Unique situation?

[s9acasl]

Could you clarify how you believe that he ruined his valve almost immediately?

The story I read is here (You need a Medpage account to read this story)
Schwarzenegger's Aortic Valve Replacement

Which states
"Initially, things seem to be going well enough that he admitted to getting on a Lifecycle bicycle while still hooked up to all his monitors shortly after surgery (How did he get away with that?!). But later that day, because "my body was too big and too strong," the pressure on the new aortic valve (previously his pulmonary valve) was too high. He started to cough, and he became short of breath as his lungs began to fill with fluid. His physician, Vaughn Starnes, MD, told him that the surgery had failed"

Which is pulled from this interview given in 2016. starting at 2:22 he states it probably didn't help that right after waking up for surgery he got on a lifecycle. I know a key factor of the Ross procedure is blood pressure control to allow the Pulmonary valve to adapt to it's new position, I imagine hopping on an exercise bike immediately is just a recipe for destroying the valve.

 

[Chuck C]

The story I read is here (You need a Medpage account to read this story)
Schwarzenegger's Aortic Valve Replacement

Which states
"Initially, things seem to be going well enough that he admitted to getting on a Lifecycle bicycle while still hooked up to all his monitors shortly after surgery (How did he get away with that?!). But later that day, because "my body was too big and too strong," the pressure on the new aortic valve (previously his pulmonary valve) was too high. He started to cough, and he became short of breath as his lungs began to fill with fluid. His physician, Vaughn Starnes, MD, told him that the surgery had failed"

Which is pulled from this interview given in 2016. starting at 2:22 he states it probably didn't help that right after waking up for surgery he got on a lifecycle. I know a key factor of the Ross procedure is blood pressure control to allow the Pulmonary valve to adapt to it's new position, I imagine hopping on an exercise bike immediately is just a recipe for destroying the valve.

Thanks for providing that. Apparently he needed a second operation in 1997 the very next day, and the fact that he got right on the bike right after surgery may have contributed to the first operation failing.

However, the second operation, the very next day, appears to have been a success, which he suggests at the end of the video. As I said in my previous post, his donor pulmonary valve lasting 21 years would be consided a normal result for the Ross. Additionally, needing his aortic valve replaced 2 years after that, would also be common with the Ross. So, I believe his situation- ultimately needing 3 OHS over a 23 year period, is a good example of a likely outcome with the Ross Procedure. It may be a little less time until the 2nd OHS or a little more, but ultimately when getting the Ross at a young age, there will likely be 2 additional valve replacements in one's future.

 

[s9acasl]

Arnold's case is just very strange all around. Guess he was just very fortunate and got a tissue valve that lasted 23 years (especially since he didn't appear to give up weightlifting or anything post procedure)... Who knows, maybe money can buy tissue valves that aren't available to us normal people. I wonder how long his Pulmonary valve would have lasted in the aortic position given his luck with a normal tissue valve.

Either way I do agree that having a Ross procedure at a young age will likely lead to both valves needing to be replaced at least once (hopefully 20+ years into the future!).

 

[Chuck C]

Guess he was just very fortunate and got a tissue valve that lasted 23 years (especially since he didn't appear to give up weightlifting or anything post procedure)...

True. Although, he is vague on some of the details. When he says "it failed" and they had to go back in the next day, that could mean that they replaced his pulmonary valve, which was now in the aortic position, with a bovine or porcine tissue valve. Or, it could mean that he had a paravalvular leak which had to be repaired and still retained the pulmonary valve in the aortic position. It lasted 23 years, which makes me suspect that he retained his pulmonary valve there, as that would be about normal valve life expectancy. If it was a bovine or porcine valve which ended up in his aortic position, that would be remarkable for it to last that long in that he was about 50.

 

[Chuck C]

Who knows, maybe money can buy tissue valves that aren't available to us normal people

I think you need to go to China for that. I hear that they have a very vibrant valve donor program.

 

[s9acasl]

I think you need to go to China for that. I hear that they have a very vibrant valve donor program.

You know I hadn't thought of that, might be worth looking into .

As for Arnold, you're correct, it's difficult to say. It would make sense that his pulmonary valve in the aortic position was just repaired, never read about such a procedure, but who knows.

Also I haven't ever read about paravalvular leakage being an issue with the Ross, but maybe I just missed it in some of the studies.

 

[carolinemc]

You're right about people thinking they are going to get TAVR but not being able to do so. In my case I've been assured that option is on the table. I'm only really considering it if I need to get things in order before OHS which potentially carries huge risks for me, just won't know until it's done.

As for the Ross I've heard wildly differing opinions. The internet is full of videos and studies pointing to it's benefits, and it being ideal for young/middle-age adults. Seems like it's making a resurgence in the aortic valve disease field.

I've noted that it appears to be based on who you speak with. The first surgeon I talked to was 100% for mechanical, but also said I would have to give up most of my hobbies due to the warfarin. The second opinion steered me towards the Ross and the guy had the data to back it up. My personal research has aligned with both of these surgeons opinions.

The Arnold story is interesting. I know a key factor for the Ross to be successful is blood pressure control for up to 6 months post-op, which allows the pulmonary valve to adapt to the increased pressure of the aortic position, and I have seen the story that mentions Arnold got on a lifecycle while still in the hospital which caused it to fail.

As for the pulmonary valve problem I've been assured that TPVR has made great strides since 2010, I know that isn't a guarantee, but it seems fairly routine at this point.

A lifecycle did not cause Arnold to have another Bypass, it was failing from the repair. An exercise machine does not break down the aortic valve. It is over time that failure of the valve is imminent and have to be repaired again or replaced. You do not know what caused his valve to fail, for he eats healthy diet. And careful with the salt intake. Show us proof that Arnold harmed his aortic valve from exercising. I will be waiting for your proof.

 

[s9acasl]

.

 

[Chuck C]

Also I haven't ever read about paravalvular leakage being an issue with the Ross, but maybe I just missed it in some of the studies.

It is a potential complication for any valve procedure. If he got on the bike right after surgery, I'm doubtful that this would have suddenly caused his pulmonary valve to go bad and need replacing. But, the increased blood pressure and volume at a time when the sutures were still fragile could have caused a paravalvular leak. Or, he may have had a paravalvular leak for some other reason. As I mentioned before, the fact that his valve lasted 23 years in the aortic position would suggest that they were able to keep his pulmonary valve there, as this would be normal for a pulmonary valve to survive this long in the aortic postition. However, this would be extraordinary if at his young age a standard tissue valve lasted that long for him, although certainly not impossible.

 

[pellicle]

I'm doubtful that this would have suddenly caused his pulmonary valve to go bad and need replacing

my reaction was sheer speculation.

Further most people come into this knowing nothing, then in a few weeks progress from shock through to a (usually false perception of) "I've got a handle on this". Often this comes from some slick, veracity free, youtube presentation or some slick doctor peddeling an idea that is out of main stream but seems magical and (claims that it) avoids the primary source of anxiety -> warfarin or reoperation.

When they claim "I did my own research" it usually comes down to:

its no skin off my nose.

Who am I to have any more knowledge after 40 years of being in this, growing up from 10 in this, following along the industry as a bystander, thinking about it, having had 3 surgeries myself (spaced apart by about 20 years each), having done a science degree in biochem microbiology, having actually witnessed and also suffered some of the sorts of issues multiple surgeries create, interacted with people here for 10 years ... clearly some guy who's boned up on this in 3 months knows more and can simply dismiss anything I say.

"Good For You" I say