44 years old Ross vs Tissue

[alan_delac]

Hi,

I’m 44 years old, and I have BAV with severe regurgitation (4/4).
I think I’ll have my AVR surgery in the next few months. I feel it is time to do it.

I have opportunity to choose between valve types. I have decided not to go mechanical for various reasons.

I can get the latest generation Medtronic tissue (porcine) valve in the city where I live or Ross Procedure about 2000km away (Melbourne, Australia). I decided to go with the tissue valve but from time to time I question that decision.

I would appreciate your comments.

Lets say that I’ll live to be 80. We all have to die one day.

With Ross Procedure I may avoid the second surgery but my guess is that it is not likely.
· It should last longer than the tissue valve
· The surgery is more complicated
· Possible complications with two valves
· Added stress for me and my family with the travel before and after the surgery

With the tissue valve
· May last only 10 years (I’m hoping for 15)
· My second valve would have to last 20-25 years to reach the target age of 80

I feel comfortable with my cardiac surgeon and I thought let’s keep it simple. My second surgery would be at my age of 55-60. I hope that by then someone will work out how to make valves that last 30 years and don’t require Warfarin. Some days it seems to me that we are almost there, but again 1995 wasn’t that long ago.

What do you think?

Alan

[PapaHappyStar]

For the Ross Procedure:

For the new aortic valve:

o The surgeon must seat it properly and there must be sufficient support around the annulus and the suture line. This is to prevent future regurgitation -- in your case with primary regurgitation I would definitely ask the surgeon about additional support for the new valve.

o If it is successfully seated and heals well I dont think there is any age limit to the new aortic valve

For the pulmonary homograft:

o This lasts over 20 years on the average -- probably over 25, and if it starts to calcify it can be ballooned or replaced via catheter ( successful replacements have been done with good medium term results )

I think if you find a good surgeon who has done a high volume of Ross Procedures with good results ( < 1 % mortality and < 10% reops in 10 years ) I would travel a bit to get this done in the hope it lasts for me ( I did do this ).

My second choice was a tissue valve but I now think I should've picked a mechanical valve over a tissue replacement for the aortic valve if the Ross had been contraindicated. At my age a tissue valve would'nt have lasted very long -- too many repeat surgeries.

All the best,
Burair

[hensylee]

Mornin, Alan. Nice to see you - sorry to know you are closer to surgery.

The others are comin along to help out. Keep us posted on how it all goes, ok?

[Ben Smith]

As I am sure most everyone will say.....this is a personal choice that no one person can really help you with.

Now, with that being stated......each of us who have been through this surgery have very strong oppinions as to which is better. I would like to clarify....if you research these discussions here on VR.com you will find very strong oppinions on what the best choice is.....but those people are speaking of the best choice for them. Not me or you or anyone else, just themselves.

Some information on the Ross. At 20 years post op the average % of freedom from reoperation is approximately 67%. A fairly good number considering there are a large number of RP's performed on infants and children that are still growing....which almost always creates a need for re-op due to growth of the child.

Really, the best way to look at the longevity of a vale type is to have each valve type broken down to age groups of each valve type. I am not sure if this information is even available (if anyone knows of this, please post a link).

Having this option for a choice is a tough decision, but remember your are very blessed to have the choice. There are many folks here who never had a choice, just woke up and heard a clicking sound comming from their chest.

I do agree with Buair. Be sure to question the surgeon as much as possible. Get their e-mail so you c an send them questions, allowing them time to answer completely in their time. But don't over send e-mails, keep them to a few questions per e-mail.

Take care and keep us posted.

Ben Smith

[alan_delac]

Thank you all for your thoughts.

I'll discuss these options with my surgeon and cardiologist.

Alan

[surfsparky]

Hi Alan,
Valve replacement can be be a tough choice, but I encourage you to do all the research on each procedure and make the choice that you feel suits your needs and preferences.
My husband Chris had the Ross Procedure in 2003 with Mr. Peter Skillingotn in Victoria and he was brilliant. He has performed the most Ross' than any other surgeon in Australia. If you have any specific questions, or just want to vent how you're feeling/ going, we are all here for you (and your family).
All the best,
Yolanda (wife of Chris)

[alan_delac]

Thanks again for your input.

