perform more valve surgeries at the Cleveland Clinic foundation than anywhere else in the United States, over 1200 in 1997 alone, and our surgeons are widely considered to be among the best in the world.   If you're interested in being evaluated here, please contact 1-800 CCF CARE and make an appointment with Mario Garcia, MD or Brian Griffin, MD,  two cardiologists who specialize in valvular disease.  
Best of luck.  Information in the Heart Forum is for general purposes only.  Specific diagnoses and treatments can only be prescribed by your physician.