Surgery scheduled w/ Dr. Ryan!

[boomersooner]

Well I had my consult on Friday with Dr. Ryan in Dallas. He scheduled my surgery for January 9th at 7:30am at The Heart Hospital Baylo Plano. We had originally talked about the Ross Procedure but Dr. Ryan said there is one thing that is keeping him from the RP and it is that the portion of heart under my aortic root is also dilated and he said that is usually a disqualifier for the Ross Procedure but he then told me if he gets in there and can see that everything is fine and he is 100% certain then we could do the Ross. Here is plan a, b and c.

A) Valve repair with a Dacron graft and a Dacron reinforced aorta (Aortic Reimplantation Technique, established by Tirone David). This procedure shows a 90% freedom from reop at 9 years and I was told if it is still good at 5 it should last 15-20 years or more . This is also good because it is my own living tissue!

B) Ross Procedure. If plan A can’t be done for one reason or another we will go to the Ross Procedure. Dr. Ryan said if he gets in there and is 100% sure that the RP will be the best option for me he will go to this procedure if plan A will not work. Given the recent tests there is a pretty good chance that I do not qualify for the Ross Procedure, but it’s just a what if.

C) Stentless Porcine Valve This thing replaces the entire root and the valve and has a 96% freedom from reop at 12 years and should last me until I am 45 or 50, which is good considering I am only 25.
I am thinking about moving option C to B because I am worried about having two valves replaced instead of one. Anyway I just wanted to update everyone with my consult information. Let me know if anyone has any feedback or suggestions.

Thanks
Jared

 

[Karlynn]

Congratulations on getting your date all set up. Now go enjoy the holidays and pamper yourself. (You'll still be able to enjoy yourself after, but this is a good excuse that the family and friends will buy now! )

 

[Phyllis]

I put you on the calendar for January 9th so it's official now! Best wishes to you and I agree with Karlynn- enjoy every minute of the holidays.

 

[KatieD]

Congratulations on getting your surgery scheduled, Jared. It takes a big relief off when that step is finally taken. You can't go wrong with Dr. Ryan. My sister MaryC and I both had mitral valve repairs by him. I was impressed with him from both sides, as the worried family member and as the patient.

 

[catwoman]

Jared:

Glad to hear that Dr. Ryan will be doing your surgery. My husband & I will keep you in our thoughts for a boring surgery and speedy recovery.

 

[ruth]

Woa, this is too spooky, Jan 9'th at 7:30 was my surgery date - 2007!

Good news is, it's a lucky date! My 99% chance of replacement ended up with the 1% chance of repair for me.

I wish you all the best.

Peace,
Ruth

 

[WayneGM]

Congratulations on setting the date. Best wishes for a succesfful surgery and smooth recovery. Take some time to enjoy yourself during the holidays. You'll have some work ahead of you during recovery.....but it's worth it. Best wishes.

 

[ALCapshaw2]

Well I had my consult on Friday with Dr. Ryan in Dallas. He scheduled my surgery for January 9th at 7:30am at The Heart Hospital Baylo Plano. We had originally talked about the Ross Procedure but Dr. Ryan said there is one thing that is keeping him from the RP and it is that the portion of heart under my aortic root is also dilated and he said that is usually a disqualifier for the Ross Procedure but he then told me if he gets in there and can see that everything is fine and he is 100% certain then we could do the Ross. Here is plan a, b and c.

A) Valve repair with a Dacron graft and a Dacron reinforced aorta (Aortic Reimplantation Technique, established by Tirone David). This procedure shows a 90% freedom from reop at 9 years and I was told if it is still good at 5 it should last 15-20 years or more . This is also good because it is my own living tissue!

B) Ross Procedure. If plan can’t be done for one reason or another we will go to the Ross Procedure. Dr. Ryan said if he gets in there and is 100% sure that the RP will be the best option for me he will go to this procedure if plan A will not work. Given the recent tests there is a pretty good chance that I do not qualify for the Ross Procedure, but it’s just a what if.

C) Stentless Porcine Valve This thing replaces the entire root and the valve and has a 96% freedom from reop at 12 years and should last me until I am 45 or 50, which is good considering I am only 25.
I am thinking about moving option C to B because I am worried about having two valves replaced instead of one. Anyway I just wanted to update everyone with my consult information. Let me know if anyone has any feedback or suggestions.

Thanks
Jared

I don't understand how you make the jump from "96% freedom from reop at 12 years" to "should last me until I am 45 or 50, which is good considering I am only 25" for the Stentless Porcine Valve, especially since it is a well known FACT that Tissue Valves deteriorate more rapidly in Younger Patients.

The Bovine Pericardial Valves are just now approaching 20 years use with projected lifetimes of 25 years for the "new improved" versions with anti-calcification treatment. Note that most patients with long term "freedom from explant" of the Bovine Pericardial Valves received them at an older age (over 60?).

