Bicuspid Aortic Foundation View From Here October 2007

October 1, 2007

In February 2004 the University of Pennsylvania released a video about aortic surgery that centers around one man's experience with bicuspid aortic valve disease. That video is available online, and after watching it several times, I wanted to share it with you this month. Before providing the link, there are some things I want to mention about this video.

This is the story of a strong, healthy 50-year-old man named Doug Wray. Fortunately for Doug, a routine physical found something that he did not know was there: a bicuspid aortic valve and a large ascending aortic aneurysm.

The video follows this man and his family through the experience of having life-saving, complex aortic surgery. At 50, he is at a very typical age for problems associated with BAVD to surface.

During his surgery, Doug Wray received a new aortic valve and replacement of his entire ascending aorta. You will hear the words "flatline EEG" as well as "flatline EKG" in the video. The EKG measures the electrical activity of the heart -- while on the heart-lung machine, Doug's heart was stopped and had no electrical activity. At one point, as the surgeon attached the Dacron graft to the aorta at the arch there was no electrical activity in Doug's brain either - this is the flatline EEG.

The surgery on the aorta described in this video is similar to what my husband had when his ascending aorta was completely replaced in 2001. His ascending aortic aneurysm was fortunately discovered that year, about 11 years after his bicuspid aortic valve had been replaced. In the video about Doug Wray, providing reverse blood flow to the brain is mentioned. My husband's surgery was different in that there was no reverse blood flow to the brain. During his surgery, it took only 23 minutes to attach the Dacron graft to his arch. For those 23 minutes, while his aorta was open and his brain was "silent" with a zero EEG, circulation in his body was completely stopped. He was extremely cold at this time, and his head was packed in ice. This is called total circulatory arrest.

This technique was pioneered by Dr. Randall Griepp, who in 1975 published his initial results with aortic arch surgery in four patients. For over 30 years, Dr. Griepp has continued to advance this work and is recognized through out the world today for his expertise and many contributions in protection of the brain during aortic surgery.

In a recently published paper by Dr. Griepp's group, "Aortic root reconstruction with a bioprosthetic valved conduit: a consecutive series of 275 procedures", 95% of the patients had hypothermic circulatory arrest with an open aorta. Another recent paper, "Perfusing the cold brain: optimal neuroprotection for aortic surgery", published in September 2007, describes research performed in pigs to further explore and advance understanding of brain protection.

My husband directly benefited from all this work on brain protection when he had his aneurysm surgery. He awoke very quickly after surgery, went home on the third morning, and recovered very well. It was an ideal surgical experience. Regardless of what else he may continue to experience because of BAVD over his life time, it is a great comfort to know that my husband's entire ascending aorta was completely removed during that surgery - no additional aneurysms can develop there because that tissue is completely gone, replaced by Dacron.

The video from the University of Pennsylvania also includes the use of stent grafts for aneurysms in the descending aorta, describing the experience of a man named Robert Smith. Aneurysms in this location are often found in the elderly. The use of stents in this part of the aorta in the chest, for those whose aortic anatomy qualifies them, has brought new hope in the treatment of the diseased descending aorta.

Some of the other underlying causes for thoracic aortic disease, such as atherosclerosis and high blood pressure, are also mentioned at the end of the video. Please note that when echocardiography is mentioned, it is also indicated that this test does not image the entire aorta.

A key point of this video for those with BAVD is the replacement of the entire ascending aorta, where aneurysms associated with BAVD typically occur. I hope that watching one man enter the hospital and return home again will give hope to all those who are approaching surgery, realizing that although it is complex, surgery to completely remove the ascending aorta while protecting the brain is offered in some centers specializing in thoracic aortic disease.*

Without further introduction, here is the link to the video.(After clicking on the link below, you will find text and a link that says "Watch the show online". That will take you to the video page, where the story is told in 3 segments.)

Penn Vital Signs: Complex Aortic Surgery

*Please note: the Bicuspid Aortic Foundation does not recommend or provide referrals to medical centers or physicians. The video featured here is for informational purposes only.

Although complex,
surgery for BAVD continues to save lives,
creating a climate of hope.

Sincerely,
Arlys Velebir
Chair, Board of Directors
Bicuspid Aortic Foundation

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