A
alan_delac
Would enyone know if the Ross procedures are becoming more common or are actually used less? Numbers of submissions at Ross Registry are falling.
Alan
Alan
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dcpickle
Well-known member
Someone posted a few weeks ago that fewer Ross Procedures were being performed. They even had a graph showing the data. I can't find the thread now. Maybe someone knows where it is. I'm not exactly sure what the reason was. I think it had something to do with a new recognition of problems which often accompany a bicuspid aortic valve, e.g. enlarged aorta. I'd like to see the information again.
David
David
G
geothoix
Heard the same today - decrease in Ross'
Heard the same today - decrease in Ross'
I heard today from a Dr researching the Ross Procedure for me that the current thinking is not supportive of RPs - at least on the West Coast. The recommendation was to get an aortic valve. This does not address the issue of re-ops for biological valves though I was told that the latest valves are even more resistant to calcium impacts - whatever that means. I could not however get an estimate of useful like in a 20 year old.
If you find that report dcpickle, please send it my way too....
Heard the same today - decrease in Ross'
I heard today from a Dr researching the Ross Procedure for me that the current thinking is not supportive of RPs - at least on the West Coast. The recommendation was to get an aortic valve. This does not address the issue of re-ops for biological valves though I was told that the latest valves are even more resistant to calcium impacts - whatever that means. I could not however get an estimate of useful like in a 20 year old.
If you find that report dcpickle, please send it my way too....
Tom F.
Well-known member
I wonder if a part of the decrease comes from the increased use of valve repair procedures. I went to the Cleveland Clinic website and saw the following: "Aortic valve repair is performed less often and is more technically difficult than mitral valve repair, however, the majority (2/3), of leaky bicuspid aortic valves can be repaired with good results."
subjective evidence
subjective evidence
with an AVR up soon (app April 2005) naturally mech/tissue/ross is on my agend as well.
my second opinion cardio (app 45y old) is strongly against ross: "dont remove what mother nature put in place as long as it works!" . He also claims that his clinic has not even engaged on ross (too complicated, higher mortality, re-op probability)
Im sure there are plenty of people here who are very happy with their 'ross' and would consider my cardio as too much old school!!
well2allofu
arbee
subjective evidence
with an AVR up soon (app April 2005) naturally mech/tissue/ross is on my agend as well.
my second opinion cardio (app 45y old) is strongly against ross: "dont remove what mother nature put in place as long as it works!" . He also claims that his clinic has not even engaged on ross (too complicated, higher mortality, re-op probability)
Im sure there are plenty of people here who are very happy with their 'ross' and would consider my cardio as too much old school!!
well2allofu
arbee
M
Moo
Descisions...
Descisions...
IMHO,The Mechanical is the Ron Popeil, 'set it and forget it' variety (Been there, done that). The Tissue AVR is the 'I want a few years to party' variety (Been there, done that), and the Ross is the 'I want to make things as complicated (read "deadly") as possible while only getting a few more years than a Tissue AVR' variety.
Side Note: Columbia University does over 2000 heart operations per year and never, before both sugeries, did the surgeons (again, the guys who did Pres. Clinton's surgery) mention the Ross Procedure as a resonable option...
Just my $0.02
Rich
Descisions...
ar bee said:
IMHO,The Mechanical is the Ron Popeil, 'set it and forget it' variety (Been there, done that). The Tissue AVR is the 'I want a few years to party' variety (Been there, done that), and the Ross is the 'I want to make things as complicated (read "deadly") as possible while only getting a few more years than a Tissue AVR' variety.
Side Note: Columbia University does over 2000 heart operations per year and never, before both sugeries, did the surgeons (again, the guys who did Pres. Clinton's surgery) mention the Ross Procedure as a resonable option...
Just my $0.02
Rich
Tom F.
Well-known member
http://www.columbiasurgery.org/divisions/cardiac/dm_ross.html
There is this link to Ross info at Columbia. They have a guy there that has done over 150 Ross surgeries. FYI
There is this link to Ross info at Columbia. They have a guy there that has done over 150 Ross surgeries. FYI
B
Baldrick
While I don't have any statistical data, it wouldn't surprise me if there has been a decline. In my experience, my previous cardiologist was enthusiasitc about the Ross when I saw her in '98, but when the time came for action in late 2000, she already had significant doubts about it and recommended mechanical. Of course that may have been case-specific to me.
It would be interesting to see a comparison of time before re-op between tissue valves & Ross. Maybe it has turned out that in many cases the benefits do not outweigh the risks. Also, I think there is more theorization that bicuspid valves are indicative of other connective tissue problems in and around the heart and swapping these parts around is only complicating things.