When was the Stentless Porcine Valve first introduced?
What is the basis for the longer projected lifetime, especially for younger patients?

I do understand that the Stentless Porcine Valve has about 1/2 the Pressure Gradient of the Bovine Pericardial Valves, which is a Big Plus in Exertion Performance for the Stentless Porcine Valve and most likely the reason it appeals to active / athletic patients.

'AL Capshaw'

 

[boomersooner]

That is what i was told by the doctor. Not sure how he arrived at that information. He said that if it lasts 12 years it should last much longer after that.....? Again no idea where he got that info but he is the doctor and I'm not so didnt ask two many questions about that topic. He did tell me that his goal would be for me to have two possibly 3 valve replacements throughout my life.

I believe the porcine valve was just introduced about 12 years ago.

 

[MaryC]

Hey BoomerSooner - I bet you were happy last night with the results of the game!

Anyway, good luck with your surgery with Dr Ryan. I think you will like the new Heart Hospital in Plano. It looked state-of-the-art when we went to their open house before my surgery. However, they didn't have a contract with my insurance company so I ended up at Presby Dallas. All worked out because my main goal was getting Dr Ryan for my surgery.

 

[Cooker]

He did tell me that his goal would be for me to have two possibly 3 valve replacements throughout my life.

I believe the porcine valve was just introduced about 12 years ago.

I don't know your what your situation is. When making my valve decision my cardio said that at 49 I would have to have at least 2 and maybe 3 OHS with tissue. That is why I went mechanical (and he agreed). I can't understand anyone signing up for a goal of 3 And that is "his" goal......what's yours?

 

[boomersooner]

Yes, i am super happy about OU winning the Big 12!

At 25 I really dont know what to expect on how many OHS to have. if the average valve lasts lets say 15 years that would put me at 3 OHS by the time I am 70, counting this one! Well maybe not OHS but valve replacements for sure.

 

[lieb2101]

Hey Boomer,

Let me know if you end up doing any further research on your valve selection.
I'm in a similar situation, I'm 29 and I'm looking at a pig valve to be put in on Jan 22nd.

After consultation with my surgeon, Dr. Deeb (UofM), his opinion is that due to my activity level, my quality of life would be much better off with a tissue valve. He described that a mechanical valve is similar to a car in that the more you use it the quicker it wears out and that I'd probably wear through it just as quickly as a tissue valve so I might as well avoid the Coumadin. The re-op rate that he told me was: Mechanical = 10-20 years, Tissue = 10-15 years. He leveled with me and said that in all reality, I was looking at re-op about every 12 years or so depending. Since I'm 29, that puts me at at least 3 re-ops any way I go.

Although, his opinion may be biased as he does work with Meditronix on the Bioprostesis products...

Check out this link if you want specifics (including Video of the procedure!): http://www.ctsnet.org/medtronic/product/401

Here's hoping for radical advancements in sub-cutaneous valve replacements in the next 12-30 years!

 

[boomersooner]

Hey Lieb!

Ask about the Stentless Porcine. From what I have been told its different than a regular porcine valve as far as how long it lasts. The bad thing about that valve is they have only been using it for 12 years so there is not as much data, but the data they have is really good. You also can look at the Ross Procedure and valve repair.

I was totally bummed out when I found out I was going to need OHS at 25 but us young guys are not alone. There plenty of people who have been in our shoes and lived full, long productive lives well into old age. Also if you have only spoken with one doctor I suggest getting a 2nd or 3rd opinion. I actually spoke with 3 different surgeons. PM me if you have any questions.

 

[ALCapshaw2]

Hey Boomer,

Let me know if you end up doing any further research on your valve selection.
I'm in a similar situation, I'm 29 and I'm looking at a pig valve to be put in on Jan 22nd.

After consultation with my surgeon, Dr. Deeb (UofM), his opinion is that due to my activity level, my quality of life would be much better off with a tissue valve. He described that a mechanical valve is similar to a car in that the more you use it the quicker it wears out and that I'd probably wear through it just as quickly as a tissue valve so I might as well avoid the Coumadin. The re-op rate that he told me was: Mechanical = 10-20 years, Tissue = 10-15 years. He leveled with me and said that in all reality, I was looking at re-op about every 12 years or so depending. Since I'm 29, that puts me at at least 3 re-ops any way I go.

Although, his opinion may be biased as he does work with Meditronix on the Bioprostesis products...

Check out this link if you want specifics (including Video of the procedure!): http://www.ctsnet.org/medtronic/product/401

Here's hoping for radical advancements in sub-cutaneous valve replacements in the next 12-30 years!

I would DEFINITELY want another opinion on the longevity of Mechanical Valves. Most (all?) mechanical valve manufacturers claim their valves are designed to last multiple lifetimes before "wearing out". The Standard St. Jude Mechanical Valves have been around for 30 years and counting. I would want to know the BASIS for Dr. Deeb's statement that mechanical valves would only last 10 to 20 years. We have MANY mechanical valve recipients on VR.com who have passed those numbers.

