Ross Procedure and Results

[Frankwurster]

Greetings,

I am a very active phsically fit weight lifter. Two years ago I had the Ross Procedure performed with which they moved by pulmonary valve to teh aortic postion and a human donor valve to my pulmonary side.

Prior to the procedure, I had severe aortic stenosis caused by a congenital bicuspid aortic valve. I had severe left ventricular hypertrophy and a max pressure gradient of 170 mm/hg.

I am two years post-op and had my second echo yesterday - everything looks great - at least I think so. My left ventricle and significantly smaller, as you might expect, than it was before the operation. I have vertually no resistance across either of the valves. I have mild (grade 1+) aortic insufficiency. My ejection fraction is 60-65%.

I take 25 mg Atenolol daily. No real question, but any comments?

[CCF-M.D.-RCJ]

Greetings to you, frankwurster:

The Ross procedure is a technically demanding procedure, and thus usually only performed at very specialized centers. The Cleveland Clinic abandoned the procedure for a time in the 1990s due to less optimal initial results.  Typically, patients do very well with the procedure if they get out of the peri-operative period (the time around the surgery), but the intial few days can be tough.  Sounds like everything is going well for you.  Your echo report certainly is indicative of a good result. Congratulations.

Hope that helps.

[Avel]

Hi,
I was very interested to read of your experience. My husband, who was also a weight lifter, had his bicuspid aortic valve replaced 12 years ago with an artificial valve - it was severely calcified and stenotic. One year ago he had his ascending aorta replaced when an aneurysm was discovered there.
In doing a search on the NIH's Medline, I found 19 medical publications that refer to the Ross Procedure and Bicuspid Aortic Valves. As in any complex area such as this, there are different studies and perspectives. There is still considerable research that remains to be done regarding the bicuspid aortic valve, the abnormalities that may co-exist in the aorta or pulmonary tissues, and what that might mean in the short, intermediate, and longer term. The good news is that research is in progress! I am sure you will continue to be followed annually by your doctors.
I do want to mention that my husband's experience illustrates the risk (for those who have/had a bicuspid aortic valve) of an aneurysm developing in the aorta above the aortic valve. A ruptured aortic aneurysm is life threatening. There is also a possibility that the aorta will dissect, or tear, which is also life threatening as the blood flow to the coronary arteries, as well as other major organs, can be blocked when this happens. At the Aortic Surgery Symposium in New York in May of this year, a paper was presented that recommends that the ascending aorta be replaced at the same time that the bicuspid aortic valve is replaced in order to avoid this. My husband was very fortunate to have his aneurysm found before there was any rupture or dissection. I can point you to medical references regarding this if you would like to have further detail. I can be reached at ***@**** Best wishes to you.

[Frankwurster]

What you say is very true - there are other complications associated with bicuspid AS, one of which is a thinned aorta, which may later cause and aneurysm. Because of this threat, I had my aorta reinforced at the time of surgery with a synthetic material. I must also add that because of this and the pressure that it puts on the aorta, I lift weights, but I do not lift heavy real heavy weights...I go more for the reps.

In earlier Ross Procedures, there were occasional problems with early rejection of the pulmonary homograph (human donor) and/or stenosis. I had a new type of valve put in from CyroLife called the SynerGraft that allows the repopulation of ones own cells in the valve.

I knew of the technical demands of the procedure and the potential post op complications, so I went to a surgeon who specializes in this procedure - Dr Elkins at the University of Oklahoma.

Let me know if I can help.

Frank

[Frankwurster]

You are exactly right - it is a very technically demanding procedure. That is why I did not mess around with the local cardiologist and surgeons who were urging me to have a mechanical valve put in. I went to Dr. Elkins at the University of Oklahoma. I am very aware of the Cleveland Clinic's Ross history, as I have communicated with several people that have had the Ross at the Cleveland Clinic. They had nothing but praise for the institution. I believe when I had my procedure performed is the period when they were not performing it. Any institution that would back a board like this has got to be good. The Cleveland Clinic just built a new facility down the street from me in west Fort Lauderdale. It is a really nice place (at least as far as hospitals go!!)

Thanks

[Avel]

Hi Frank,
It is very interesting to read further details of your experience. I have found some of Dr. Elkins' publications in the medical literature. The SynerGraft sounds very interesting. I will have to read more about it.
Were you given guidelines for your target blood pressure with normal activity and with exercise, and if so what are they? Also, what is the most weight that you lift?
There is a support website for aneurysm families at www.westga.edu/~wmaples/aneurysm.html  You may be interested in the aortic aneurysm and dissection area, where there are some accounts by weight lifters - Rob's is dated June 30, 2000, Ben's is dated July 10, 2000. I documented my husband's experience there also, dated November 30, 2001.
Thanks for sharing and take care.