Aortic Repair and Low EF

[bwest1]

On 9/24 I underwent surgery for severe aortic regurge at a top notch leading cardiac hospital.  It was initially thought that I would need a David procedure but it turns out that a BAV repair Aortoplasty and resection of the ascending aorta was performed, no need for the David procedure.  I was on bypass less than 1 hour. (At the time of surgery TEE showed good valve function with no leakage) A week later when I was discharged I was informed that my EF had dropped from a 60 to a 35 according to bedside echo.  They told me that with a low EF that I was a CHF patient and told me to get a cardiologist near home.  (I find it odd that they did not assign a CHF specialist or someone to follow up with me, I have not heard from the hospital since discharge.)  The cardiologist at discharge said he hoped it would get better but did not know why  the EF dropped.  Put me on Lisinopril, metoprolol, Lasix and aspirin. I located a cardiologist near home, explained the situation, he performed an echo and confirmed that my EF was low (37%) and the heart was not functioning as well as it should, plus the echo shows moderate aortic leakage.  Granted it has only been 4 weeks since surgery, but simple tasks leave me out of breath or dizzy. I can walk well on flat ground but inclines are trouble.  I am a W 46 year male, non smoker.    Any ideas/explanations/comments from you fine folks on my situation?  I was rather active and now I am rather limited.  The local cardiologist also is hoping that my EF will increase with time and I will get somewhat more normal in activities, but I wish I could understand why I went in with severe AV leakage and now I have moderate leakage with Heart Failure, rather depressing.  I welcome and comments, thoughts so I can become more knowledgeable about my condition and what I may need to do in the future.  

[themajor]

A related discussion, LOW EF from Myocarditis was started.

[francie12]

My 15 yr old son has a bicuspid AV with mod/severe regurg. and dilated asc. aorta.  I'm educating myself as much as possible.  The dr's response said that the CCF is the only place that does a bicuspid repair well.  Can anyone explain this in more detail?  Do they do something specific differently from other places?  A surgeon we consulted spoke about pulling up a prolapsing cusp and suturing it into place.  The CCF is on our short list of potential places for the surgery--it has definately moved up after this post.  Any details much appreciated.
Bets of luck to you, bwest1.  Your answer was reassuring.

[Cleveland Clinic]

CCF is probably the only place that does a bicuspid repair well.  Again, unfortunately, that repair only buys you some time before valve replacement is necessary.  That's good, though.  Since you are young, you don't have to deal with having a prosthetic valve that would require anticoagulation, etc.  I think it is definitely worth it.  However, close follow up is definitely necessary.  It is very unusual, however, that with a normal EF prior to the operation, your EF is abnormal at this point.  It should get better with time.  

[bwest1]

It was a bicuspid repair with and a aortoplasty at CCF

[Cleveland Clinic]

You really should be seen by an experience cardiologist.  There are a few very important questions that must be answered.  First, was there any coronary artery disease on the catheterization prior to the operation and, second, are there any wall motion abnormalities on the current echo.  If the LV dysfunction is global than most likely the severe aortic regurgitation went on for too long and affected your ventricle.  If there are wall motion abnormalities, then coronary artery disease or surgical complications must be rulled out with a catheterization.   The good news is that, unlike with mitral valve regurgitiation, aortic regurgitation associated cardiomyopathy is more likely to improve over time.  Your heart will probably never have an EF of 65% but that does not matter all that much.  What concerns me more is the fact that you are having a lot of symptoms from this.  It is therefore extremely important that you stay on the right medications, the lisinopril being most important in this particular situation.  I am not exactly sure what exactly happened in terms of your operation.  Did they repair your bicuspid aortic valve and performed an aortoplasty (aorta resection)?  David procedure is not a really good option for bicuspid valves.  It turns out that bicuspid valve repair is not very durable.  It prevents you from having a valve replacement but the durability of that repair is not that great and future rate of reoperation is pretty high.  The moderate regurgitation shouldn't be too much of a concern at this point.  It may improve with EF improvement.   For now make sure you are taking the right meds and that you follow up with your cardiologist.  Symptomatic improvement is what matters most, so that's what you should look forward to, not the improvement in EF.  Don't get depressed over this.  I think you will do well.