AVR details

Hi,

I'm a 48 yoa male diagnosed in 9/98 with aortic stenosis and regurgitation. I have had regular 3 month echoes and 6 month stress tests w/echos to establish a baseline and to monitor the status of my left ventricle hypertrophy (spelling?). I recently had my periodic stress test and the results indicated to my cardiologist that I need to pursue surgery in the next 3 months. For the first time during the stress test I experienced a noticeable shortness of breath.

I too have had many questions since I found out about my situation -- should I select a mechanical, or a bioprostetic type etc., and what my particular life style would be best suited to. I am leaning towards the homograft because I read it has a longer average life cycle than does a porcine valve and because I really don't want to be on coumadin. Perhaps when I need to have the bio replaced I will be more inclined to go with a mechanical valve and the requisite coumadin because I would be much less physically active than I am now.

My questions are based on the following answers to other posts here:

1)
"Answered By: CCF CARDIO MD - DLB on Sunday, December 12, 1999
     A mechanical valve is a simpler surgery. However, assuming your surgeon is experienced, a homograft surgery should be reasonably save in a young, healthy individual such as yourself. The homograft is usually placed as a full root, primarily because the aortic roots of people with aortic valve disease are usually at least a little dilated and diseased."

What impact is there, if any, on subsequent surgery for a mechanical valve down the road when the homograft needs replacing?

2)
"Answered By: CCF CARDIO MD - DLB on Saturday, December 04, 1999
     These are all good questions. You are right - the amount of leak can actually decrease while exercising due to the increase in the heart rate, though whether that actually happens in an individual is complex. If exercising caused the blood pressure to become very high, the leakage could increase. However, in a well-conditioned athlete, I would not expect this to happen to a great extent. I think continuing to exercise in a moderate fashion is OK, though I would avoid heavy-weight lifting and would avoid competitive running. However, most cardiologists would give the same advice that yours did - that it is safer to avoid doing anything strenuous until after the surgery. In a runner, I would recommend an aortic homograft instead of a mechanical valve - you would probably be able to keep running with a homograft."

Can you give me an understanding of the limitations that the mechanical valve would pose in this example?

I really appreciate all that have posted their experiences and comments here because I have learned much from this board in a very short time and when I need the answers the most.

Thanks,
Steve

[Cleveland Clinic, MD]

Question 1) There are no special limitations of a homograft - just the additional difficulty of a second surgery whereas with a mechanical valve repeat surgery is not usually needed.

Question 2) - The limitation with athletics and a mechanical valve is the coumadin.  This may or may not be a problem depending on the sport.  Your doctor can give recommendations for your particular situation.