Webcast of Ross Procedure on 10/26

[Shine_on_Syd]

http://www.or-live.com/bethisrael/1244/

Unique Aortic Valve Replacement for Younger Patients- Avoids Need for Blood Thinners and Repeat Valve Replacements
See the Ross Procedure - An Aortic Valve Replacement from Beth Israel Medical Center in New York City
Live Webcast: Tuesday, October 26, 2004 11:00 am EDT


New York, NY- Each year several thousand Americans under the age of 50 learn that they have a narrowed or leaky aortic valve. As the condition progresses, it can result in shortness of breath, chest pain, dizziness, or loss of consciousness. The typical surgical solution is an aortic valve replacement, which involves replacing the diseased valve with either a mechanical or animal valve. Neither solution is ideal for children or young adults. The mechanical valve requires blood-thinning medications, which pose a bleeding risk for active people. The animal valve solution will only last 12 to 15 years, requiring younger patients to undergo repeat valve operations.

The Ross Procedure is a lesser-known surgery that allows the patient to avoid the need to take blood thinner medications or have a repeat valve replacement surgery. With the Ross Procedure, surgeons use the patient's own pulmonary valve to replace the damaged aortic valve. Then surgeons replace the patient's pulmonary valve with one from a human donor.

See Beth Israel Medical Center surgeons perform the Ross Procedure in a live webcast on October 26 at 11:00 am.

Cardiothoracic surgeon Paul Stelzer, MD will perform the procedure. He completed his residency training in 1981 and has been at Beth Israel since 1996. Dr. Stelzer has done over 370 of these operations and currently performs the Ross Procedure more than anyone else in the world. In fact, there are currently only approximately 50 "busy" Ross Procedure surgeons in the entire United States. Robert F. Tranbaugh, MD, chief of cardiac surgery at Beth Israel, will explain the procedure and provide background information during the Webcast.

[Mary]

Somebody please watch this for me and let me know what happens!
Mary

[PapaHappyStar]

I will be watching, could give live play-by-play commentary if you wish, definitely a post-game analysis :)

[Mary]

Ok, Burair.
I'm counting on you for the play by play.
By the way, have you decided who is going to do your surgery?
Mary

[Shine_on_Syd]

Cardiothoracic surgeon Paul Stelzer, MD will perform the procedure. He completed his residency training in 1981 and has been at Beth Israel since 1996. Dr. Stelzer has done over 370 of these operations and currently performs the Ross Procedure more than anyone else in the world. In fact, there are currently only approximately 50 "busy" Ross Procedure surgeons in the entire United States. Robert F. Tranbaugh, MD, chief of cardiac surgery at Beth Israel, will explain the procedure and provide background information during the Webcast.

[PapaHappyStar]

I'm counting on you for the play by play.


Will do my best...


By the way, have you decided who is going to do your surgery?


I am leaning toward Dr. Quaegebeur, partly instinct -- it is tough to choose a surgeon over Dr. Stelzer and I am sure if the Ross is what is done for me I will be in excellent hands with either surgeon. Dr. Q has about 150 RP's and he is a professor of surgery at Columbia ( my alma ) and I can relate to his crusty attitude ( this was the instinct part ).

I definitely think Dr. Stelzer is an excellent choice for the RP.

Burair

[Shine_on_Syd]

I am so excited that Dr. Stelzer will be doing the surgery during the webcast 10/26. He knew that I was an extremely inquisitive and demanding patient, (well its hard to be demanding with him as he so genuine and nice!). He was so kind to take digital photos during my OHS to share with me after the operation. A gifted surgeon and teacher.

[PapaHappyStar]

As advance viewing here is a video of Paul Stelzer and Charles Geller performing the "Modified Ross Procedure", this is from Dr. Stelzer's website http://www.ps4ross.com

http://www.ps4ross.com/ross/video/clips/rossannularsupport.mpeg

you need an MPEG player to view it, its around 80MB without commentary -- but you can get an appreciation of the delicacy of this procedure.