Plain ordinary untreated Pig Valves typically last 8 to 12 years in more elderly patients, LESS in younger patients.

Read "They Tore Out My Heart and Stomped That Sucker Flat" by Humorist / Columnist Lewis Grizzard who received a Pig Valve following a bout of Endocarditis due to a dental problem. He did NOT survive his THIRD valve replacement. Of course that was several years ago also...

'AL Capshaw'

 

[Lynlw]

This may be true but I don't find it very helpful, especially to a member that decided he is getting a tissue valve. I thought when people made their choice, we support them and offer helpful advice.

Read "They Tore Out My Heart and Stomped That Sucker Flat" by Humorist / Columnist Lewis Grizzard who received a Pig Valve following a bout of Endocarditis due to a dental problem. He did NOT survive his THIRD valve replacement. Of course that was several years ago also...

 

[Isis]

Hey Boomer,

Let me know if you end up doing any further research on your valve selection.
I'm in a similar situation, I'm 29 and I'm looking at a pig valve to be put in on Jan 22nd.

After consultation with my surgeon, Dr. Deeb (UofM), his opinion is that due to my activity level, my quality of life would be much better off with a tissue valve. He described that a mechanical valve is similar to a car in that the more you use it the quicker it wears out and that I'd probably wear through it just as quickly as a tissue valve so I might as well avoid the Coumadin. The re-op rate that he told me was: Mechanical = 10-20 years, Tissue = 10-15 years. He leveled with me and said that in all reality, I was looking at re-op about every 12 years or so depending. Since I'm 29, that puts me at at least 3 re-ops any way I go.

Although, his opinion may be biased as he does work with Meditronix on the Bioprostesis products...

Check out this link if you want specifics (including Video of the procedure!): http://www.ctsnet.org/medtronic/product/401

Here's hoping for radical advancements in sub-cutaneous valve replacements in the next 12-30 years!

Wow, that's a new one on me. Never heard that mechanicals only last 10-20 years. And they wear out quicker the faster your heart rate is.

I'd do a little more research on mechanical valves before you discount them based on that statement. It may be true for all I know, I've just never heard or read that before .

Not saying you should chose a mechanical, as a tissue or mechanical will improve your lifespan. Both are good options. Decide which is best for you and keep on keep'n on.

 

[lieb2101]

Don't worry, I'm still 2 months out and I've got another consultation with my surgeon in two weeks. I'll make sure I quiz him on these concerns in depth. I keep a notebook handy all the time. Right now though, it looks like the Freestyle option C that Boomer has listed is my best bet.

Boomer, can you tell me more about your option A? I'll look it up but is it similar to the Ross?

p.s. I do appreciate the input from everyone, even when it makes me think twice

 

[boomersooner]

Lieb,

Well, the doc said that if the valve is not calcified or if it is not stenotic and if it’s just leaky because of the two cusps instead of three, that he should be able to repair it. He will cut out my aortic valve, replace my root with a Dacron graft and reinforce my sinuses with Dacron to ensure that they do not dilate. Then he will repair my valve and put it back in! Sounds simple enough The repair only messes with the aortic valve where as the ross replaces both the pulmonary and the aortic with a homograft and an autograft. The david sparing procedure is a popular method of repair for a root/valve issue.

In regards to the stentless porcine, there are a few types from what I have read. The freestyle which you talked about and the Toronto SPV (stentless porcine valve) http://www.sjm.com/devices/device.aspx?name=Toronto+SPV®+Valve&location=in&type=19 . There is also the Edwards Prima Plus Stentless Bioprosthesis. I would talk to your doc to see which one he recommends and which one he is most comfortable using.

 

[tcopel]

From one fellow OU sooner to another, happy Fiesta Bowl!

A couple of things, boomer. First, I noted in one of your post that you said that " he is the doctor and I'm not so I didnt ask questions". I hope that you do ask questions because the more informed you are on this stuff, the better decisions you can make on your behalf. Its just too important for your health. Sometimes when you are on the doctors 'turf', it can be intimating but it is your life.

I also saw that you mentioned the David procedure. I not entirely sure it that can be applicable to a bicuspid valve. Repairs are a lot more technical and I would definately need assurance that your doc has done a lot, not just one every once in awhile. It is a procedure that has been implemented consistently for only about 10 to 15 years for tricuspid aortic valves so the learning curve for the surgeon is steep and not all are experienced. I'm not questioning you current doc, I just dont know him so I just bring it up for thought.

Thirdly, I guess I'm confused about what you said about the longevity of the mechanical valve. Its my understanding that their main advantage over the biologicals was their ability to last for a lifetime (assuming all goes well of course) as leib and alcapshaw suggest.
Lastly, as lynlw points out, I do want to be supportive of whatever decision you make. Its one of the hardest that I've made for me (David procedure). and I just wanted you to keep the faith, man...keep the faith