Hi PAN,
I am 42 and was in the same boat you're in. I required aortic valve replacement and repair of my ascending aorta. I saw a local surgeon who had a ton of experience with AVR and aortic repair. He recommended the mechanical valve, stating that it was a "one and done". I got an opinion with the Cleveland Clinic, who recommended the Ross. The advantage being that the Ross does not require lifelong anticoagulation. I too came across some of the studies that suggested a shorter lifespan in patients with mechanical valves, and it made me dig deeper and do a lot of thought and research on the decision. I got a third opinion from Yale, who agreed with the Ross, citing the same things.
The bottom line was that I agree with my cardiologist, who said "There is not a wrong answer". The Ross procedure is more complex, involves two valves, and carries a SLIGHTLY increased mortality rate relative to a mechanical valve replacement. However, lifelong warfarin is not needed.
The mechanical valve requires lifelong warfarin. However, it should last a lifetime. Having an aneurysm repaired at the same time further decreases the chance of any further open heart surgeries in the future.
I'm not saying my assessment is correct, but what I found was that the cardiothoracic surgery world is entrenched into two camps on this: The pro-mechanical valve surgeons will tell you it's "one and done" and that the Ross creates a "two valve issue", and that complications with it can be very challenging to fix.
The pro-Ross surgeons will tell you that you won't need warfarin, and that if one of the valves require re-intervention in the future that it can be done minimally invasively (ie a TAVR approach). They will also cite the survival rates.
I was leaning towards the mechanical valve but was concerned about the survival data. Thanks in large part to this forum, along with my own analysis, I decided that there were way too many variables to make any definitive conclusions. The studies on decreased survival typically cite complications from the warfarin, both bleeding and thromboembolic events. Most of that data is older. Do we know what other comorbidities the patients had, and how well they regulated their INR? Have we factored in the impact of home testing?
Unfortunately there will be no guarantees. Even with the Ross, there is no guarantee that a future intervention could be done without having to open things up again. And at my age, it was pretty much a guarantee that one of the valves would go should I live to my 70s and beyond.
In the end I went with the mechanical valve, and had it done on November 10th of this year.
I think it comes down to personal preference and knowing yourself. I'm anxious, type A, and neurotic about most things in my life. I had little doubt that I'd be diligent with tracking my INR and managing my warfarin. In fact I bought a home kit before my surgery even happened, so that I had it in place when I got home. I am still in the early stages of managing it and have gotten a lot of help from the folks on this forum. I knew I did not want to have another open heart surgery if I could avoid it, and that I'd be worrying all the time about the status of my repaired valves should I go with the Ross.
Now that I'm on the other side of it, having dealt with some small bumps in the road post-surgically, I'm currently content with my decision. The additional variables the Ross brought would have caused my anxious self to worry about even more bumps or complications.
This is all assuming the Ross is done by a highly experienced surgeon who is well-versed in the Ross, working at a center that is well-experienced in it. Things can go terribly wrong with it in inexperienced hands, and having to re-operate on a Ross that goes wrong is very difficult.
So I guess to summarize...do you want a more established, "simpler" (I use that term very lightly of course) surgery that hopefully will not require reintervention in the future, but subjects you to lifelong warfarin management (which potentially carries a survival risk, but I think that's very debatable)....or do you want a slightly more involved surgery that will allow you to avoid lifelong warfarin, but will likely require re-intervention on a valve later in life, which could be done minimally invasively but is not a guarantee?
Again, I don't think there's a wrong answer.
There are others on this forum that are much more well-read on things than I am and have great resources, so that's just my two cents. I wish you all the best!
P.S.- If you don't mind, I'd love to see the papers you're referencing as well
