Ross procedure / Aortic Homograft vs on-x valve

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ashadds

Well-known member
Joined
Nov 14, 2016
Messages
102
Location
India , Bangalore
Hi Guys

I dont need surgery right away but I am young 26 with moderate stenosis and this would be my future . I would still be young maybe by the time I need to replace this valve . I have narrowed down my choices to three possibilties .

1. Ross procedure
2. Aortic homograft cadaver valve cryo preserved
3. ON-X mechanical

Please members tell me what is the con of the ross procedure ? It seems to offer no blood thinners , and the valve for a few people lasts 30 years . What is the reoperative complications for the ross ?
 
The problem with a Ross Procedure is cutting out a perfectly well valve from the pulmonary position to use in the aortic position. This leaves you open to two valve surgeries in the near future.

1. I have had the Ross Procedure done, but when I was 8, and at the time it was a viable choice to help me to grow. 14 years later, the valve began to regurgitate severely, my aorta was dilated and I began to get mild regurgitation in my pulmonary valve. Multiple surgeries are riskier, given the amount of scar tissue covering the heart from previous surgeries and complications do compound, I myself took a slight hit to my liver (I'm greatful that it regenerates). They also had difficulty in stabilising me as I was losing more blood than average, as I suspect it to be down to all that cutting of the previous scar tissue. Multiple surgeries are also bloody painful! - I blame the scar tissue and previous opening of the sternum.

As I've had a Ross procedure in the past, my pulmonary valve will need to be monitored and maybe replaced, less-invasively or even clipped to prevent regurgitation - (My hospital have said they have that tech right now).

'and the valve for a few people lasts 30 years' - Do you want to take that risk? for some people, especially on this forum, a Ross Procedure has not lasted very long at all; a few years at most.

2. Aortic homograft - I don't really know much about homografts in the aortic position, but sort of going back to 1, why do you want to guarantee yourself another surgery with compounded risks? Given your age, you could look at 3 maybe 4 replacements. Why subject yourself to that?

3. Mechanical valve. It has the chance to last your entire lifetime, I say chance because there are risks with all valve types really, mainly endocarditis, a chance of an aneurysm etc. These are very low, and the guaranteed chance of replacement with the other valves far outweigh these tiny risks. I'm not saying there's a guarantee that you won't need a mechanical valve replaced in the near future, but you have a high chance that you wont when compared with a ross procedure (2 valves) or the homograft which will probably not last that long. Many members on this forum have made it past the 25 year mark, **** has had his for 50 years.. wow.

The On-X valve also claims to ****** pannus tissue with its pannus guards, which is a pretty neat feature.

I've only seen three real reasons to avoid a mechanical. One if you're female and want a child, two if you're old and a tissue valve could last the rest of your life and three if your body can't tolerate 'blood thinners' for some other reason.

'blood thinners' or anticoagulants is not an issue. I am self testing now and I am always in range. If it does go down (very rarely through) I can bump up the dose to take me within range. It takes me about 10 seconds a day to take the pills and a few minutes to draw my blood at home to check my INR - (I test weekly for peace of mind). I haven't had to change my diet at all.

Feel free to ask a lot of questions with regards to taking warfarin/coumadin. There are a lot of experienced members on this forum who can tell you more about the drug. From my experience however, it's not an issue at all!

I appreciate the decision at the end of the day is yours, I just hope you're aware of all the risks before settling on something.
 
I have an ON-X valve and could not be happier with my choice. Coumadin has not been a problem. self test every two weeks INR range 1.8 to 2.2. Everyone 's situation is different and it is a very personal choice there is no right or wrong choice. You must way the plus and minus's of each.
 
Arnold Schwarzenegger had the Ross procedure it blew out the same day and he had to have to replaced the next day. Talk about a scary situation because your chance of death is now 10% instead of 2%. I'm 55 and when/if I have to have my valve replaced it wouldn't be a Ross for sure
 
Arnold Schwarzenegger had the Ross procedure it blew out the same day and he had to have to replaced the next day. Talk about a scary situation because your chance of death is now 10% instead of 2%. I'm 55 and when/if I have to have my valve replaced it wouldn't be a Ross for sure
 
jasond1979;n874956 said:
Arnold Schwarzenegger had the Ross procedure it blew out the same day and he had to have to replaced the next day. Talk about a scary situation because your chance of death is now 10% instead of 2%. I'm 55 and when/if I have to have my valve replaced it wouldn't be a Ross for sure
Arnie had an exercise bike delivered to his room and got on it......that was far, far too soon to be getting on an exercise bike, that was why his replacement valve had to be replaced ! You're supposed to get up and walk abouts soon after surgery but you shouldn't get on an exercise bike !
 
Paleowoman;n874957 said:
Arnie had an exercise bike delivered to his room and got on it......that was far, far too soon to be getting on an exercise bike, that was why his replacement valve had to be replaced ! You're supposed to get up and walk abouts soon after surgery but you shouldn't get on an exercise bike !

Yeah, but Arnie is a T-800/T850 - He is a cybernetic organism. The valves just didn't work with his exoskeleton. Hence they've tried mechanical.
 
Hello,

i used to be in similar shoes as you. I did a lot of research on Ross versus tissue vs mechanical.

i ended up choosing a medtronic 3f equine valve in a bio bental operation (my aortic root needed replacing too) at age 34.

i was initially drawn to Ross Procedure, but concluded that this is a good option for someone in their mid 40s. You can think of the Ross as a tissue valve with longer life span. Ie 15-25 years as oppose to 10-20 with tissue/homograft. How long it lasts also depends the type of ross procedure. Ross can be done as a root replacement ( which is the way its mostly done in the US), Subcoronary implementation (Hans Sievers Germany) or Root inclusion (Peter Skillington -Australia). Root replacement leads to neo-aortic root dilatation, because while the pulmonary autograft leaflets can withstand systematic pressure in the aortic position, the pulmonary walls dilate after a decade and a half or so. Some surgrons tried to get around this by either reinforcing the root replacement or minimising distance between autograft and your heart. This appears to work but it is unclear if this is a permanent solution or just gets you 5 more years on the autograft.

the reasons for the longer lasting sub coronary or root inclusion type operation is that is that your native tissue is used in reinforcing the walls preventing dilatation. But those types of operations are technicslly challenging and only two surgeons operating today (Sievers and Skillington) use them in large series.

So if your aortic root exceeds 30mm in diameter these techniques can not be used jn a Ross, which is why I was advised against it.

Then it was down to mechanical versis tissue. I ended up choosing the tissue with the best travk record in the lab, the Medtronic 3F, at the time of my surgery.

both tissue and mechanical have complications. Antivoagulaton and bleeding are compications of mech valves, even when payients self administer and self test as shown in the German Gelia study. I discussed this wigh a number of cardios and surgeons in Germany, the place which first allowrd self dosing, and they though agreed that while self dosing means less complicationswith mech valve they are still complications nevertheless. If you look at recent studies comparing outcomes in Ross patients versus mech valves, survival with optimal anti coagulation is similar, but the complication rate d bit higher.

of course with Ross, the ultimate complication rate are multiple reoperations given that the valves may fail at different points in time. On top of this the ross is a vanishimg op meaning that there may not be an expert around to do reop in 20 years from now. A these reasons led me to go for tissue, but being in Europethere is such a TAVI boom in people of all ages thst this influnced me too.

i hope this helps
 
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