I have contacted Dr Skillington and I’m impressed with his results, however I’m still more inclined to go for a tissue valve.
If I were in my 30-s I would definitely go for the Ross Procedure.

It is a gamble. If medical science (industry) produces a durable (say 30 years) warfarin free valve in the next 10 years I think I will be better off with a tissue valve. If things stay as they are and the tissue valve lasts only about 10 years I’ll have a difficult decision to make for my second operation.

And with Ross it’s a gamble again. Some doctors say that it turns one valve problem into two valve problem. I prefer to see it as two valve solution for one valve problem. Things could go great for 20-25 years or I may need pulmonary valve replacement after 15 years and aortic valve replacement after 20 years. I must say that I’m happy that I managed to convince my cardiologist that Ross is a viable option. He used to dismiss the procedure as out of date and unsafe.

As it is impossible to predict how would our bodies react to specific valve types or procedures, in some cases, all our thinking could be as good as flipping a coin.

These are difficult problems but lets not forget that only 50 years ago there were no suitable valves or procedures and today were have choices and ever second open heart surgery is reasonably safe.


Alan

[stormrev]

Hi Alan

I've just celebrated my one year anniversary after the Ross Procedure. As well as Peter, the Ross is also carried out here in Melbourne by cardiac surgeon George Matalanis whom I found to be excellent. It would be worth chatting to him as well. He was keen to see me have the Ross given my fitness and relative youth (48!)

Interestingly, Chris ("Surfsparky") and I were mates before either of us had our heart surgery! i'm hoping we can get some winter surfing in again this year...

I'm in NZ this week visiting my Dad (another BAV with mechanical fix 10 years ago) and have a brother in Perth who had the Ross five years ago (in Melbourne).

I've been active all my life, running marathons etc etc. Am now 48 and looking forward to continuing to re-gain some of the fitness lost over the last couple of years.

One of the main reasons for me choosing the Ross was the improved expectations of longevity before possible reoperation and the positive surgical outcomes from contemporary Ross procedures.e.g. my brother! That and the capacity to again resume a very active lifestyle with little medication etc. I take half an aspirin and 2mg coversol (blood pressure) tablet daily.


All the best in the decision making and let us know if we can help in any way.

Kind regards

Grant

[ddarsch]

Alan:

As others have indicated the valve choice is very personal, and whatever decision that you make, it will be the correct one, especially with you putting as much thought into the process as you are.

In 1991 (34 years old), I had a porcine valve put in. This valve lasted until 2003 when I went through the procedure again and chose another porcine valve.

These of course were both very very difficult decisions, and I am happy with each of them.

Dave

[crzylolo27]

Alan:

As others have indicated the valve choice is very personal, and whatever decision that you make, it will be the correct one, especially with you putting as much thought into the process as you are.

In 1991 (34 years old), I had a porcine valve put in. This valve lasted until 2003 when I went through the procedure again and chose another porcine valve.

These of course were both very very difficult decisions, and I am happy with each of them.

Dave
Hi you had the porcine valve put in and still ticking. I will need valve replacement and will be 31 at time of surgery and serious considering the bovine valve. can you give me info on your decision mine is leaning towards that because of the side effects of the mechanical valve please let me know

thanks
carlos

[ddarsch]

Carlos:

I did have the porcine valve put in both times (1991 and 2003), and I am a fortunate person, I have no life constraints (food, activites, medication, etc.) The choice of a valve is a very very personal choise, and there is no correct answer other than the answer that is correct for you.

After deciding to have the biological valve in 1991 (against the mechanical), I was only aware of the porcine as a choice. In 2003, I researched the bovine and the porcine and while I was very much leaning towards the bovine, my doc told me that he only did porcine.

My research, while not exhaustive, indicated that the bovine could have had a longer potential duration. But, I am very happy with the results of the implantation of the porcine

Dave