Aortic Value and Root Replacement Surgery.

[bocarider]

So I posted about this a few years ago and, as would be predicable, my aortic valve leakage has gotten worse and my aortic root dilation has increased, to the point where it is categorized as “severe”. I have no symptoms whatsoever and am still riding my bike 4 days a week, albeit not with the same intensity as I used to. My goal these days is to ride strong, but not fast. My wife and I love to travel with our bikes and, if I can make it to retirement in a few years, we have a lot of places we want to ride all over the world.

My cardiologist and cardiac surgeon both tell me that I am going to have to have valve replacement in the next few years. I posed the question to them of whether it makes sense to just do it and get it over with now, as opposed to waiting until I am symptomatic. I’m only 56, in otherwise great health and good shape – why not get it done and not worry about experiencing the symptoms of heart failure. I want to ride my bike and live an active lifestyle, so getting it done now makes a lot of sense. Both said doing it on an elective basis now would be fine. Certainly there are risks, but it is a very common procedure with a very high success rate. I should do fine and have a good prognoses for many years to come after surgery.

Any forumites had value replacement? Would you be willing to share your experience with me (feel free to PM me if you don’t want to put it out in the forum)?

I am most interested in:

-what was the surgery experience like?
-what was your recovery like and what did you do as far as rehab work?
-how long were you laid up?
-when did you get back on your bike and what was it like riding again?

Perhaps my most important question is (and all of the foregoing sort of dance around this) was how did you handle the anxiety that goes along with this experience?

Any information you would be willing to share would be appreciated as I move towards getting this done on an elective basis.

Thanks very much.

[numbskull]

Surgery of this degree is rarely worth doing before you reach well established criteria. Yes, your active lifestyle may favor slightly earlier timing but not by much.

You seem to (possibly) be over-estimating the risks of your condition and under-estimating the risks of the surgery. Heart failure is not likely to develop abruptly in chronic valvular heart disease when a patient is followed carefully....although aortic dissection unfortunately is less predictable.
Which condition is pushing action.....the valve or the aneurysm?

Have you been quoted an actual mortality and stroke risk for the surgery?
You need that information even though it is uncomfortable to hear it in order to make an informed (rather than emotional) decision. "Small" and "should do OK" are not answers.
Also, have they discussed the possible cognitive impacts of cardiac surgery?

How solid is the evidence that your condition is worsening? Echo measurements and regurgitant estimates are very subjective and operator dependent........it is not uncommon for numbers to go up and down without actual change. Have there been thoracic CT scans and Cardiac MRI's to confirm the echo findings? Or a repeat echo in 6 months?

Also, with chronic valve conditions be very careful about accepting an echo description as showing "severe regurgitation" if heart size, function, and estimated PA pressures are normal. Understand that most of the time the decision to undertake surgery is not solely based on the degree of regurgitation. Rather it is based on evidence that the heart is having trouble dealing with the regurgitation.

As for your questions about recovery.......most people are out of the hospital in about 5-7 days. They'll typically be worn out for 2 weeks and over the hump by 4 weeks. Most are walking several miles by 4 weeks but you will likely be prohibited from riding a bicycle for at least 6 weeks (and more likely @2-3 months depending on your surgeon) until your sternum has fully healed. .

[biker72]

I had a friend that had this done. He knew for years that the valve was not working properly but had no symptoms. Once his yearly physical diagnosed an enlarged heart, surgery was scheduled. Still no real symptoms.

They actually rebuilt the valve rather than putting in a new one. Out for about 4 weeks. He's now almost 80 and a working college professor.

I do have experience with anxiety. Heart bypass surgery wasn't new in 1987 but still a pretty big deal. The night before the surgery the surgeon drew me a picture of what he was going to do the next day. He then assured me he was a much better surgeon than an artist. I felt a lot better after that.

[Ralph]

Would health insurance pay for surgery before it is necessary? Perhaps "severe" category enough to trigger health coverage. I doubt if my Medicare would, or my United Health secondary without proof. They would require imaging to back up need for surgery.

[mowyang]

I had my aortic valve replaced in 1995, when I was 38 years old. I had been followed by a cardiologist for 10 years, with echo exams every 6 months and exercise echos about every year. The only symptom I had was a heartbeat so strong it shook the bed and a blood pressure of 160/20 that stunned nurses who didn't know my condition. My cardiologist finally said it was time to have an office visit with a cardiac surgeon, who shocked me when he said something like, "I have an opening next Friday, want to do it then?"

So to the surgeon it sounded like a walk in the park, which may be part of the reason I never really became very anxious about my then upcoming surgery. Being an optimistic person helped. I just assumed everything would be fine.

And in fact, everything was fine. Though when the surgeon came to talk to my family when he finished, he told them the condition of my valve was worse than he had ever seen. I think I stayed in the hospital for 4-5 days.

At a follow-up appointment two weeks after discharge, I had to be readmitted to the hospital for a day due to an excessive accumulation of fluid around my heart. During those first weeks after surgery, I had started to go for walks around the block, but had felt mildly nauseous during them. During rides in a car, I also felt a little sick. It was due to the fluid around my heart. The fluid build up really should have been picked up before two weeks had gone by; nurses were supposed to have been calling me to see how I was doing, but they didn't. Once the fluid was drained, I had no other problems.

My heart has continued to be fine ever since. I was not a cyclist at the time, so I can't comment on how long you'll be off a bike. But I think the limiting factor for that is whether your sternum has healed -- though these days, I think aortic valves can be sometimes be replaced without cracking the sternum.

Funny memory of my time in the hospital. Following the surgery, I was in the surgical ICU. I woke up and remember feeling like I was on one of the hospital shows on TV. My surgery was done at a University teaching hospital, and all of the doctors and nurses were young and good looking!