It would be interesting to see a comparison of time before re-op between tissue valves & Ross. Maybe it has turned out that in many cases the benefits do not outweigh the risks. Also, I think there is more theorization that bicuspid valves are indicative of other connective tissue problems in and around the heart and swapping these parts around is only complicating things.
M
Moo
Re: FYI
Re: FYI
And your point is...???
Dr. Naka, does over 200 AVRs himself per year all while being the Director of Cardiac Transplantations (AVRs are like a side job
). Dr. Quaegebeur has 150 RPs in her Lifetime.
Regardless, she is in the Pediatrics Division and last time I checked, the people who are asking are not children .
Sorry about the attitude, it's one of those days.
Rich
Re: FYI
Tom F. said:
And your point is...???
Dr. Naka, does over 200 AVRs himself per year all while being the Director of Cardiac Transplantations (AVRs are like a side job
). Dr. Quaegebeur has 150 RPs in her Lifetime.Regardless, she is in the Pediatrics Division and last time I checked, the people who are asking are not children
.Sorry about the attitude, it's one of those days.
Rich
A
alan_delac
It is a bit hard to understand why is Ross getting less popular. Based on the Ross Registry data it is still a very successful procedure with a good chance to be alive and well 25 years after the operation. Problem could be in underreporting unfavourable data, so picture looks too good. The other possible explanation is money. The procedure is more expensive and the insurance companies could be pressing hospitals for less expensive options. The last possibility is that over all the procedure in not less common it is just less reported. The Ross Registry has only one operation reported for 2004 and that is very unlikely. As far as I know the Ross surgeons are very busy.
Any thoughts?
Any thoughts?
Well I know for a FACT that more than one member on this board has had a RP in 2004, so indeed I would think that the Ross Registry is incorrect.
I have no idea if the numer of RP's are declining, and if so by how much, and why. I do know that the RP is not for everyone, and I recommend finding a surgeon you trust with your LIFE to make that decision once s/he gets inside and evaluates your individual situation.
I have no idea if the numer of RP's are declining, and if so by how much, and why. I do know that the RP is not for everyone, and I recommend finding a surgeon you trust with your LIFE to make that decision once s/he gets inside and evaluates your individual situation.
P
PapaHappyStar
I decided on the Ross Procedure rather than a tissue valve because it puts your own living tissue in the aortic position. Its a difficult thing to prep and suture a valve that has not been optimized for surgical implantation -- this must be done on the fly for the autograft. You need an experienced, gifted surgeon. The lifetime of the autograft is possibly the same as a normal three leaf aortic valve if implanted well.
I choose Dr. Quaegebeur because he does many pediatric Ross Procedures which require greater precision and have smaller margins of error ( I think the 150 RPs in the link below are all adult ), he has an excellent success rate. Also he is a congenital heart surgeon and does a lot of procedures like the switch procedure for transposition of the great arteries, he is used to repairing congenital heart conditions. I think congenital heart surgeons and valve and transplant surgeons come with different philosophical and practical mindsets. One concentrates on trying to repair developmental and congenital mistakes, the other is more inclined toward searching for optimal solutions to mend a damaged heart. Both are valid positions and depend on how you ( and/or your cardiologist ) approach the problem.
I have also seen the decline from the STS data in the number of Ross Procedures. One explanation is that the increase in the number of RP's came because more inexperienced surgeons were attempting the RP and the mortality rates went up leading in turn to a decline ( sort of a predator-prey relationship ). I dont know of any new studies that contraindicate the Ross Procedure. Some people say if you have regurgitation rather than stenosis the rate of failure due to aortic dilatation increases -- but I havent seen a comparison study between the RP and other valve options that conclusively show that a Ross procedure is a worse option than other replacement valves for AR.
The gist is if you want a good option for a valve replacement and want to stay off coumadin the Ross remains a good option ( maybe the best option in terms of valve replacement choice for the Aortic valve ), you do need to be particularly careful choosing a surgeon and the pulmonary valve is now compromised although the average rate of progression of damage to the pulmonary valve for tissue valves is lower than in the aortic position because of the lower pressure situation in the right ventricular outflow tract.
I choose Dr. Quaegebeur because he does many pediatric Ross Procedures which require greater precision and have smaller margins of error ( I think the 150 RPs in the link below are all adult ), he has an excellent success rate. Also he is a congenital heart surgeon and does a lot of procedures like the switch procedure for transposition of the great arteries, he is used to repairing congenital heart conditions. I think congenital heart surgeons and valve and transplant surgeons come with different philosophical and practical mindsets. One concentrates on trying to repair developmental and congenital mistakes, the other is more inclined toward searching for optimal solutions to mend a damaged heart. Both are valid positions and depend on how you ( and/or your cardiologist ) approach the problem.
