Ross-bio-autograft

[garyr]

While the Ross procedure even in the right surgeon's hands is the most radical of all heart surgeries but has a low failure rate, competitive re-op rates, and natural as opposed to bioprosthetic devices, it still seems very risky and controversial.

A goodly number of the patient stories are fraught with numbness,
tachychardia, infections, and many other apparently predictable
downsides that scare me off.

Would it be better to resign oneself to two AV replacements in the next 8-20 years, taking the chance the second surgery will occur far enough out into the future that the research in tissue engineering will produce a result that is far superior to all others to date,  including Ross? Would the scar tissue in the Ross preclude some of these other exciting possibilities because of all the suture lines, a dead pulmonic homograft that is always vulnerable, and trauma to the heart?

[Cleveland Clinic, MD]

We have been having a long-running discussion in this forum about the relative advantages and disadvantages of different procedures.  The best valve is still the one you were born with and when the time comes that it needs replaced there are no perfect solutions.  Dr. Petterson is doing some Ross procedures here so if this is the one you want you should ask to have him as your surgeon.

[Mario]

HI GARY, I HAD MY AORTIC VALVE REPLACED WITH A HOMOGRAFT MAY 99. LIKE YOURSELF I DID ALOT OF RESEARCH AND SOME GUIDANCE FROM TODD. OF THE THREE MAJOR POSSIBILITIES THE MECHANICAL AND THE PORCINE WHERE QUICKLY CROSSED OUT. THAT LEFT THE ROSS OR THE HOMOGRAFT. AFTER A FEW DISCUSSIONS WITH BOTH THE SURGEON AND THE CARDIO I DECIDED ON THE HOMOGRAFT. ALTHOUGH SOME CENTERS ARE HAVING 'GREAT' RESULTS WITH THE ROSS THERE WERE CENTERS REPORTING LESS THAN FAVOURABLE RESULTS. I WAS RECIEVING TOO MUCH CONFLICTING INFO. FROM THE RESEARCH THAT I WAS ABLE TO GATHER IT SEEMS TO ME THAT THE BIGGEST ADVANTAGE OF THE ROSS IS THAT THE HOMOGRAFT IS PLACED IN THE LOWER PRESSURE PULMONIC POSITION WHILE THE 'LIVE' PULMONARY VALVE IS PLACED IN THE 'HIGHER' PRESSURE AORTIC POSITION. THE AORTIC POSITION BEING THE HIGHEST PRESSURE ZONE WILL FAIR BETTER WITH THE 'LIVE' VALVE. YOU ARE RIGHT IN STATING THAT THE ROSS PROCEDURE IS A VERY RADICAL SURGERY AND THAT ALOT OF SCAR TISSUE IS LEFT AND I FIND MOST SURGEONS DOWNPLAY THE FACT THAT AFTER THE ROSS YOU ARE A TWO VALVE PATIENT. I HAVE FOUND OUT THAT ALTHOUGH THERE HAVE BEEN GREAT ADVANCES IN VALVE SURGERY THE PERFECT VALVE STILL REMAINS ELUSIVE TO MOST PATIENTS. IT ALL BOILS DOWN TO WHAT ONE PERSON IS MOST COMFORTABLE WITH.TAKE CARE AND REMEMBER THERE IS NO RIGHT OR WRONG DESCISSION AND THAT AFTER A DESCISION IS MADE HINDSIGHT IS 20/20 VISION....MARIO

[Cleveland Clinic, MD]

Thanks to all for their comments.  This issue is far from settled in the medical community.  Until then you have to trust the judgement of your surgeon.

[gary (again)]

uhh...that's PORCINE.....

[Gary]

Thanks for the feedback, Todd, but my problem with possibly excluding the homograft (nothing has been definitively eliminated yet) is the preservation of the CAs for the second operation out in the future.

I'm asking the Doc here if he/she thinks that it would be best to do the least cutting and suturing now (in the next 90 days), to keep the field as intact and free from scar tissue as possible and leaving the CAs alone would be part of that strategy.  If I believed in prayer I would pray that mine could be repaired, too. The best to you.

[gary (addendum)]

Forgot to add,  that the current bioprosthetic surgery of choice, a Medtronic procine stentless, inserted in a minimally invasive procedure, with only a diagonal suture line in the aorta, leaving all else unmolested, including the CAs,
would be the most conservative?, leading a reasonably active life (no competitive sports or heavy weight lifting) until tissue engineering renders these valves obsolete and leaving a relatively clean field for the re-op, if necessary (I hope this is now clearer).

[Todd]

Why not a homograft replacement? - typically lasts longer than porcine.  That was my choice until I found out my aortic valve could be repaired (my regurg was secondary to an asc. aorta aneurysm).  I'm a little past a year since my aneurysm and valve were repaired.  With a porcine valve you should not have to limit your activities, should you?  I was playing hockey 3 months after surgery which I thought I could even if my valve was replaced with a tissue valve.  Anyway Good Luck - your doing the right thing by researching and asking lots of questions.  Two surgeons told me my valve could not be spared and it was because of my research - so get a second or third opinion if your not comfortable.  It's a big decision - but it'll work out fine.