bicuspid aortic valve repair Vs. replacement?

[Janele]

  I am anticipating having valve surgery at the Cleveland Clinic soon.  The surgeon, after viewing my Echo tapes said that he thought there was a good chance that he could repair the valve instead of replacing it.  I have done some research on the options for AVR, but did not realize that repair for congenital aortic insufficiency was an option.  The prospect of having my own valve repaired is very appealing to me because I am only 30 years old, and am not a good candidate for a mechanical valve because of a bleeding tendency.  I was told that I would most likely require a second AVR sometime down the road.  I would appreciate any information regarding this surgery ie how long has it been being performed,  what is the long term outlook for someone having aortic valve repair Vs. replacement (is it likely that a young person undergoing this operation would require further surgery after the valve has been repaire. Would any medication be required?  What are the contraindications for this procedure?  I would like to research this further, can you cite any journal articles that I could look up?  Thank-you once again for this service.  It has been incredibly helpful to me.  If anyone reading this post has had Aortic valve repair, please e-mail me.  I would love to hear what your experience was like.

[CCF CARDIO MD APS]

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Dear Janelle,
Aortic repair is a fairly new technique and so there are no large scale comparison type studies done on it
to evaluate it against say a replacement.  Since most patients with valvular heart disease are best addressed
individually, such a study will probably never be done, however the more this type of surgery is done, the
more we will know about its' success.  As a general rule all attempts at repair should be made before a replacement is done, most especially in the young patient.
Repair in an aortic valve is a possibility when there is simply a regurgitation of blood, but there is the chance that the repair will cause a stenosis of the valve
which is of course unacceptable at moderate and severe levels-this will be determined by an intra operative TEE done while you are under general anesthesia before and after the repair.
Any repair or tissue valve replacement in a young individual will almost definitely require further valve surgery in the ensuing 10-20 years.  So the advantage of a mechanical valve replacement is that
it can last a lifetime, but as you know, this is at the cost of lifelong coumadin therapy.  Coumadin is not really an option in people with bleeding disorders but especially in female patients of
child bearing age who wish to get pregnant.  As you may know already, these decisions are very complex and
involve most importantly the patient and the surgical team.  It is of the utmost
importance that you discuss with your surgeon and cardiologist what is most important to you.  
It should make you feel better to know that repair of valves was essentially born here at the Cleveland Clinic and
the surgeons are not only the best in the world, they are constantly reevaluating their work to improve the outcome for the patients.
Information provided in the heart forum is intended for general medical informational purposes only, actual diagnosis and treatment can only
be made by your physician(s). I hope that this information has been helpful.