Ross Procedure?

[Barry P.]

Soccerdad

Soccerdad

I had mine done in B'ham, AL by Dr. John Harlan in 1996. He and his team are phenominal. I am sure they are all good due to the high standards that are demanded.
My first waking thought after the operation was, "Wow do I feel good!"
Best wishes!

 

[all that glitters]

If your surgeon says your a good canidate I say go for it! I just had this done 7 weeks ago and I feel great!

 

[tobagotwo]

The biggest contraindication (in my nonprofessional opinion) for the Ross Procedure is active connective tissue disease. This doesn't include everyone who has a bicuspid valve, but does include people who have active aortic dilation or aneurysms.

The most common negative issue seems to be that the tissue in the pulmonary valve being used to replace the aortic valve isn't strong enough to withstand the increased pressure in the aortic position. This happens with much greater frequency when there are active connective tissue problems. These problems might show up as an aneurysm, dilation of the aorta, mitral prolapse, bicuspid pulmonary valve, or congenital heart or aortic malformations (like ToF or coarctation of the aorta).

There were a lot of Ross Procedures being done for a while on candidates who had these issues, or candidates who had bicuspid valves but weren't being checked for the sometimes accompanying connective tissue problems. I can recall reading about one in which the surgeon went ahead and replaced a heavily calcified, stenotic/regugitative bicuspid aortic valve with a bicuspid pulmonary valve. I suppose on some occasions something like that might actually work out long term, but it seems a nearly unmitigated risk to me, a case of surgical hubris.

That fad has gone mostly out of favor now, and the unfortunate results of that freewheeling time have badly affected the success rate of the Procedure. Tissue in the pulmonary valves became slowly myxomatous and couldn't hold up to the aortic pressures, and the valves wound up having to be replaced with mechanical or tissue valves.

However, when done appropriately, the Ross Procedure has an excellent success rate. And it's the only permanent fix without any limitations after recovery.

Go to - or contact - someone like Dr. Stelzer. Someone who knows what works and for whom. There is no substitute for experience in OHS, and Dr. Stelzer is far and away one of the most experienced in the Ross Procedure.

You still have all your other options open. Even if you determine the Ross is the way for you to go, you should have a backup (mechanical or tissue) that the surgeon can use if something unexpectedly shows you not to be a good RP candidate.

Best wishes,

 

[ottagal]

]"The biggest contraindication (in my nonprofessional opinion) for the Ross Procedure is active connective tissue disease. This doesn't include everyone who has a bicuspid valve, but does include people who have active aortic dilation or aneurysms.The most common negative issue seems to be that the tissue in the pulmonary valve being used to replace the aoritc valve isn't strong enough to withstand the increased pressure in the aortic position. This happens with much greater frequency when there are active connective tissue problems. These problems might show up as an aneurysm, dilation of the aorta, mitral prolapse, bicuspid pulmonary valve, congenital heart or aortic malformations (like ToF or coarctation of the aorta)."[/I]

On asking my surgeon if I was a candidate for the Ross procedure, his response was practically word for word with Bob H's reply (above). I also have pulmonary valve regurgitation which confirmed it to be a 'no go'. Good luck with your decision and don't be afraid to ask for a second opinion from the specialists.

 

[Bill B]

What Bob H wrote and my surgeon clearly told me as well is not something you will see often when you read the literature about the Ross procedure. Because this procedure has been done often in patients with BAV and would seem to offer some advantages versus "standard" tissue or mechanical AVR, I was interested in it, and this was the main reason I approached the surgeon I did. Prior to meeting with him, my impression from reading about the Ross procedure was that the primary issue was age. Most centers do not perform the procedure on patients over 55 or so, and that seemed to be related problems with re-implanting the coronary arteries in the face of CAD. I was curious about this and wondered if my freedom from CAD would allow the procedure. As I learned, that was not the problem in my case, but rather it was the underlying pathology in BAV as Bob so skillfully summarized above.

 

[sylviayasgur]

hi soccerdad,
amen to all those who recommended contacting dr. paul stelzer. he is a God when it comes to ross procedures. stretchL will confirm that.
he is a brilliant, skillful, patient and kind surgeon and man.
he has done over 300 rp's (joey is number 340) and has seen all there is to see_ no surprises.
i feel that if you go to a surgeon who has done many many of these, you will be in good hands.
please go for that second, or even if you need to for peace of mind, a third, opinion. you will end up feeling more comfortable with the whole thing and will be able to decide if this is the right way to go_ for you.
good luck and please keep in touch,
sylvia

 

[rckrzy1]

Let's not leave Dr Ryan in Dallas out, he has over 200 done and is one of the best.

 

[soccerdad]

Thanks for all of the great input and words of encouragement.
I've decided to go with a St. Jude mechanical. Given my condition, age, re-op rates, etc., I feel that it's the best route to take for me. I've found a great surgeon (McGiffin / UAB-Kirklin Clinic) and am looking forward to getting it done Dec 29th. Thanks all.

 

[Bill Moriarty]

Soccerdad, good choice. I am the husband of the late "vhmoriarty", and, though I would still recommend the Ross, I think the mech valve is the safest way to go.

The Ross is a wonderful procedure, and for the people who have been successful with it I am very happy. I'm just kind of bitter-sweet to it.

 

[COLLEEN S]

Soccerdad,
I put you on the calendar. Prayers for an uneventful surgery for you on the 29th.

 

[rckrzy1]

Ok, got this straight my surgeon yesterday, The ross has fallen out of favor for those with aortic Insufficiency, NOT for those with stenosis. He went into details but if your root and aorta is normal and you just have AS the ross is still a good choice for some. I am a poster child. 3yrs later and I have a fully normal life, no worries, even when riding triple digits on my triumph speed triple.

Hi,
I'm new so excuse the length. I'm 46 in fairly good shape and was born with aortic stenosis and over the last year I've certainly been feeling the effects. Shortness of breath, tight chest, and can't do the things I used to do. When I was 5, they told me I'd have to have valve replacement when I was 45, so they were dead on it. Anyhow, I had my checkup today with my cardiologist. We've scheduled a heart cath for next Monday. We've briefly discussed my choices for valve and I mentioned the Ross Procedure and he told me he'd check into it. He told me today that the Ross Procedure has "gone out of favor".... Not exactly sure what that means but it looks like their recommendation is for tissue or mechanical. I'm 46 and really don't look to be on blood thinner for the rest of my life and feel that the benefits of a dual valve replacement out-weigh the thought of blood thinner. Even before today, I knew I would not use this group to perform my surgery but would opt to go to University of Alabama / Birmingham (UAB). Does anyone have anything to add to the comment that the Ross Procedure has "gone out of favor" or should I follow my gut, go to UAB, get a second opinion and talk to the surgeon... My cardiologist is not the surgeon and I feel like they may just try to do what they "normally" do...

Thanks in advance.

 

[everstochance]

Ok, got this straight my surgeon yesterday, The ross has fallen out of favor for those with aortic Insufficiency, NOT for those with stenosis. He went into details but if your root and aorta is normal and you just have AS the ross is still a good choice for some. I am a poster child. 3yrs later and I have a fully normal life, no worries, even when riding triple digits on my triumph speed triple.

Thank you. Very well said.

 

[river-wear]

Any info on why the Ross isn't a good choice for insufficiency?

 

[rckrzy1]

Any info on why the Ross isn't a good choice for insufficiency?

The insufficiency is usually caused by weak walls and such and a pulmany valve alone won't hold as well as a mechanical ring. That was my intereption and
he said alot of AI folks have dialted aortic roots as well.