Does anyone have any thoughts on the Ross Procedure?
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perico75
Member
scott.eitman;n870108 said:
Right Scott, I am 42 now and I need an AVR and Ascending aorta to be done shortly. I have been reading a lot about the Ross Procedure and I don't like the idea of living with a 2-valve risk. I also don't like the idea of being on warfarin forever not only because the need to be more careful but mostly because the increased long term risk of undesired events (bleeding, clot).
It seems that an ideal solution does not exist. I will mostly likely go for the mechanical option as I don't like the idea of a reoperation and this is the only alternative that has very high chances of never needing a reoperation.
hi perico,
my husband, joey, is the patient, but i am the one here. if you did decide on the ross procedure, would you have it done in argentina or travel to have it done? i would highly recommend consulting with dr. paul stelzer at mt. sinai hospital in new york city. he was joey's surgeon in 2001 and is truly a genius. back then he was ahead of his time and i imagine he has learned even more to date.
valve selection is a very personal thing. my father has a mechanical st. jude's aortic valve and does his self-checks at home. he is 84 y.o. and finds this to be very helpful and effective.
if you have any questions, i'm here to help anytime.
wishing you the best of luck in your choice and decision. please remember, no choice is right or wrong. either way, it saves your life.
my husband, joey, is the patient, but i am the one here. if you did decide on the ross procedure, would you have it done in argentina or travel to have it done? i would highly recommend consulting with dr. paul stelzer at mt. sinai hospital in new york city. he was joey's surgeon in 2001 and is truly a genius. back then he was ahead of his time and i imagine he has learned even more to date.
valve selection is a very personal thing. my father has a mechanical st. jude's aortic valve and does his self-checks at home. he is 84 y.o. and finds this to be very helpful and effective.
if you have any questions, i'm here to help anytime.
wishing you the best of luck in your choice and decision. please remember, no choice is right or wrong. either way, it saves your life.
Alchemist
Member
I'm a bit daunted by the lively nature of this thread but that's a great testament to the Forum's strengths, bar Pellicle's lost post, however to respond to Atomlo's original question, can I suggest he look at the Ozaki Procedure, used for over 10 years by Professor Ozaki and now available at the Royal Brompton in London.
https://www.raconteur.net/sponsored/the-ozaki-procedure
It's indicative of how things are evolving, even if the techniques are not being disseminated worldwide.
If you go onto the Harefield and RB's site you can find out about Overseas referrals and Remote Second Opinions:
https://www.rbhh-specialistcare.co.u...eas-referrers/
I hope this will inform you and help you make your decision making a little easier.
https://www.raconteur.net/sponsored/the-ozaki-procedure
It's indicative of how things are evolving, even if the techniques are not being disseminated worldwide.
If you go onto the Harefield and RB's site you can find out about Overseas referrals and Remote Second Opinions:
https://www.rbhh-specialistcare.co.u...eas-referrers/
I hope this will inform you and help you make your decision making a little easier.
pellicle
Professional Dingbat, Guru and Merkintologist
Hi
Glad you were not daunted so much as to not share your piece of the puzzle.
My view is that as long as individuals are not targeted for personal criticism or insulted that a lively moot court is an informative one
Alchemist;n879843 said:
Glad you were not daunted so much as to not share your piece of the puzzle.
My view is that as long as individuals are not targeted for personal criticism or insulted that a lively moot court is an informative one
Northernlights
Well-known member
I agree these threads can be daunting, Alchemist, and can put people off contributing. Myself I feel: more heat, less light - I don't care for shouting. However this thread has not been bad compared with some others on the forum!
Atomlo made his choice for the Ross last year, and since Pelico's priority is avoiding reoperation mechanical is obviously best for him ( incidentally Cleveland does do the Ross - they had stopped when Scott had his op as their surgeons couldn't get good results, but then appointed Gosta Pettersson who was already a very experienced Ross surgeon in Denmark - he also does Ozaki).
As Pelico recognises , there is no ideal valve. But for those who don't want a mechanical valve ( an equally valid personal choice!) the Ozaki is a definitely a useful addition to the various possibilities, so thank you for posting this.
