This is a clinical negligence claim relating to aortic valve replacement surgery performed on TN… on 5 March 2014. 
The operation on 5 March 2014… involved the implantation of a 19mm mechanical valve. Cs say that was negligent as a larger sized valve should have been implanted, albeit that would have required an aortic root enlargement (“ARE”); they further contend there was a failure to properly advise TN as to the risks arising from the implantation of a smaller valve, alternatively in performing an ARE. 
on 18 March 2015, TN underwent re-do surgery… during which an ARE was undertaken and a larger, 23 mm, valve inserted. There were difficulties during the re-do operation and complications during TN’s post-operative recovery; after her discharge, TN’s condition continued to deteriorate and she died of heart failure on 29 January 2020. Cs say the re-do operation, and TN’s subsequent deterioration and death, would have been avoided had an ARE been performed on 5 March 2014 and a larger valve implanted. 
the parties agree that the issues I have to determine are as follows:
i) Was it negligent to implant a 19mm mechanical reduced valve during TN’s surgery on 5 March 2014?
ii) Alternatively, was there a negligent failure to explain, as part of the consent process, that the largest possible valve should be implanted to avoid the risk of cardiac dysfunction (although this would involve an ARE, which was more complicated and involved higher risk)? If so, would TN have opted to undergo ARE?
iii) If an attempt had been made to implant a larger valve, would TN have suffered the same complications that she did during surgery on 18 March 2015?
iv) Did the failure to implant a 21mm valve cause the cardiac dysfunction requiring re-do surgery on 18 March 2015, with associated complications, and TN’s subsequent death on 29 January 2020? 
it was not negligent to implant a 19mm mechanical reduced valve during TN’s surgery on 5 March 2014. 
there was a negligent failure to warn TN of the potential risk that an ARE might have to be undertaken, but there was no breach of duty in failing to go beyond that and to provide the explanation suggested by this question. Moreover, had D advised TN as he should have done, I am satisfied (in either event) that it would have made no difference to the outcome. 
any attempt to implant a larger valve on 5 March 2014 (which would have necessitated undertaking an ARE) would most likely have caused TN to suffer the same complications as she did during surgery on 18 March 2015. 
I cannot be satisfied that the difficulties that required TN’s re-do surgery were caused by the size of the valve that had been fitted on 5 March 2014, as opposed to possible tissue overgrowth or mechanical failure, which would better explain the gap in time before TN began to experience adverse symptoms. 
For all the reasons provided, I dismiss this claim.