Must choose again 6 yrs. after The Ross

[sajopack]

Hi. I am a 41 year old man who had the ross procedure 6 years ago (10/'98) in Chicago. I had the surgery due to a large aortic root aneurysm (6.0 tp 6.5 cm.) and a leaking aortic valve. Due to my active lifestyle (lots of softball, tennis, biking, etc.) and my age, the ross was recomended. I wanted to avoid coumadin, so i did the ross and after a few months of a hellish recovery began to gain my strength back.
Now, six years later, feeling good, still active, it looks like I'm having surgery again on January 5, 2005
It seems that my aortic root (now pulmonary) is stretched out again to near 6.0cm and they want to take it out along with the valve (pulmonary serving as aorta). Of course We are totally freaked out to have to do this again(my wife, 2 kids etc.) so soon and now we have to decide on a Bovine or mechanical (st.Jude) valve. I'm worried about a third surgery with the bovine, and worried about coumadin with the mechanical. PLUS, we don't know if I'll need the pulmonary homograft replaced eventually )which has slight stenosis now.) That would mean a third surgery anyway. I am leaning toward the mechanical aortic valve, and hoping the homograft will hold on.They will be replacing the aortic root with dacron.
Has anyone had to make this choice after the Ross? My new surgeon is in Chicago and recently came from the Cleveland Clinic. I asked him what would he do if I were his brother and he said 51% for the mechanical.What do you think?

 

[geebee]

Hi and welcome.
I have a mechanical mitral valve and have been on Coumadin for 24 years. I live a perfectly normal life except for testing and having to be a little more cautious about injuries.
Obviously the ultimate choice of valve will be yours (with input from doctors and family) there are a couple of things to consider.
If you go with a bovine valve you are most certainly looking at a third surgery down the road. If you go with mechanical and the homograft holds, you may not need surgery again in your lifetime. Of course, there are no guarantees as things can go wrong with any valve.
I am sure you will hear from others about choices and thoughts. I personally would always choose a path that would give me the lowest chance of additional surgeries.
Hope you get the information you need to make a decision you can feel really comfortable with.
Smiles,
Gina

 

[Ross]

Sounds to me like your talking to my old surgeon Dr. Patrick McCarthy. That man saved my life when my aneurysm ruptured! Excellent Surgeon and really knows his stuff. You are in the best of hands with him. In fact, I'm jealous. Now you have him and I don't.

Personally in your position, I'd go Mechanical now. Coumadin is not the big monster that so many people are telling you that it is. In fact, about 90% of what you've heard already is likely hogwash. I would encourage you to go see our resident Coumadin/Warfarin experts site and read through his pages.
Al Lodwick is a Certified Anticoagulation Expert. http://www.warfarinfo.com
Once you read through there, many of the nightmare stories your hearing now will be dimished to mere urban legends.

There are no guarantees no matter what you do, but Mechanical at this point would be prudent and could well last you the rest of your life. I certainly wouldn't want to have a go at a third surgery if it could be helped at all.

I doubt McCarthy remembers me now, but tell him I said hello and wished he'd of been my surgeon in 2002 when the repair he did on me needed to be changed out to the valve. I miss the guy bigtime!

 

[surfsparky]

Sorry to hear your news..it's a scary facing more surgery. Good to hear from Ross though, that you are in excellent hands, that always reassuring. I thought I may facing surgery again next year, but it look like I can wait for a couple of more years. I had the Ross too (last year) and I have stenosis on my homograft (this is pretty rare, so don't worry about it happening to yours.). When I found out, it shook myself and my wife up for quite a while. I'm not sure what I would do in your position, it's a hard one. I just wanted to offer you our support, thoughts and prayers.
Keep us posted,

 

[RCB]

Ross is right

Ross is right

If you are speaking about NW Memorial and Dr. McCarthy, I completely agree
with Ross. There is no finer surgeon in the world than he. The more complicated, the more he stands out. I had researched my 4th heart surgery for 8 years and he was the go to one. Sadly for me he left the Clinic
just as I needed surgery. I couldn't wait a few month for him to get up to speed at NW, so I went with another surgeon at the Clinic.
You have the best, now trust what he says- you be fine in no time!

