Dr. Eric Roselli’s Interactive Chat Scheduled For July 7!

For aortic valve replacement, what is the best approach — minimally invasive (intercostal), semi-sternotomy, or full sternotomy and WHY? What are the risks and benefits of each surgical procedure?

(Please make a transcript or recording of this interactive chat available on-line — work prevents me from being able to participate live.)

I had open chest surgery in 2008 to repair an ascending aortic aneurysm with a valve sparing procedure on my BAV. The first follow up echo showed a mild leak at the valve. The second follow up just recently, some 17 months post surgery revealed a moderate leak. Should I expect the valve to progressively worsen fairly rapidly, or is it possible that a “leveling off” might occur, giving me some years before a second surgery to replace the valve would be necessary?

Hi
Had a sucsessfull aortic valve operation due to aortic stenosis, on march 25 this year in Uppsala Sweden. Following 20 days I suffered from tight sub sternal pressure every time I swallowed food or liquid, and couldn\’t lay down for more than 2 hours at a time. I was very tired and had to sit down for a while after just walked up a small stairs. Finaly I had 155 rest hartrate and bloodpressure 90/60. My local doctor then sent me back to hospital, where they discovered liquid inside of my pericardium. They sucsessible suck out 1,5 liter of blood, and all my bad feelings dissapered at once.
My questian is if this is a common situation after a aortic valve operation, and if it\’s hard to make the diagnose?
Kind regards
Hasse B from Sweden

On April 7, 2009 I had successful aortic valve replacement and an ascending aorticthing replaced due to a slight aneurysm and have been very active ever since with NO issues, save one.

Dr Roselli was my surgeon,Thank God.

I have a balance problem I did not have prior to surgery, where I find myself having to catch my balance, on occasion, when I get into an awkward bending position. Have not fallen yet, but it does concern me. I will be 70 next week acting like a 40 year old, and do not want to break a hip. Is this related to the surgery or something else.

Thanks Doc, Great Job
Jim Nelson

Dear Dr Roselli,

I am a 66yr old female, 5’2″ who will at best be able to receive a 23mm aortic valve prosthesis, maybe only 21mm. I have moderately severe aortic stenosis, calcification at the sinotubular junction and an anomalous circumflex artery apparently rendering reoperation difficult. I really do not want to take Warfarin, particularly because of bleeding complications as I get older, frailer and will require various procedures.

What is the progress of the OnX PROACT study? Is there a good chance that there may be a mechanical valve which requires no Warfarin?

Regarding the ATS 3F valve, apparently I have calcification just where this valve would be sewn in. A surgeon advised me that he would find it difficult to sew this in on me and in any case the gradients are not any better that with an ordinary tissue valve. What is your opinion?

I appreciate you help. Thanks

Judy

Hi Adam,
I have your book–thank you.
At age 59 I am advised that i need aortic valve replacement do to reguritation coupled to aortic anurism needing attention.
Dilema is mechanical vs tissue. I wish to avoid the Warphrin associated with the mechanical option but would then need to replace tissue valve in 15 yrs?? Am hoping that we would have non invasive surgery by then?? Question: will the second operation be more onerous due to having had the first?? Any input welcome. Thank you. Gianni

Dear Dr. Roselli,
My 19 year old son is having an aortic valve replacement on 7/1/10. The doctors said it was necessary to have the full sternotomy, as they are also doing a repair of the aortic root area. My question is this, the valve they are utilizing is expected to last hopefully 10-15 years; do you think that valve replacement science is moving in the direction that he may be able to have a minimally invasive surgery the next time around? Additionally, do you believe that they will be able to develop a mechanical valve that will not require the use of daily blood thinners? Thank you for your thoughts.

My son name Mobeen age 11 year, was operated last year for Sub aortic membrane and AV repair for moderate AR. After repair AR reduced to mild but in recent check again increased to moderate. Although cardiologist has put him on medicine( speromide and cardice), he says that your child will require AV replacement in next 2-3 years time. He also says that this child age size of AV is not available.

Kindly advice best course of action for AV repair of our child

I had my aortic valve repaired but, was told that in repairing I am now experiencing some stenosis. How long typically does a repair to a valve last? Does weight factor into the length of time that I have before needing the next surgery?

Are there any circumstances under which aortic valve repair is possible?

How effective and safe is aortic valve replacement with stent through artery? Is there anywhere in USA that does this? TX in advance.

Is a dilated ascending aorta (4.5 cm) a contraindication for AVR via minimally invasive techniques?

I am a 44 year old female. I have a BAV (severe stenosis/moderate regurgitation) with aneurism of ascending aorta (4.5cm). Have seen a surgeon who has recommended Bentall Procedure – conduit – mechanical valve/dacron. He will be replacing the aorta up to the arch (the arch is fine). Just not sure whether he should have the dacron all the way up to the arch (which means as far as I understand it, cannulation through the subclavical and clamping) or have the dacron almost all the way up with a sleeve wrapped around what is left of the native aorta for extra support (apparently this does not require clamping). My question is, what are the risks of the 2 different procedures, which is the safest and which provides better long term results? Thanking you in advance.

I have been diagnosed (in March 2010) with a leaking aortic heart valve rate as a 4 out of 5. The cardiologist indicated I might not need surgery for 5 to 10 years. I have read about the doctor in New York who does the surgery by making an incision below the breast (less invasive). My valve will need to be replaced. Are there doctors in Cincinnati, Ohio who have experience doing this surgery? My option my be to go to the Cleveland Clinic, but I would prefer to do it locally. I am 69 years old.

My name is Jason, I am 39 yrs old and was diagnosed yesterday with Aortic Stenosis. I’m not sure of the severity of the condition. I haven’t had any symptoms yet but, I’m kinda freaked out about the whole thing. I’m seeing another cardiologist for a second opinion and , to get more detail about what steps I can take to slow the progression of the narrowing of the valve. I was hoping to hear from other people with similar diagnosis’.