Valve Surgery

[Robert]

I am a 47 YO male with a biscuspid aortic valve sith severe insufficiency and moderate stenosis without symptoms.  Both the valve and nearby aorta show calcification on the echos.  I have been followed for years, and now my cardiologist is recommending surgery.  I am in the process of researching both valve types and locations for the surgery.

Is there a national data base on AVR surgery outcome statistics?  I know results can vary from place to place.  While I can find some numbers, they are not always comparable.  My cardiologist is recommending that I have the operation at our local hospital where they seem to have some good experience with CABG but I cannot get any statistics on valve outcomes.

Thanks to the Docs for their time in responding to the questions on this site.

[lub-dub]

Check this out:

Ross Procedure Statistics

[Gary]

Leaning to one more try at a "homovital" valve, the stats
being what they are: Average 25 yr. longevity without reop.

Cannot find any cooperation among the surgeons in the US I've talked to(two cardiologists I spoke with don't know what it is) to so I'm going to try Dr. Yacoub or Dr. Ross's successors in England, or another in Australia, where this operation has been performed routinely for 27 years with very good results particularly when donor is tissue matched in HLAs, age, size, configuration, and other factors. It could last the longest and is 'installed' exactly like a cadaveric frozen homograft.

Barring that procedure I am leaning to the Ross done by Elkins, Stelzer, or Jaggers; the Porcine Medtronic Stentless done here in Pgh, at Shadyside Hospital by Dr. "Raj"; Minially Invasive  by Cosgrove in Cleveland or Colvin in New York (huge numbers of successful MI procedures) with whatever valve they like best exclusive of Mechanical ones, and last, the Baxter C-E pericardial Bovine tissue valve which is the most reliable but a bit bulky and occlusive compared to the Porcine, stentless done in the subcoronary position here at UPMC Presby by Dr. Griffith, resigning myself to two heart surgeries within 12-18 years.

I am not at the computer which has the URLs for the stats on the procedures but will post later. (Have to see another surgeon at
3:15 re: Medtronic Porcine STENTLESS valve which he uses in place of homograft and to discuss his reasoning about the limits of a homograft:  As I understand it, the homografts are good for Stenotic patients but the stats drop off for aortic incompetence and regurg patients, but no explanation was given in the literature as to why. And with Regurg as my problem, I think it's important to pursue it before excluding or including it among the options.  

I don't like to tie up this bbs with specific issues that take time to explore but you can e-mail me directly at ***@****.

[Robert]

Thank you for responding.  However I could not find any statistics by specific hospital on the STS site.  Additionally, given your skepticism about the data, how would you suggest going about choosing a hospital in which to have the surgery?

Gary, thank you very much for responding.  It looks like we have some things in common.  I would very much appreciate getting the URLs for the hospitals you are looking into.  If you are about my age, I wonder what valve you are leaning to?

[Gary]

I too need AVR and for similar reasons, sever regurg and mild stenosis.

I have been researching the options for months now and there are several sources I can post for various surgeries stats.  The Ross procedure page has 4,000 patients in its database, and there are several from individual institutions.

If your hospital will not provide you with their statistics, something's amiss. Nearly every hospital C-T group I spoke with has been forthcoming except the very same one that did my cath! I had to pull teeth to get some stats from them and am still not satisfied they are telling the truth so I am not going to have it done there. Arrogant and elitist, they can find some other sucker who won't ask any questions and be stuck with no options.

Howver I know of no National data base tracking the over first time 70,000 valve jobs done in this country annually.

If interested I will get the other URLs for you.

[CCF CARDIO MD - DLB]

The thoracic surgery website, www.sts.org, lists such statistics. However, I do not put much weight in such statistics, because a hospital with a higher mortality rate may mean that the hospital is not good, or that the hospital is in fact very good , but tackles very high risk cases.