Our Summary

This paper examines the outcomes of surgeries on patients who have problems with both their aortic root and their mitral valve in the heart. From 1987 to 2016, they studied 118 patients who had these combined issues. Most of these patients had an aortic root aneurysm (a bulging of the aorta that can rupture), with a smaller portion having an aortic dissection (a tear in the aorta’s inner layer).

Different procedures were performed including a valve-preserving root reimplantation, a Bentall procedure, and a homograft root replacement. In recent years, doctors have increasingly opted for the combination of valve-preserving root reimplantation and mitral repair.

In terms of outcomes, there were two deaths directly linked to the surgery (1.7%). Within 15 years, 71% of the patients were still alive, and about 12% needed another operation within 10 years. Patients who underwent the combined valve-preserving root reimplantation and mitral repair had a survival rate of 89% after 10 years and a reoperation rate of 7.8%.

Overall, the research concluded that patients with both aortic root and mitral valve issues didn’t face a high risk from the combined surgery and the valves held up well over time. They also suggested that when possible, a valve-preserving root reimplantation and mitral repair should be considered as this approach appeared to have better outcomes and avoided certain complications like blood clotting and lifestyle limitations.

FAQs

  1. What were the most common issues found in patients with both aortic root and mitral valve problems?
  2. What procedures were performed on these patients and which one is most preferable in recent times?
  3. What were the survival and reoperation rates for patients who underwent the combined valve-preserving root reimplantation and mitral repair?

Doctor’s Tip

A helpful tip a doctor might tell a patient about valve replacement is to consider a valve-preserving root reimplantation and mitral repair if possible, as this approach may have better outcomes and avoid certain complications. It is also important to follow up with regular check-ups and adhere to any recommended lifestyle changes or medications to ensure the longevity of the replaced valves.

Suitable For

Patients who are typically recommended valve replacement include those with aortic root aneurysms, aortic dissections, or mitral valve issues. In particular, patients who have problems with both their aortic root and mitral valve may be candidates for valve replacement surgeries. These patients may experience symptoms such as chest pain, shortness of breath, fatigue, or heart palpitations, and may benefit from surgical intervention to improve their quality of life and prevent serious complications such as heart failure or stroke. It is important for patients to discuss their treatment options with their healthcare provider to determine the best course of action for their individual situation.

Timeline

Before valve replacement:

  • Patient may experience symptoms such as shortness of breath, chest pain, fatigue, and dizziness
  • Patient undergoes diagnostic tests such as echocardiogram, stress test, and cardiac catheterization to determine the severity of the valve issue
  • Patient and medical team decide on the best course of treatment, which may include medication, minimally invasive procedures, or valve replacement surgery

After valve replacement:

  • Patient undergoes valve replacement surgery, which may involve a mechanical or biological valve
  • Patient recovers in the hospital for a few days to a week, depending on the type of surgery performed
  • Patient undergoes cardiac rehabilitation to regain strength and endurance
  • Patient follows up with their medical team for regular check-ups and monitoring of the new valve
  • Patient may need to take blood thinners or other medications long-term to prevent complications
  • Patient can resume normal activities and enjoy an improved quality of life without the symptoms of a faulty heart valve.

What to Ask Your Doctor

  1. What are the different surgical options available for valve replacement in my case?
  2. What are the risks and potential complications associated with each type of surgery?
  3. How long is the recovery process expected to be and what can I expect in terms of post-operative care?
  4. Will I need to take any medications long-term after the surgery?
  5. What lifestyle changes may I need to make following the surgery?
  6. How often will I need to follow up with you after the surgery?
  7. What signs or symptoms should I watch out for that may indicate a potential issue with the replacement valve?
  8. Are there any restrictions on physical activity or diet that I should be aware of?
  9. What is the long-term outlook for someone who undergoes valve replacement surgery in my situation?
  10. Are there any support groups or resources available for patients who have undergone valve replacement 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