Aortic Valve Surgery Archive Questions

Below are Dr. Brown’s answers to Aortic Valve Surgery questions
received through the Ask the Expert feature.

This content is provided for informational purposes only, and is not intended
to be a substitute for individual medical advice in diagnosing or treating a
health problem. Please consult with your physician about your specific health
care concerns.



Now displaying records 1 to 15 of 49.

1

2

3

4

---

Q : 1 12/21/2009	I am 69 and have aortic stenosis (but no symptoms) and I plan to have surgery. I have been told to consider stentless because I am very active, but others say stented will be fine. Stentless doesn't seem to have significant advantages to warrant a full sternotomy, correct? Also UMMC uses Bovine over Pig valves, why is that? We see no clear cut advantages to stentless except in certain surgical situations. Both Bovine and Porcine are good, we have had good results with good hemodynamic response with the Bovine but we use both. We do use catheterization for coronary assessment. Jo Ann Sikora, CRNP
Q : 2 11/21/2009	In surgery, do you still use almost 95% tissue valves and only about 5% mechanical valves? Why? Do patients always have a choice or are there situations where you have to use a mechanical valve? The ratio is at least that, probably more than 95%. The decision of valve type is made on an individual basis with the surgeon and the patient. If you are interested in scheduling a consultation with Dr. Brown at UMMS, please contact our office 410-328-7741. Jo Ann Sikora, CRNP
Q : 3 10/13/2009	What are the advantages/disadvantages of the stentless tissue valve for a reop AVR? Do you use them? Dr. Brown has used the stentless valve in certain cases. There is no clear cut advantage to using it except in rare cases, and reoperation is not one of them. Jo Ann Sikora, CRNP Aortic Valve Program Coordinator Nurse Practitioner with Dr. Jamie Brown
Q : 4 08/08/2009	Is minimally invasive aortic valve replacement less successful than breastbone procedure? No, it is as successful when performed on the right patient in the right situation. Jo Ann Sikora, CRNP Aortic Valve Program Coordinator Nurse Practitioner with Dr. Jamie Brown
Q : 5 08/03/2009	I have an aneurysm of my ascending aorta and a bicuspid aortic valve. I am a 49 year old male who enjoys endurance sports and I would like to be able to continue doing these post-surgery. I also have two sons and would like to minimize the mortality risk of the surgical procedure I select. Is there a minimally invasive option for my situation? Should I consider the Ross procedure? Although still performed in some situations, the Ross procedure has fallen out of favor here as it takes a 1 valve problem and makes a 2 valve issue out of the procedure. Dr. Brown feels that the best option in your situation, if it can be done, is a valve sparing procedure. In order to determine that he would need to see your echocardiogram and catheterization, and we would have to perform a CT scan with reconstruction of your aorta here for evaluation. In cases where the aorta and the valve are concerned, a minimally invasive approach is not the best option. If you are interested in being evaluated for surgery here at UMMS by Dr. Brown, please contact our office 410-328-7741. Jo Ann Sikora, CRNP Aortic Valve Program Coordinator Nurse Practitioner with Dr. Jamie Brown
Q : 6 07/14/2009	What happens if while doing a minimally invasive aortic valve replacement it is determined that the surgery can't be performed via minimally invasive techniques? Do you go to "PLAN B," open up the chest and complete the surgery? Dr. Brown has a protocol to evaluate patients for the minimally invasive procedure, and generally knows going in to the OR if it is a feasible option. However, safety is always primary, and if it becomes necessary that the incision be extended or changed to the traditional incision, he will do that. Jo Ann Sikora, CRNP, Aortic Valve Program Coordinator Nurse Practitioner with Dr. Jamie Brown
Q : 7 07/04/2009	I am a 36 year old male and I am considering aortic valve replacement. After surgery would I be able to to have a physically active lifestyle? What is the life of a mechanical valve? Will I be able to have normal sex life? The chances are excellent. However, if you choose a mechanical valve over other options there is the risk of needing Coumadin (blood thinner) therapy which may impact a physically active lifestyle. Normal sex life is to be expected after surgical recovery. Jo Ann Sikora, CRNP Aortic Valve Program Coordinator Nurse Practitioner with Dr. Jamie Brown
