deteriorated pig valve

  My grandfather is a 68 year-old male who underwent a pig valve replacement about 20 years ago.  His valve has now deteriorated and he is suffering from stenosis.  I was informed that his aorta is about 4-5 times normal size and there appears to be significant calcification.  Upon first assessment, he was given a very poor prognosis and the surgeons said they could not operate at that facility.  What are his options and what are the risks associated with the options?  I would greatly appreciate any information or links to information.  Thanks.  Scott Killian

[CCF CARDIO MD APS]

Dear Scott,
The risks with any open heart surgery are mainly three (heart attack, stroke, and death.)
If the open heart surgery involves repairing an abnormal aorta (dilated, or dissected) then add the risk of paralysis.
The risks are determined then for each patient based on comorbidities (a diabetic is at slightly higher risk than a non-diabetic),
reoperations are more risky than first time operations, the amount of work that needs to be done (a combined valve and aorta, or
a combined valve and bypass is more risky than just the valve itself), and age, especially if the increased age has led to a calcified aorta
which not only makes stroke more likely, but makes manipulating the aorta very difficult and risky.  
There are some centers that do the more risky surgeries on a regular basis and the Cleveland Clinic is an
example as such, if you want your grandfather evaluated here you can call 1-800-CCF-CARE and ask for a cardiothoracic
surgery evaluation for bioprosthetic aortic valve stenosis.  The actual risk for an individual patient also depends on
the particular surgeon's experience, and this is why many complicated cases so to speak are sent to centers such as this,
the Cleveland Clinic Foundation.  
Of course there is balloon valvuloplasty for stenotic aortic valves, however these are usually only done as
a temporizing procedure to bridge the very sick patient to a surgical replacement; as well this carries a very high risk of
stroke.  Good Luck. Write back with any further questions.  
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).