On the forum, M1ffb's son at 13 and Chet have both had an Ozaki. It is available in a few centres in the US. It has several advantages. The new leaflets are attached directly to the native annulus and thus there is no artificial sewing ring. The sewing ring or stent, common to all mechanical and most tissue valves, is convenient for the surgeon and makes for a fast easy insertion. However the sewing stent is inherently stenotic and is the main reason for the heightened gradient in artificial valves; it also doesn't expand with exercise, unlike the native valve, so the gradient in artificial valves generally doubles with exercise. So the Ozaki has advantages for patients particularly with a small aortic root.
Because the new leaflets are made of the patient's own pericardium it won't suffer from calcification caused by the immune system (unlike tissue and homografts) - a big plus for young patients. The leaflets are however treated with glutareldyhyde, which is also a source of calcification ( hence the hopes for the new glutareldyhyde- free Resilia valve) , but any calcification will presumably be confined to the leaflets rather than the root ( a big problem with homografts) which will make reoperation simpler. The lack of foreign material also lessens the risk of endocarditis, and of course while homografts and the Ross need access to a homograft bank, everyone comes with their own pericardium! It should be noted that some surgeons are doing the Ozaki with bovine pericardium, which seems to me to negate one of its advantages, though it does mean the bovine pericardium can be pre-treated.
It's basically a rather drastic repair, which importantly can be used for a much wider range of problem valves including stenotic ones ( repair is otherwise only an option for regurgitation). Like repair, because it's pretty new ( Ozaki started it in 2007) there is a question mark about how long it will last - probably longer than tissue, probably less than mechanical. However valve repair rather than replacement is now the gold standard for mitral valves and there is a definite desire among surgeons for aortic repair to make the necessary advances to be able to match this.
Like all the alternatives to straightforward tissue/ mechanical stented valves it needs more surgical skill ( though probably less than a complex conservative repair as the leaflets are cut out with a standardised template ), and it is a longer operation, but there is a real interest in it from those who deal particularly with young congenital patients who see staged interventions as the best way forward for their patients and are looking for something as close to the native valve as possible for a first intervention. So maybe it should be seen as a repair for those who want a repair but aren't necessarily suitable for a more conservative repair, or who have stenosis rather than regurgitation.
In m1ffb's son's case they were able to repair 1 native leaflet and construct the other 2 using the Ozaki method.
My personal feeling is that all these advances are helpful in giving us more choices for something that fits our individual circumstances and priorities ( I personally find it an interesting possibility if I require reintervention on my Ross in the future, whereas the Ross was m1ffb's backup!) but if anyone wanted the Ozaki it would be advisable to go to a surgeon who was experienced in all aspects of valve repair. There will also be a learning curve for the surgeon, though new techniques are introduced much more carefully now as Alchemist's link shows, particularly in the UK where surgeon's individual results are available.
If you Google you will find Ozaki's report on his first 404 cases, and you can see the op on youtube!
Atomlo made his choice for the Ross last year, and since Pelico's priority is avoiding reoperation mechanical is obviously best for him ( incidentally Cleveland does do the Ross - they had stopped when Scott had his op as their surgeons couldn't get good results, but then appointed Gosta Pettersson who was already a very experienced Ross surgeon in Denmark - he also does Ozaki).
As Pelico recognises , there is no ideal valve. But for those who don't want a mechanical valve ( an equally valid personal choice!) the Ozaki is a definitely a useful addition to the various possibilities, so thank you for posting this.
On the forum, M1ffb's son at 13 and Chet have both had an Ozaki. It is available in a few centres in the US. It has several advantages. The new leaflets are attached directly to the native annulus and thus there is no artificial sewing ring. The sewing ring or stent, common to all mechanical and most tissue valves, is convenient for the surgeon and makes for a fast easy insertion. However the sewing stent is inherently stenotic and is the main reason for the heightened gradient in artificial valves; it also doesn't expand with exercise, unlike the native valve, so the gradient in artificial valves generally doubles with exercise. So the Ozaki has advantages for patients particularly with a small aortic root.