Q : 8 06/17/2009	My 70 year old mother is going to need this surgery in the near future. Looking for the best before moving forward. Do you always use synthetic material or do you use pig valves also? Why? What makes a decision on the type of incision used? The valve choices are mechanical, pig, or cow. The choice of valve depends on the patient's request, and the surgeon's recommendation. In someone your mother's age it is pretty clear that the pig or cow valve would be the best choice. The choice of incisions is made after reviewing the echocardiogram, catheterization, medical information, and seeing the patient. If you are interested in forwarding this information, or setting up a consultation with Dr. Brown, please contact our office 410-328-7741.
Q : 9 06/08/2009	I had open heart surgery in 1994. Now I need an aortic valve replacement as it is narrowing. I am female, 75 years of age, 5'71/2" tall, borderline diabetic, exercise 4 days weekly. I would like to avoid cracking my chest again. Is this feasable? There is the option of the aortic valve bypass which is a newer procedure which is approached from the left side and avoids the sternum, and is a good option for patients who have had prior bypass surgery. We would need to know the status of your bypass grafts (with a catheterization) to determine if you are a candidate for this procedure. If you would like to discuss this, please contact our office 410-328-7741.
Q : 10 06/03/2009	I had CABG in 1991. Does the resulting scar tissue prevent me from being a candidate for minimally invasive aortic valve replacement? The upper hemi-sternotomy is a good surgical option for patients who have had prior surgery. If, however, you need your bypass grafts redone, you will need traditional surgery. Jo Ann Sikora, CRNP Aortic Valve Program Coordinator Nurse Practitioner with Dr. Jamie Brown
Q : 11 05/29/2009	I am 32 years old and I had both my aortic and mitral valve replaced with a mechanical valve. I want to know if I can have a baby with this situation? Your cardiologist will have to advise you as to the best way to handle this situation. Coumadin is dangerous to the fetus, so your cardiologist will have to determine if there is any option for you. You also must discuss this with your women's health physician. Jo Ann Sikora, CRNP Nurse Practitioner with Dr. Jamie Brown Aortic Valve Program Coordinator
Q : 12 05/20/2009	Can aortic valve bypass be performed on someone with a failing prosthetic valve? Also, the criteria requires no blockage of coronary arteries; what about the presence of coronary stents (4)? Aortic valve bypass can only be performed if the valve is stenotic (narrowed). Minimally invasive aortic valve replacement can be performed if the valve is stenotic or leaking. The stents do not matter for either procedure. If you are interested in having further discussion, or you would like to schedule an appointment for aortic valve surgery here at UMMS, please contact our office 410-328-7741. Jo Ann Sikora, CRNP Aortic Valve Program Coordinator Nurse Practitioner with Dr. Jamie Brown
Q : 13 04/26/2009	I know there are new minimally invasive and percutaneous procedures that can correct aortic stenosis and mitral valve regurgitation without the risks of open heart surgery. If someone has both conditions, are you aware of any techniques or procedures whereby both valves can be corrected at the same time or at least would allow each valve to be corrected at separate times? The safest approach to operating on both valves is to do a standard sternotomy. If you are interested in being evaluated for valve surgery here at UMMS, please contact our office 410-328-7741. Jo Ann Sikora, CRNP Nurse Practitioner with Dr. Jamie Brown Aortic Valve Program Coordinator
Q : 14 04/05/2009	Could you give me an estimate for the duration of the bovine cow tissue aortic valve. I am active 62 yr old male, this is my first choice. Projections for the current generation of the bovine valve is a risk of need for re-operation at about 10% at 15 years. We use this valve predominately at UMMS is patients of all ages. If you are interested in being evaluated for aortic valve surgery by Dr. Brown here at UMMS, please contact our office 410-328-5842. Jo Ann Sikora, CRNP Aortic Valve Program Coordinator Nurse Practitioner with Dr. Jamie Brown
Q : 15 02/12/2009	My father was diagnosed with aortic stenosis quite a few years ago. Last April he had to have valve replacement surgery. Almost a year later his valve is leaking. Is this common? If not, what could be the cause of this? Sometimes there is a valve leak after surgery, the question is how much and how is the valve leaking. The cardiologist or surgeon reviewing the echocardiogram should be able to give you a better idea why the valve is leaking. Jo Ann Sikora, CRNP Aortic Valve Program Coordinator Nurse Practitioner with Dr. Jamie Brown

1

2

3

4