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When do you operate?

I have been following aortic root for dilation for a year or so , last sonogram measured at 5.2cm , but recent TEE came out with a measurement of 4.9.Also have a BAV , with no stenois and very little leakage noted from TEE,We were looking at possibly surgery from the 5.2 measurement , but now are taking a watch and see approach it seems.My question is and I realize it all has variations , but what seems to be the general rule for surgery with a well functioning BAV?I have heard 5.0 as the time to consider.I am 49 yrs old and suffer from RSDS and am wondering if I would be better having surgery while I am younger to help with recovery as the RSDS has me limited on my activity.Thank you , RB
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Avatar universal
I'll tell you my story, it might help. I'm a 59 year old male, with a BAV. Doctors discovered an aneurysm a year and a half ago. First test (echo) showed it to be 4.8 cm in size. Then took a CT scan, which showed it to be around 5.2 cm. However, when I had surgery to repair it, the surgeon said it actually measured 5.8 cm. He said sometimes depending on how the aneurysm is situated in your body, it might be hard to determine the real size of it, even with a CT scan. I had the valve sparing procedure. I'm doing well now. Hope all goes well with you.

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5.0 is the general rule of thumb among most surgeons, but some who are particularly knowledgable about BAV will operate at 4.5.  Oftentimes the aortic tissue is weaker in BAV folks and more susceptible to rupture or dissection than in someone who does not have BAV.  That changes the risk/benefit ratio.  I don't know the significance of your RSDS, but possibly this would also "put a thumb on the scales" toward operating ealier.

A few surgeons are doing valve-sparing aneurysm repairs.  You might be a good candidate, since your AV is leaking only slightly.  This is a new technique, and I would only consider having it done by one of those few surgeons who are on the cutting edge with it.  I don't believe even the most experienced surgeons have done more than several dozen this way, so you are not going to find someone who does it every day.  Dr. Petterson at Cleveland Clinic, that sponsors this site, does it.  I would trust him and a few others to do a valve-sparing aneurysm repair.  Dr. Joseph Coselli in Houston and Dr. Sharo Raissi in Los Angeles are two more.  If you can go to a major heart center with a thoracic aortic surgery center, valve-sparing surgery might be an option.  Otherwise, if you opt for a traditional procedure in which your valve will be replaced, get the most experienced aortic surgeon you can.
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