Hi daVinci
As a Ross Procedure (RP) recipient, I'd figure I'll share my experience with the Ross. Please keep in mind that my experience is just one data point in the thousands of RPs performed to date.
Although I had a heart murmur all my life, it eventually proved to be due to a bicuspid aortic valve which progressed to aortic stenosis and regurgitation. I progressed to severe at which time I was referred to a thoracic surgeon who specialized in Ross Procedures as well as traditional AVRs. At the time, I was 42 (in 2004) and the Ross Procedure was becoming a popular option in addition to Mechanical or Bioprosthetic valve replacements. My surgeon recommended the Ross since I was deemed a good fit. At the time, the Ross community thinking was that the replaced pulmonary valve would last between 25 and 30 years, and that a transcatheter valve (TPVR) might be used as an option for future PV dysfunction/ replacement although TAVR and TPVR were relatively new technologies in 2004.
I had considered going mechanical but did not know much about ACT at the time, so I went with the Ross as my surgeon had done many RPs, with great success. The surgery was uneventful and recovery was fast. I continued to have my yearly echos but my autograph aortic valve began to leak due to the dilation of the aortic root (due to possible connective tissue dissorder in BAV patients???). After 7 years (2011), I was referred back to my surgeon who told me he can repair the root to reduce/eliminate the regurgitation, however, I did not want to have to risk another future OHS, so I elected to get an ON-X mechanical valve with a dacron graft ( due to the dilation of the root and ascending aorta). I chose the ON-X, but not for the lower ACT recommendation since the results of that study were not published before 2011.
To this date, I have had no issues with my ON-X mechanical valve. It is very quiet and I self manage my ACT. I maintain a 2.0 to 3.0 INR range and believe that the advertised ON-X lower ACT regimen is way too risky. At 20 years now, my pulmonary homograph (which was a cryopreserved cadaver homograph when implanted) is moderately stenotic and regurgitant and will need intervention within the next 2 to 7 years. My current thorasic surgeon has been using Edwards TPVRs in her RP patients that have PV dysfunction and are suitable candidates. So, 20 years down the road from the RP, I have to consider what my best course of action will be to fix the PV issue. There is scant data on the long term outcomes of TPVRs and valve-in-valve TPVRs, although there is some data on VIV aortic valve redos that isn't particulary great in my opinion.
So, in summary, any necessary valve replacement is better than not doing anything. I still stand by decision to do the Ross at the time, but knowing now what I did not know back then, I would have just gone with the "one and done" OHS using a mechanical valve at age 42.
Again, this is just my story and there are many RP patients that have had no issues with their transplanted aortic valves, but will eventually have to face the PV issue later on. The use of TPVR is not a guarantee since you be sure that the coronary arteries are not susceptable to compression during the valve inflation/ expansion process. Just somethings to consider if you are leaning to the Ross. Best of luck on your decision!
