Re: aortic valve replacement

Posted By CCF CARDIO MD-APS on July 07, 1998 at 09:18:14:

In Reply to: aortic valve replacement posted by Ralph on June 29, 1998 at 20:33:01:






I had heart failure in October 1995 most likely from a serious regurgitation of the aortic valve. I have done well on medications and my heart has strengthened and has reduced in size by 1 meter.  I do still have serious aortic valve leakage.  My cardiologist and a heart surgeon is now recommending that I have the aortic valve replaced with a mechanical
valve and have the mitral valve repaired.  Neither has mentioned the Ross procedure.

Would the Ross procedure be preferred to a mechanical valve?  I had been on Coumadin for 2 1/2 years and have dealt with it well.  I will be talking to my cardiologist in two weeks and I want to know all of my options.



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Dear Ralph,
Although the Ross procedure is an option to consider it is most likely not the best choice in you.
Essentially, your physicians want to put a valve in your heart that will last a long time (has the best durability)
and currently the best choice is a mechanical valve.  Tissue valves on average will degenerate in about 10 years time (the
Ross procedure involves using your own tissue vavle, the pulmonic valve) and thereafter would require replacement.
Mechanical valves last years and years, however the person must be on life long anticoagulation (blood thinners) and take
antibiotics prophylatically to avoid infection of the valve.  For any young person the way to go is with the mechanical valve so long as there are
no contraindications to anticoagulation (such as future pregnancies in a young woman.)  In addition to the above statement I would add that the Ross
procedure is a longer operation (which means more potential risk for you)and since it is done much less frequently than artificial
valve replacement, most surgeons have much less experience doing this procedure.  When going in to a major surgery like this two of the most important parameters are
the experience of the surgeon(how many valve does s/he do a year?) and minimize the time on the bypass pump (this is the machine that they place you on to pump your blood while they
operate on your nonbeating heart.)  
Lastly, since surgery and not medications are the proper treatment of any regurgitant vavular disease of the heart (barring no contraindications to surgery)
you should consider this surgery as soon as possible (i.e mechanical aortic valve replacement with mitral valve repair.)  Good luck.
Information provided in the heart forum is intended for general medical informational purposes only, actual diagnosis and treatment can only be made by your physician(s).