Because the new leaflets are made of the patient's own pericardium it won't suffer from calcification caused by the immune system (unlike tissue and homografts) - a big plus for young patients. The leaflets are however treated with glutareldyhyde, which is also a source of calcification ( hence the hopes for the new glutareldyhyde- free Resilia valve) , but any calcification will presumably be confined to the leaflets rather than the root ( a big problem with homografts) which will make reoperation simpler. The lack of foreign material also lessens the risk of endocarditis, and of course while homografts and the Ross need access to a homograft bank, everyone comes with their own pericardium! It should be noted that some surgeons are doing the Ozaki with bovine pericardium, which seems to me to negate one of its advantages, though it does mean the bovine pericardium can be pre-treated.
It's basically a rather drastic repair, which importantly can be used for a much wider range of problem valves including stenotic ones ( repair is otherwise only an option for regurgitation). Like repair, because it's pretty new ( Ozaki started it in 2007) there is a question mark about how long it will last - probably longer than tissue, probably less than mechanical. However valve repair rather than replacement is now the gold standard for mitral valves and there is a definite desire among surgeons for aortic repair to make the necessary advances to be able to match this.
Like all the alternatives to straightforward tissue/ mechanical stented valves it needs more surgical skill ( though probably less than a complex conservative repair as the leaflets are cut out with a standardised template ), and it is a longer operation, but there is a real interest in it from those who deal particularly with young congenital patients who see staged interventions as the best way forward for their patients and are looking for something as close to the native valve as possible for a first intervention. So maybe it should be seen as a repair for those who want a repair but aren't necessarily suitable for a more conservative repair, or who have stenosis rather than regurgitation.
In m1ffb's son's case they were able to repair 1 native leaflet and construct the other 2 using the Ozaki method.
My personal feeling is that all these advances are helpful in giving us more choices for something that fits our individual circumstances and priorities ( I personally find it an interesting possibility if I require reintervention on my Ross in the future, whereas the Ross was m1ffb's backup!) but if anyone wanted the Ozaki it would be advisable to go to a surgeon who was experienced in all aspects of valve repair. There will also be a learning curve for the surgeon, though new techniques are introduced much more carefully now as Alchemist's link shows, particularly in the UK where surgeon's individual results are available.
If you Google you will find Ozaki's report on his first 404 cases, and you can see the op on youtube!
Alchemist
Member
Thank you Northernlights for your 'illuminative' post.
Whilst personally I would not wish for a longer operation, the combined factors of my active lifestyle, stenosis, no LVH and small aortic root, will make the Ozaki procedure well worth consideration besides the new Edwards Resilia, as both are capable of reoperation and future options.
Your point about expertise is critical and though the Harefield and Royal Brompton see themselves as pioneers, I'm not sure about being a guinea pig when there are very experienced surgeons with supporting statistics available to choose from. Whomever one chooses for one's initial appraisal, you are going to know their recommendation from their expertise in a particular procedure. That said I'm tempted to try the Royal Brompton however because of the wide range of techniques they have at their disposal.
Thanks for the Youtube suggestion but not before bedtime...
Whilst personally I would not wish for a longer operation, the combined factors of my active lifestyle, stenosis, no LVH and small aortic root, will make the Ozaki procedure well worth consideration besides the new Edwards Resilia, as both are capable of reoperation and future options.
Your point about expertise is critical and though the Harefield and Royal Brompton see themselves as pioneers, I'm not sure about being a guinea pig when there are very experienced surgeons with supporting statistics available to choose from. Whomever one chooses for one's initial appraisal, you are going to know their recommendation from their expertise in a particular procedure. That said I'm tempted to try the Royal Brompton however because of the wide range of techniques they have at their disposal.
Thanks for the Youtube suggestion but not before bedtime...
Just going to chime in here on the Ozaki.
My operation was ~ 8 hours and was fairly complicated. I also still have mild regurge. Valve repair/Ozaki type procedures are very unique to you specific valve. I have a unicuspid so one section was reused and two others were created and added. My only advice is to seek out a qualified surgical team. I'm very happy with my results but will definitely need a re-op in my life (planning on mech at that point).
My operation was ~ 8 hours and was fairly complicated. I also still have mild regurge. Valve repair/Ozaki type procedures are very unique to you specific valve. I have a unicuspid so one section was reused and two others were created and added. My only advice is to seek out a qualified surgical team. I'm very happy with my results but will definitely need a re-op in my life (planning on mech at that point).
