Still a Ross candidate with dilated aortic root?

[carrie999]

-We are investigating valve replacement options for my 41-year old previously very active husband who has a moderately stenotic bicuspid aortic valve. Very much leaning toward the Ross procedure, but I have read that having a dilated aortic root (43mm) may preclude him from consideration for the surgery at least by some surgeons. I've read about aortic root tailoring but suspect it is suited to milder cases... So far we have had one consultation with a (Seattle) surgeon who was pushing for a stentless porcine valve and has no experience himself with the Ross. We will consult with a Ross surgeon once we've got our data together but wondering if anyone has had similar experience. thanks.

 

[LeakyUK]

I am not an expert, and will be going mechanical myself (age 58). As far as I can tell the Ross is intended to give an Aortic valve which lasts longer than a tissue, but why not go straight to mechanical and live with the warfarin?

 

[mainframe]

My first surgery I had hoped to go with a Ross procedure and met with Verrier at UW who had done alot of Ross procedures. (the other in Seattle that had done alot of Ross procedures at the time was Gartman at Swedish) The plan was scrapped 3 days prior to surgery due to the fact my aortic root was dialatied. I think my root measured 42 at the time. I ask for a porcine which Verrier was o.k. with, but woke up with a boving due the way my cardiac arteries lined up. (from what I'm told).

Who are you talking to in Seattle? You might want to get a second opinion. I remember the guy who did a ton of Ross procedures in OKC a few years back did them for folks with dialated roots. I don't remember his name.

Welcome to the VR.com!

 

[dfelder]

I remember the guy who did a ton of Ross procedures in OKC a few years back did them for folks with dialated roots. I don't remember his name.

Pretty sure you are talking about Dr. Ronald Elkins Sr. He has retired but I think his son has filled his spot.

 

[mainframe]

Thanks, that was the guy.

 

[Jason]

Mainframe, your aortic root was/is the same measurement as mine is now, which was not replaced in the operation I had in March. Did it dilate further and need replacing in 2009? I have a carbomedics mechanica valve too, although I don't think it is a tophat. Was your 2009 operation a valve, root and ascending aorta replacement, or was the root okay again?

 

[bdryer]

Jason

Google the details from your Carbomedics wallet card, that should reveal the model name.

carrie999

Regarding the Ross procedure, a co-worker had the procedure done at 39 or 40 years of age. He is into his 11 year. No problems. Note that he had no other procedures accomplished, only the Ross.

My surgeon at age 55 recommended a MHV to compliment a graft of the ascending aorta, [not the root]. I was going mechanical anyways, this just reenforced my choice. Many members here have had a tissue and an aorta root procedure carried out. Guess it differs depending on the surgeon.

 

[mainframe]

Jason my first surgery only replaced the valve. I was told that the determining measurement is 4.5 for the surgeon to consider aorta work at the time of VR by both my first surgeron and second. My second surgery the aorta had increased to 5.0 so it was replaced with our friend the dacron tube. (I was told I had a Bentall procedure). Though my aortic arch was also slightly dialated, Dr. Miller didn't address that out of concern I wouldn't survive the surgery as it was pretty long as it was.

Hopefully your aorta will remain the size it is for many years and be a non factor. Guess that's why we need to stay on top of our yearly checkups.

 

[carrie999]

Who are you talking to in Seattle? You might want to get a second opinion.

He saw Joseph Teply at Swedish. I've previously spoken with Verrier's office and was told he doesn't do the Ross anymore. From what I can gather, no-one does them in Washington state anymore. We are considering the Cleveland Clinic (Eugene H. Blackstone?) or even Peter Skillington in Australia (we're Australians).

sorry, this was in response to Chris (thank you!).

 

[mainframe]

I've heard good things about Teply from an anesthesiologist friend of the family who does heart surgeries at Swedish, should you decide on something other than the Ross and to stay local. Another surgeon if your willing to travel is Dr. Paul Stelzer at Mount Sinai Hospital in New York. He has done many, many Ross procedures including several members of on this board. Good luck with your decision.

 

[Jason]

Jason my first surgery only replaced the valve. I was told that the determining measurement is 4.5 for the surgeon to consider aorta work at the time of VR by both my first surgeron and second. My second surgery the aorta had increased to 5.0 so it was replaced with our friend the dacron tube. (I was told I had a Bentall procedure). Though my aortic arch was also slightly dialated, Dr. Miller didn't address that out of concern I wouldn't survive the surgery as it was pretty long as it was.

Hopefully your aorta will remain the size it is for many years and be a non factor. Guess that's why we need to stay on top of our yearly checkups.

Thanks for the information. I had my surgery fairly quickly after the CT showed my ascending aorta at 5.4cm, so I didn't have much(any) time to review the Echo's, get information from places like this, etc. There is no use second guessing at this point, but I am wondering if another surgeon would have replaced the root since it is at 4.2cm. I will be talking to the surgeon on Monday, and I will see what her thoughts were on it at that time. Perhaps the CT that was done showed a better number; I don't know. 4.2cm isn't far dilated, but the point behind the mechanical valve was that I wouldn't need another surgery in my lifetime. Only time will tell, and I am sure she had her reasons for not doing the root at the same time, but it does make me wonder. In any case, thanks for the information on your history.