Ross procedure contraindicated for Aortic Insufficiency in 55 yr old?

[garyr]

Have read discussions among Ross surgeons that Aortic incompetence is a reason to exclude Ross procedure due to the
expansion of the aortic root on the autograft, resulting in failure.  Apparently this is not the case for Aortic Stenosis.

If I have a bicuspid AV and my main problem is Regurgitation (Aortic insufficiency) will I be at much greater risk if the surgeon would still perforom the Ross on me?

I have also read this exact same problem exists with a homograft
valve in the Aortic position, it too will fail for same reasons:
Root expansion in the short term after surgery.

Age over 45 has also been cited as a reason not to do the Ross.

Is this a reflection of middling surgical skills or lack of experience?  

[CCF CARDIO MD JMF]

Thank you for your donation.  
( even I get a letter to donate when i answer questions!)

It sounds as though you are in excellent hands.  Dr Isada will provide a very thorough evaluation for you and will answer all of these and other questions that you may have.  As far as this technique of Dr. Elkins, i would have to defer to my surgical colleagues as i am unfamiliar with the exact details of this procedure.  

Best of Luck.

[Gary]

Thank you once again for your response, (I wish i could convince the folks who ask for a donation every time I post a question
that I already donated $100.00 the first time because I value this forum to not remind me again.  I know.  It's probably just automatic but I don't want them to think i don't support the forum).  I was supposed to receive a call from a Mr. Stuart?,
Dr. Cosgrove's aide, today, regarding options, but he has not called yet.  If you think Dr. Lytle is a better choice, then I will try and reach him if I have not heard from Dr. C's  aide by wednesday.  Dr. Loretta Isada is my consulting Cardiologist & with whom I have a second followup appointment on January 12, (if my sternotomy is not recent history by then, as Dr. David in Toronto is reviewing my cath, echo and stress echo reports as we post here).

Dr. Elkins, I found, in his exceedingly detailed surgical drawings yesterday, uses a dacron flat ring to solve the AI problem but this is recent, looks like a fine solution for AI but that still leaves the age issue. The stentless valves seem like a great compromise among the three main ones:  the Ross (too much scar tissue; long pump runs; FEAR! of all that time under, proximity to the first septal coronary ), the bovine pericardial Stented valve (obstruction, mainly) the homograft (full root replacement and that god-awful idea of detaching the CAs and then reattaching them. Does not that kill any capillary blood flow thru the wall of the CAs??)

[CCF CARDIO MD JMF]

Dear Gary,

Much of what you say is true regarding the limitations of these procedures.  However, there are always individual circumstances that may mitigate these circumstances.  I would consider a second opinion with a surgeon with much expertise in this area.

I would most certainly recommend Dr. Bruce Lytle at the cleveland Clinic.