Aortic Valve Surgery - The Third Millennium

[StretchL]

Here is a link to an interesting opinion piece from 2004 on the Cardiothoracic Surgery Network site. The premise, "We have lost our way in aortic valve surgery."

http://www.ctsnet.org/sections/newsandviews/inmyopinion/articles/article-13.html

The piece mentions some of the big cutters: David, Duran, Ross, Yacoub, Loop and Lytle.

 

[MikeHeim]

EXTREMELY interesting article. I would love to hear a response from some of the "big-name" surgeons mentioned...

 

[davidfortune]

Interesting Stretch.

Another situation with multiple opinions. I have heard "Never replace the aortic root" and with the Ross always use the full root replacement technique and with the Ross use the subcoronary technique with root stabilization unless root dilation is extreme.

That is a question I just sent to my surgeon last weekend since the Ross is in consideration for my surgery.

Interesting article. He definitely bashes on stented valves. However, absurd exaggeration in the attempt to prove a point (mouse valve into elephant proves patient-prosthesis mismatch is relevant) is not critical analysis.

Obviously a valve that is way to small or way to big wouldn't as well as a correctly sized valve. The real discussion in that instance is small degrees of difference impacting valve or patient longevity. The mouse vs. elephant statement doesn't prove the real issue related to patient-prosthesis size match.

Still an interesting thought though. Doesn't really give us an practical answers.

 

[StretchL]

No Answers...

No Answers...

No... but an interesting piece of opinion.

I think he hits the nail on the head when he says "we are experiencing chaos. There is no universal direction we should go in order to best serve our patients."

The heated discussion generated by my posts in the References section well attest to this.

And of course I got an opinion today from a Dook doc that I'd be better off with a mechvalve.

Who's your surgeon, btw? I'm cosidering Stelzer, which you may have already heard...

Here are the must read articles about the Ross that I've forwarded to my cardiologist here in Richmond. If you've not read them, and you're considering a Ross, they're well worth the time:

http://www.stretchphotography.com/avr/Ruel2005_Long-term outcomes.pdf
(This is the abstract of a 2005 article that concludes, "Late outcomes of modern prosthetic valves in young adults remain suboptimal.") OK, doc, tell us something we don't already know...

http://www.stretchphotography.com/avr/RossJacksonDavies1992.pdf
(This is the long term study of Donald Ross's original patient group.)

http://www.stretchphotography.com/avr/Doty1996.pdf
[This was sent to me by the folks at Cryolife, who supply some (all?) of the cryopreserved allografts for the Ross. Doty mentions on page 256 that the "actuarial freedom from reoperation was 85% at the 20 year mark." I've also heard this kind of figure from Dook today.]

http://www.stretchphotography.com/avr/Ross@10Yrs - Oswalt et al.pdf
http://www.stretchphotography.com/avr/OlderRossPtsFareBetter.pdf
(These two were also sent to me by Cryolife.)

http://www.stretchphotography.com/avr/SwissWeeklyRoss.pdf

http://www.stretchphotography.com/avr/AthletesAfterRoss.pdf
(This is an interesting paper by James Ourywhere he compares the cardiac performance of athletes following the Ross to a control group.)

There's even more at www.stretchphotography.com/avr