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Heart Disease (Expert Forum)
Re: Aortic Valve Replacement
This forum is for questions and support regarding heart issues such as: Angina, Angioplasty, Arrhythmia, Bypass Surgery, Cardiomyopathy, Coronary Artery Disease, Defibrillator, Heart Attack, Heart Disease, High Blood Pressure, Mitral Valve Prolapse, Pacemaker, PAD, Stenosis, Stress Tests.
Re: Aortic Valve Replacement
by CCF Cardio MD - MTR, Jan 01, 1995 12:00AM
Posted By CCF CARDIO MD - MTR on February 18, 1999 at 11:50:20:
In Reply to: Aortic Valve Replacement posted by Joe on February 17, 1999 at 16:26:15:
I have an aortic valve that needs to be replaced. I have stenosis and aortic insuffiency. I had ohs when I was 9yrs to clip a fiberous band from my aorta. They were going to replace the valve then but deemed it was not as bad as originally thought. I have been going yearly and lately twice a year for checkups. My cardiologist has now referred me to a surgeon who said I need to have the valve replaced. I am 29 years old a little overwight and have not had any symptoms. The pressure on the valve and the amount of leakage in mild to moderate and has not changed in the past several years. If I decide to have it replaced should I go with a St. Jude or a tissue valve? I have had strong recommendations for each. Also having tried to get life insurance and failed, my blood test revealed my triglycerides at 420 and cholesterol at 226, are the high and what should I do to lower them? Thanks I know the was long but I am worried.
Dear Joe, thank you for your question. I'll first detail the options of aortic valve replacement for you.
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. Our surgeons at Cleveland Clinic have pioneered minimally invasive valve replacement, so you may want to consider coming to Cleveland for an evaluation.
Thus, in your case, I think either a mechanical valve or a homograft would be the best option. I would not recommend a tissue/porcine valve since it will need replacement in 10-15 years.
As far as the elevated triglycerides and cholesterol, your first step should be to eat a strict low fat, low cholesterol diet and exercise daily (once your valve is replaced). If these measures don't lower your lipid levels, then medications can be used. However, since you are young and probably don't have coronary artery disease at this point, I think diet and exercise should be tried first.
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.
In Reply to: Aortic Valve Replacement posted by Joe on February 17, 1999 at 16:26:15:
I have an aortic valve that needs to be replaced. I have stenosis and aortic insuffiency. I had ohs when I was 9yrs to clip a fiberous band from my aorta. They were going to replace the valve then but deemed it was not as bad as originally thought. I have been going yearly and lately twice a year for checkups. My cardiologist has now referred me to a surgeon who said I need to have the valve replaced. I am 29 years old a little overwight and have not had any symptoms. The pressure on the valve and the amount of leakage in mild to moderate and has not changed in the past several years. If I decide to have it replaced should I go with a St. Jude or a tissue valve? I have had strong recommendations for each. Also having tried to get life insurance and failed, my blood test revealed my triglycerides at 420 and cholesterol at 226, are the high and what should I do to lower them? Thanks I know the was long but I am worried.
Dear Joe, thank you for your question. I'll first detail the options of aortic valve replacement for you.
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. Our surgeons at Cleveland Clinic have pioneered minimally invasive valve replacement, so you may want to consider coming to Cleveland for an evaluation.
Thus, in your case, I think either a mechanical valve or a homograft would be the best option. I would not recommend a tissue/porcine valve since it will need replacement in 10-15 years.
As far as the elevated triglycerides and cholesterol, your first step should be to eat a strict low fat, low cholesterol diet and exercise daily (once your valve is replaced). If these measures don't lower your lipid levels, then medications can be used. However, since you are young and probably don't have coronary artery disease at this point, I think diet and exercise should be tried first.
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.
