Our Summary

This research paper looked at patients who had both aortic root and mitral valve problems, which is becoming more common among those undergoing heart surgery. The study observed 118 patients from 1987 to 2016 who had surgery for these issues (not including conditions like aortic stenosis, endocarditis, or reoperations). The main problems found in the patients’ aortic roots were degenerative aneurysm and aortic dissection. Aortic valves were found to be bicuspid in 15% of patients. About 29% of the patients had Marfan syndrome. 78% had degenerative mitral disease. The types of surgeries they underwent included aortic root reimplantation, the Bentall procedure, and homograft root replacement.

The study found that the combined surgery risk was low and the durability of the valve was high. There were only 1.7% operative deaths, with a survival of 79% at 10 years and 71% at 15 years. The rate of needing another operation was 4.7% after 5 years and 12% after 10 years. The best results were achieved when a valve-preserving root reimplantation and mitral repair were combined, with a survival rate of 89% and a reoperation rate of 7.8% at 10 years. The study concludes that when possible, this combined approach should be considered to avoid issues like prosthesis degeneration, need for anticoagulation, and lifestyle limitations.

FAQs

  1. What were the main problems found in the patients’ aortic roots in the study?
  2. What were the types of surgeries that the patients in the study underwent?
  3. What did the study find about the risk and durability of combined aortic root and mitral valve surgeries?

Doctor’s Tip

One helpful tip a doctor might tell a patient about aortic valve replacement is to consider a combined approach with mitral valve repair if possible, as this has been shown to have better long-term outcomes in terms of survival and reoperation rates. This can help avoid potential issues such as prosthesis degeneration, the need for anticoagulation, and lifestyle limitations. It is important to discuss all treatment options with your healthcare provider to determine the best course of action for your individual situation.

Suitable For

Overall, patients who are recommended for aortic valve replacement typically have aortic root and/or mitral valve problems, such as degenerative aneurysm, aortic dissection, bicuspid aortic valves, Marfan syndrome, and degenerative mitral disease. These patients may undergo surgeries such as aortic root reimplantation, the Bentall procedure, or homograft root replacement. The study mentioned above found that a combined approach of a valve-preserving root reimplantation and mitral repair had the best outcomes in terms of survival and reoperation rates. This approach may be recommended to avoid issues associated with prosthetic valves, such as the need for anticoagulation and lifestyle limitations.

Timeline

Before aortic valve replacement, a patient may experience symptoms such as chest pain, shortness of breath, fatigue, and dizziness. They may undergo diagnostic tests such as echocardiograms, cardiac catheterizations, and CT scans to determine the severity of their condition. Once it is determined that aortic valve replacement is necessary, the patient will undergo preoperative preparations including blood tests, imaging studies, and consultations with their healthcare team.

After aortic valve replacement surgery, the patient will typically spend a few days in the hospital for monitoring and recovery. They will be closely monitored for any complications such as bleeding, infection, or arrhythmias. Physical therapy and breathing exercises may be recommended to aid in recovery. Once discharged from the hospital, the patient will need to follow up with their healthcare team regularly for monitoring of their heart function and valve durability.

Overall, aortic valve replacement can greatly improve a patient’s quality of life and reduce symptoms associated with aortic valve disease. With proper postoperative care and follow-up, patients can expect a good long-term outcome and improved survival rates.

What to Ask Your Doctor

  1. What are the risks and benefits of aortic valve replacement surgery for my specific condition?

  2. What type of aortic valve replacement procedure do you recommend for me, and why?

  3. What is the expected recovery time after aortic valve replacement surgery?

  4. Will I need to take medication or make lifestyle changes after the surgery?

  5. How often will I need follow-up appointments to monitor my heart health after the surgery?

  6. What are the potential complications or side effects of aortic valve replacement surgery?

  7. Are there any alternative treatments or procedures that I should consider?

  8. How long can I expect the replacement valve to last, and what are the chances of needing another surgery in the future?

  9. How experienced are you and your medical team in performing aortic valve replacement surgeries?

  10. Can you provide me with information or resources to help me better understand the procedure and what to expect before, during, and after surgery?

Reference

Authors: Javadikasgari H, Roselli EE, Aftab M, Suri RM, Desai MY, Khosravi M, Cikach F, Isabella M, Idrees JJ, Raza S, Tappuni B, Griffin BP, Svensson LG, Gillinov AM. Journal: J Thorac Cardiovasc Surg. 2017 May;153(5):1023-1030.e1. doi: 10.1016/j.jtcvs.2017.01.006. Epub 2017 Jan 31. PMID: 28262292