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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 December 22, 1998 at 08:07:45:
In Reply to: aortic valve replacement posted by mario on December 21, 1998 at 15:49:19:
i am 39 years old and have a leaky aortic valve since 6 years old due to rhuematic fever. up until recently i would have not beleived i needed surgery because i could of done anything i wanted physically with little problem. i am now on lanoxin quinate and dyazide since 1990. the problem now is that i have noticed i tire out very easily and when i excert myself i usually get palpitations which are very effectivly handled with 5mg of valium my cardiologist has suggested valve replacement as quickly as possible because my heart had reached 69 milimeters or centimeters in width. i am at the montreal heart institute and they seem to be a bit behind in the latest surgical options availible. when i asked for the ross proceedure no one there does it and when i asked about minimly invasive the same thing was answered they dont do it. my question is how would i go about being reffered there what would it involve at surgery being from montreal. how long would i have to stay in cleveland before taking a plane or train back. any info would be app...thanks mario
________
Dear Mario, thank you for your question. 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.
The Ross Procedure is generally reserved for patients less than 30 years old, so it may not be the best option for you. However, minimally invasive AVR with an aortic valve homograft may be the best option for you. I'm not sure how you should arrange a referral from Canada to Cleveland, but I'm sure there would be financial implications. To inquire about a surgical referral here at the Cleveland Clinic, please call the phone number listed below and ask the operator to page Cathy at 24774. Cathy works in the cardiac surgery department and she would be a good resource for you. Typically, the normal post-operative stay for a minimally invasive AVR is 4-5 days and then 2-3 days in a nearby hotel before returning to Canada.
I hope this information is useful. Information provided in the heart forum is for general purposes only. Only your physician can provided specific diagnoses and therapies. Feel free to write back with further 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 mario on December 21, 1998 at 15:49:19:
i am 39 years old and have a leaky aortic valve since 6 years old due to rhuematic fever. up until recently i would have not beleived i needed surgery because i could of done anything i wanted physically with little problem. i am now on lanoxin quinate and dyazide since 1990. the problem now is that i have noticed i tire out very easily and when i excert myself i usually get palpitations which are very effectivly handled with 5mg of valium my cardiologist has suggested valve replacement as quickly as possible because my heart had reached 69 milimeters or centimeters in width. i am at the montreal heart institute and they seem to be a bit behind in the latest surgical options availible. when i asked for the ross proceedure no one there does it and when i asked about minimly invasive the same thing was answered they dont do it. my question is how would i go about being reffered there what would it involve at surgery being from montreal. how long would i have to stay in cleveland before taking a plane or train back. any info would be app...thanks mario
________
Dear Mario, thank you for your question. 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.
The Ross Procedure is generally reserved for patients less than 30 years old, so it may not be the best option for you. However, minimally invasive AVR with an aortic valve homograft may be the best option for you. I'm not sure how you should arrange a referral from Canada to Cleveland, but I'm sure there would be financial implications. To inquire about a surgical referral here at the Cleveland Clinic, please call the phone number listed below and ask the operator to page Cathy at 24774. Cathy works in the cardiac surgery department and she would be a good resource for you. Typically, the normal post-operative stay for a minimally invasive AVR is 4-5 days and then 2-3 days in a nearby hotel before returning to Canada.
I hope this information is useful. Information provided in the heart forum is for general purposes only. Only your physician can provided specific diagnoses and therapies. Feel free to write back with further 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.