I have also seen the decline from the STS data in the number of Ross Procedures. One explanation is that the increase in the number of RP's came because more inexperienced surgeons were attempting the RP and the mortality rates went up leading in turn to a decline ( sort of a predator-prey relationship ). I dont know of any new studies that contraindicate the Ross Procedure. Some people say if you have regurgitation rather than stenosis the rate of failure due to aortic dilatation increases -- but I havent seen a comparison study between the RP and other valve options that conclusively show that a Ross procedure is a worse option than other replacement valves for AR.
The gist is if you want a good option for a valve replacement and want to stay off coumadin the Ross remains a good option ( maybe the best option in terms of valve replacement choice for the Aortic valve ), you do need to be particularly careful choosing a surgeon and the pulmonary valve is now compromised although the average rate of progression of damage to the pulmonary valve for tissue valves is lower than in the aortic position because of the lower pressure situation in the right ventricular outflow tract.
S
sajopack
re-do after the ross
re-do after the ross
Hi! My husband had a re-do surgery after having the Ross in 1998 by a premier surgeon in Chicago. (see thread in valve selection). He apparently has tissue that is pretty stretchy, and we still wonder if he has some type of connective tissue problem, although not the commonly diagnosed ones (had 3-4 hernia surgeries etc.) and was born with a bicuspid aortic valve. His first aneurysm was 6.5 centimeters. This past Wednesday he was operated on by Dr. patrick McCarthy in Chicago, formerly of the Clevelad clinic. Apparently, his pulmonary valve in the aortic position was also "stretchy" and he developed another ascending aortic. aneurysm. This time, He received a st. Jude valve and dacron for the aortic root. I'm happy to report that the surgery was a huge success and he was up walking around and even shaving last night, 48hrs. post Icu.His valve is ticking away!!!
So my point is, they now know NOT to perform the Ross if there is any question about the health of the aortic tissue as the pulmonary tissue is the same!! There's no looking back at our choices now, as we begin a life on coumadin. He did get 6 years at least of not worrying about that. But was it worth it doing the Ross? In hind sight it's hard to say...but wished we gotten it right the first time.
re-do after the ross
Hi! My husband had a re-do surgery after having the Ross in 1998 by a premier surgeon in Chicago. (see thread in valve selection). He apparently has tissue that is pretty stretchy, and we still wonder if he has some type of connective tissue problem, although not the commonly diagnosed ones (had 3-4 hernia surgeries etc.) and was born with a bicuspid aortic valve. His first aneurysm was 6.5 centimeters. This past Wednesday he was operated on by Dr. patrick McCarthy in Chicago, formerly of the Clevelad clinic. Apparently, his pulmonary valve in the aortic position was also "stretchy" and he developed another ascending aortic. aneurysm. This time, He received a st. Jude valve and dacron for the aortic root. I'm happy to report that the surgery was a huge success and he was up walking around and even shaving last night, 48hrs. post Icu.His valve is ticking away!!!
So my point is, they now know NOT to perform the Ross if there is any question about the health of the aortic tissue as the pulmonary tissue is the same!! There's no looking back at our choices now, as we begin a life on coumadin. He did get 6 years at least of not worrying about that. But was it worth it doing the Ross? In hind sight it's hard to say...but wished we gotten it right the first time.
P
PapaHappyStar
Sajopack - Congratulations on a successful surgery, sounds like your husband is doing very well.
I talked to Dr. Stelzer in New York about what he would do if there was aortic dilatation and he often shores up the aortic root with dacron or with trimmed tissue from explanting the pulmonary and aortic valves. Stelzer mentioned that surgeons judgement in these situations is what makes the difference -- he talkes about this on his RP webcast.
http://www.or-live.com/bethisrael/1244/
I dont know if a mechanical valve replacement originally without a dacron replacement of the ascending aorta would have been any more successful.
Best wishes for a smooth recovery.
Burair
I talked to Dr. Stelzer in New York about what he would do if there was aortic dilatation and he often shores up the aortic root with dacron or with trimmed tissue from explanting the pulmonary and aortic valves. Stelzer mentioned that surgeons judgement in these situations is what makes the difference -- he talkes about this on his RP webcast.
http://www.or-live.com/bethisrael/1244/
I dont know if a mechanical valve replacement originally without a dacron replacement of the ascending aorta would have been any more successful.
Best wishes for a smooth recovery.
Burair
Tom F.
Well-known member
Sajopak - would you mind saying who did the Ross surgery that has failed? If you do not wish to post it publically, could you e mail or message me with that info? Thanks you.
G
geothoix
There is a decline in RPs
There is a decline in RPs
A couple of surgeons have independantly reported that RPs are down. It seems that this is driven by more careful selection of potential candidates especially among adults.
This should be good for all.
There is a decline in RPs
A couple of surgeons have independantly reported that RPs are down. It seems that this is driven by more careful selection of potential candidates especially among adults.
This should be good for all.
