pellicle
Professional Dingbat, Guru and Merkintologist
lets look at this paper:
https://www.academia.edu/21842085/Under_use_of_the_Ross_operation_a_lost_opportunitystatement: The Ross procedure (figure) is the only operation that guarantees long-term viability of the aortic valve substitute.
reaction: false, the cryopreserved homograft has this
question: what is long term?
ans?: the citation for that assertion is here: Long-term outcomes after autograft versus homograft aortic root replacement in adults with aortic valve disease: a randomised controlled trial - PubMed
it is a study that one should read carefully:
https://pubmed.ncbi.nlm.nih.gov/11380096/
with respect to 2: its not a large study, and as shown in a larger study above the actual better survival and freedom from replacement was quite high too at 15 years not 10
with respect to point 3: I'm personally more interested in 20 years than 10, so 15 is better IMO ... again I seldom see Ross figures cited out past 10 years. Same goes with tissue prosthetic.
Personal statement: I can not in good conscious tell a person to have something that I do not believe myself to be the best for them. I personally have spent a lot of time looking at survival and reoperation data in an analytical and detached way.
I personally now have a mechanical valve and I have personally had a repair (as a child) and a homograft as a 28 year old.
The statistics speak to me more than my personal experience because my personal experience is not replicatable in other peoples situations. Thus I only comment about what's possible and probably for others. I do not try to speak about my choices except to offer a voice of experience about my (and the people I assist to manage) INR management related situation.
I believe strongly that there is a hysteria around avoidance of anticoagulation which is backed by two things: what the surgeons statistically see (which is the result of poor compliance and poor INR management) and what the general public perceive (which is often wrong).
I take responsibility for my words, choosing them carefully and doing my best to ensure they fit the needs of the person I'm replying to. I follow up on what I've written and provide corrections when I find errors.
I would hope all participants here do the same, however I don't see that. I see people "rooting for their own teams" which smacks of justifying their own decisions.
https://www.academia.edu/21842085/Under_use_of_the_Ross_operation_a_lost_opportunitystatement: The Ross procedure (figure) is the only operation that guarantees long-term viability of the aortic valve substitute.
reaction: false, the cryopreserved homograft has this
question: what is long term?
ans?: the citation for that assertion is here: Long-term outcomes after autograft versus homograft aortic root replacement in adults with aortic valve disease: a randomised controlled trial - PubMed
it is a study that one should read carefully:
- The primary endpoint was survival of patients at 10 years after surgery.
- 228 patients were randomly assigned to receive an autograft or a homograft aortic root replacement. 12 patients were excluded because they were younger than 18 years; 108 in each group received the surgery they were assigned to and were analysed
- There was one (<1%) perioperative death in the autograft group versus three (3%) in the homograft group (p=0.621). At 10 years, four patients died in the autograft group versus 15 in the homograft group.
- Actuarial survival at 10 years was 97% (SD 2) in the autograft group versus 83% (4) in the homograft group.
https://pubmed.ncbi.nlm.nih.gov/11380096/
Actuarial late survival at 25 years of the total cohort was 19 +/- 7%....
... an actuarial 15-year freedom in the 861 patients having aortic valve replacement +/- CABG surgery of 92%
For all cryopreserved valves, at 15 years, the freedom was
47% (0-20-year-old patients at operation),
85% (21-40 years),
81% (41-60 years) and
94% (>60 years).
Root replacement versus subcoronary implantation reduced the technical causes for reoperation and re-replacement (p = 0.0098).
myself I got 20 years from that valve (I was in the 21 to 40 group at the time). I may have gotten longer but an aneurysm drove replacement. This is not just a casual mention, for if you have a Ross and then later an aneurysm you'll likely need another valve in the Aortic position and you'll face a dikky tricuspid in the future ... and probably monitoring of 2 valves instead of one.with respect to 2: its not a large study, and as shown in a larger study above the actual better survival and freedom from replacement was quite high too at 15 years not 10
with respect to point 3: I'm personally more interested in 20 years than 10, so 15 is better IMO ... again I seldom see Ross figures cited out past 10 years. Same goes with tissue prosthetic.
Personal statement: I can not in good conscious tell a person to have something that I do not believe myself to be the best for them. I personally have spent a lot of time looking at survival and reoperation data in an analytical and detached way.
I personally now have a mechanical valve and I have personally had a repair (as a child) and a homograft as a 28 year old.
The statistics speak to me more than my personal experience because my personal experience is not replicatable in other peoples situations. Thus I only comment about what's possible and probably for others. I do not try to speak about my choices except to offer a voice of experience about my (and the people I assist to manage) INR management related situation.
I believe strongly that there is a hysteria around avoidance of anticoagulation which is backed by two things: what the surgeons statistically see (which is the result of poor compliance and poor INR management) and what the general public perceive (which is often wrong).
I take responsibility for my words, choosing them carefully and doing my best to ensure they fit the needs of the person I'm replying to. I follow up on what I've written and provide corrections when I find errors.
I would hope all participants here do the same, however I don't see that. I see people "rooting for their own teams" which smacks of justifying their own decisions.
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