On an aside -- I talked with probably two of the best RP surgeons in the world in Drs. Stelzer and Quaegebeur. Dr. Stelzer is a very bright guy -- understanding and personable as well; and the evidence is he is a very good RP surgeon. Dr. Quaegebeur is economical with words ( maybe crusty was not a fair description ) and the day we talked ( a day earlier than scheduled ) I was taking care of my son who had just woken up hungry, so I couldnt talk at any length anyway.
My opinion is Dr. Q is remarkably gifted -- a purist, as far as I am able to make a judgement; and he has a no-nonsense approach about him that I found comforting.

My purpose in watching Dr. Stelzer live is to have some questions for Dr. Q when we talk again on Friday, also to gain an insight on how one of the best surgeons in the world operates. I will report with the eyes of someone who is going to get this done to his own heart so its going to be interesting I am sure.

Burair

[Mary]

James and Burair,

My husband, who has worked in critical care as an RRT since 75, will be watching the procedure from his workplace at our medical center.
His interest is both clinical and personal.

I should have all points of view covered between the three of you! :)
Mary

[Shine_on_Syd]

Burair,
You are fortunate that you have a choice between Stelzer and Quaegebeur. You can't go wrong with either.
On a spectrum of bedside manner, Dr. Stelzer would be on the opposite extreme of "economical with words." He has a beaming smile and noticed the whole whole cardiac ICU lght up when he came in. Just so you know, his personality goes beyond being talkative, he was extremely excellent with my wife post op and he was by my beside like a mother hen for the fours days I was in BI. He made me feel like I was his only patient and the center of all his attention. To me that was a part of my speedy recovery.
That attention has gone well beyond my surgery. Any problems, echo reports, concerns that I have had post op, I take my PCP and cardios comments and e-mail or call Dr. Stelzer for his advice. With his busy schedule he gets right back to me and in the end I only listen to him. The charge nurse in The cardiac ICU told me that Dr. Ross wanted to rename the procedure the Ross-Stelzer procedure in recognition for the improvements Dr. Stelzer. Dr. Stelzer response was that Dr. Ross deserves the honor of retaining the procedure in his name.
You are lucky to have two such wonderful surgeons to choose from.
Jim

[PapaHappyStar]

My husband, who has worked in critical care as an RRT since 75, will be watching the procedure from his workplace at our medical center.
His interest is both clinical and personal.

I should have all points of view covered between the three of you! :)

Mary,

It would be very instructive to have your husband provide his input to us as well

Burair

[PapaHappyStar]

I have started the broadcast window but looks like I am not the only one ( the image freezes occasionally because of traffic congestion )

[PapaHappyStar]

They are showing the excision of a highly calcified stenotic aortic valve.
Dr. Stelzer's 375th procedure -- according to the narrator the theme of the operation is the use of judgement.

[PapaHappyStar]

They are showiing the excised autograft -- he is sizing it and making sure there is no large discrepancy -- seems like a match for this patient -- testing it by seeing if it holds water i.e not leaky.

[PapaHappyStar]

They are working on explanting the coronaries a very delicate procedure --- they need to make sure that the coronaries go in nicely.

They are putting in the felt to support the aortic annulus to prevent dilation -- sized according to the pulmonary, using a running suture, ( longer-lasting -- dont know why )

[PapaHappyStar]

The technique which is being used is total root replacement -- they are suturing the felt in and making sure there are no loose sutures -- the autograft is in place an being examined and tested -- nice view of the neo-aortic valve.

[PapaHappyStar]

Now he is going to reattach the coronary arteries to the new aortic root -- they are working on the right coronary. Dr. Geller is sewing on the right coronary button.

[PapaHappyStar]

They are using a '33 homograft'. The pulmonary artery is very thin where the coronaries are sutured, they are using a techique used in pulmonary bypass -- fine sutures. The right button is somewhat calcified and they need to be careful with it. ( If the button is larger than the button-hole makes it hard to get your shirt on in the morning -- Stelzer :) )

[PapaHappyStar]

This guy was in bad shape -- massive calcification plus a history of endocarditis -- also a hole in his septum? -- wow. He was playing hockey though -- amazing.

[PapaHappyStar]

keeping the heart perfused while they are doing this -- now they are trying to fit the felt around the outside of the autograft.