 

[sajopack]

Thanks for your fast replies! Yes, it is Dr. McCarthy, so I'm glad to see you guys think highly of him. I just wish he said...do this one definitely...without leaving me to choose and wonder if i'm choosing the right thing. Mostly I'm concerned about the coumadin and the related sports issues with the mech. valve. Of course a second surgery is pretty scary,(to say the least!) but it seems on these forums so many have had more than a few. I also went to the coumadin site, Ross. Thanks. Any other ideas you all have would be much appreciated. What about post-op recovery the second time around? Any hints?

 

[Ross]

It's really hard to say. Both of my surgeries turned into nightmare situations. I don't get along with surgery period. it depends on your body really. If you had a tough time the first time, I can almost say you will with the second, but this isn't always true either. The more you have, the tougher it gets to bounce back, but you do bounce back in the end. I guess the answer is flip a coin?

Realize this, no matter what valve you choose, it will be the right one for you. Once you choose, be content with that choice. They all have there own draw backs. The only reason why I say Mechanical for you is your age and looking at additional surgeries down the road. You may or may not need another going with mechanical. Again, no guarantees one way or the other.

 

[tobagotwo]

Sajopack,

My feelings are that if you feel there is a good likelihood of resurgery further down the road for other reasons, the biological valves are probably more body-friendly and lifestyle-friendly. If there is a low likelihood of resurgery later for other reasons, and you don't feel you can handle the resurgery well, then the mechanicals are probably a better choice for you. With a tissue valve (xenograft/allograft or homograft), you will require at least one more surgery. In twenty (?) years, when you have that surgery, the valves may have been improved so that it is your last OHS, or you may even decide at that point to go with a mechanical valve (yes, you can switch).

There are continuing improvements in every kind of valve. The average useful lifespan of an implanted mechanical valve is probably around twenty-five to thirty years (I believe more toward thirty). This is not due to failure of the valve mechanism, except very rarely, but other issues that come up in the heart or the tissue the valve is mounted in. However, there have been improvements in the last few years to the mechanicals which might make them remain implanted longer, particularly where the mounting tissue has been a problem.

In tissue valves, the top porcine valve (Mosaic) expects to last over twenty years, and the top bovine pericardial valve (Carpentier-Edwards Perimount Magna) over twenty-five. However, you're young enough that your system will probably corrode either of them at least five years early, despite their anticalcification treatments.

I had an easy time with my surgery, so I have more confidence about having it again than you might. And that is the difficulty of this decision for each individual: apart from some very particular circumstances, there is no "right" choice. Any choice that works for you is right.

Each person and each surgery has unique features that make it impossible to say for certain how a particular recovery will go. The odds for survival of the surgery either way are excellent. The odds for longevity are about the same for either choice, as over time, the risks of reoperation for tissue and the warfarin-related risks for mechanicals seem to balance each other out.


Best wishes,

 

[Debrinha GT]

Very frustrating!

Very frustrating!

I know how frustrated you must be feeling right now, but by what I've read, it seems you'll be in great hands! As for the valve choice, it's a really difficult issue and unless we had a christal ball, we can never be sure whether we've made the right choice. I remember that my priority at the time of my third mitral valve replacement which was nine years ago, was to get pregnant and that was why I opted for a tissue one again. When I first started visiting this site, I didn't know anything about the pros and cons of either tissue or mech, except that I would need to take coumadin and that was it. I've been a member of VR for nearly one year now and have already decided that despite the risks involved in reoperations, I'll go for yet another tissue one when the time for my fourth surgery comes which should be in a couple of years providing there's no sudden worsening. As you can see, we all have our own personal reasons for choosing a specific type of valve and I'm sure you too will choose the one that suits you best. Good luck and take care!
Débora from Brazil