[PapaHappyStar]

Congested again -- shucks -- think he was taking strips out of the pulmonary area to implant in the autograft??? add to the elastic tissue in the aorta??? This guys aorta was not dilated -- when it is they cut out some of it. Beautiful new aortic valve !!!!

[PapaHappyStar]

Online Question: Does the thinness of the pulmonary artery compared to the aortic cause long-term effects.

Answer ( Stelzer ):
a) dont take too much of the aorta out (3 cm vs 5??)
b) incorporate support

Use Judgement.

Asked is their a chance of dying..

Stezer: Me or the patient :D

[PapaHappyStar]

World's third largest series of Ross -- the other two are by retired surgeons.

Wow -- I though Sir M. Yacoub had more...

Mortality is around 1.5% for Dr. Stelzer. He says hes learned to judge from experience. He has learned from doing this many times -- and since 99? hasnt lost anyone.

Candidates for the ross slide 10

[PapaHappyStar]

Advantages:

[PapaHappyStar]

6-8 weeks before normal activity -- no rejection problems for the homograft ( not impossible but very uncommon )

[PapaHappyStar]

view of the homograft, they are going to use excess tissue to shore up the donor valve in the pulmonary position, they are trimming it -- 47 year old donor, they try to match the size mostly, the largest size they had ( get him to play hockey again, big tall fella -- Stelzer :) )

[PapaHappyStar]

Question: Hospital stay and recovery

Ans: 4 days -- one stayed for 3. Airplane travel after a week.

He talked about women he's done the Ross on ( backed away a bit clumsily from taking full responsibilty for children born after the Ross :D )

Youngest patient: 17 years -- regulated from doing pediatric at beth israel??

[PapaHappyStar]

First Ross procedure in 1967:

The idea was the pulmonary threw a clot it would go to the lung instead of the brain and the pulmonary valve is not as critical as the valves on the workhose side .

[PapaHappyStar]

Optimistically -- according to Stelzer -- the Ross can last upto 40 yrs.

Live broadcast has ended -- looking at a patient from a week ago looks like he got through very fine.

Superb work.

[PapaHappyStar]

My thoughts:

I was a bit disappointed in the length of the broadcast itself -- they didnt have time for preliminaries and a summary.

Dr. Stelzer is a superb surgeon and highly experienced, I would have no qualms about having him do my Ross Procedure.

[dcpickle]

That last patient was me, I guess! So far I AM doing fine! Quite fascinating!

David

[PapaHappyStar]

David,
Happy to see you -- now I really know your heart!!!
Hows everything coming along for you.
Burair

[dcpickle]

Actually, I was not the one shown at the beginning (I don't think) I believe it was a guy with whom I've made friends (He's from my hometown and works where I used to work) but at the end, the shot of the beating heart right before being closed up I thought might be me because he said it was "a couple of weeks ago" and the other guy's RP was September 9. So, it may or may not have been me. But, I was Dr. Stelzer's previous RP.

At any rate, the webcast was quite fascinating, and Dr. Stelzer is an amazing surgeon!

David

[sylviayasgur]

hey, james..
thanks so much for that.... i missed it this morning and just watched the whole thing....excellent!!!

dr. stelzer is truly a God in our book. cannot recommend him highly enough.
AND, yes, he was there to check on joey from start to finish... such a nice man... told us all about how he got into medicine, etc.

thanks again and hope you're all well,
sylvia

[Mary]

Golly Burair.
I'm glad you did that! Bob couldn't get it at the hospital; computers there didn't have something needed to show the broadcast.
I just read your posts aloud to him; and I guess he will try to watch a replay from home.
It makes me very comfortable to know Dr. Stelzer is doing my surgery and very relaxed knowing no patient has died since 99.
Thanks for the play-by-play!
Mary

[PapaHappyStar]

Golly Burair.
Thanks for the play-by-play!
Mary

I feel a bit weird because I actually enjoyed that -- did I miss my calling.....

Perhaps surgeons are not too different from experimental scientists, ( no one's life depends, literally anyway, on the judgement of scientists -- except in sci-fi mostly -- but the work is pretty exacting and precise at times and the level of concentration needed is comparable sometimes )

Was fun ( now I just have to carry that attitude into the surgery... :eek: )