A
alan_delac
I had an appointment with my new cardiologist and thought some of you could be interested in what he had to say. I live in Brisbane ?Australia.
His name is Greg Scalia, he spent several years in Cleveland clinic in US working close to (rather than with) Dr Cosgrove. He is about 44 years old. He spent more than one hour explaining my situation and various options. My impression of him was very positive.
He said if he had to have AVR, he would choose the latest generation pig valve. The main reason would be to have approximately 15 years of care free lifestyle. Of course he explained that in terms of durability the mechanicals are the best.
The interesting info was about homografts. He said that only 3 years ago he would recommend me a homograft, however these days they have to deal with replacing homografts that were implanted 15-20 years ago and that seem to be very challenging. If I understood well, these valves (together with part of aorta) harden with calcification and that hardening somehow penetrates (or gets stuck to) the surrounding tissue. This process makes explanting and replacing these valves very difficult. Now they are trying to implant pig valves inside that hardened aorta.
So conclusion was that homografts are excellent while they last but once they have to be replaced the real problems start.
I asked him about Ross. He said that while working in Cleveland clinic and doing echocardiograms on patients with Ross he saw too many problems with implanted homografts in pulmonary position (within several years from the operation). He thinks that data from the Ross registry do not reflect the real picture and that Ross is not justified at least for our age group. He admitted that if things go well, the solution could last a very long time. I personally would still be interested if I could get a SynerGraft in the pulmonary position.
He mentioned that for about $50000 (cost of the operation) he could organise an operation by Dr Cosgrove at Cleveland clinic. Apparently Dr Cosgrove is able to repair-reshape bicuspid aortic valves. In his opinion Dr Cosgrove is the best surgeon in the World.
I hope some of you find this info useful.
Alan
His name is Greg Scalia, he spent several years in Cleveland clinic in US working close to (rather than with) Dr Cosgrove. He is about 44 years old. He spent more than one hour explaining my situation and various options. My impression of him was very positive.
He said if he had to have AVR, he would choose the latest generation pig valve. The main reason would be to have approximately 15 years of care free lifestyle. Of course he explained that in terms of durability the mechanicals are the best.
The interesting info was about homografts. He said that only 3 years ago he would recommend me a homograft, however these days they have to deal with replacing homografts that were implanted 15-20 years ago and that seem to be very challenging. If I understood well, these valves (together with part of aorta) harden with calcification and that hardening somehow penetrates (or gets stuck to) the surrounding tissue. This process makes explanting and replacing these valves very difficult. Now they are trying to implant pig valves inside that hardened aorta.
So conclusion was that homografts are excellent while they last but once they have to be replaced the real problems start.
I asked him about Ross. He said that while working in Cleveland clinic and doing echocardiograms on patients with Ross he saw too many problems with implanted homografts in pulmonary position (within several years from the operation). He thinks that data from the Ross registry do not reflect the real picture and that Ross is not justified at least for our age group. He admitted that if things go well, the solution could last a very long time. I personally would still be interested if I could get a SynerGraft in the pulmonary position.
He mentioned that for about $50000 (cost of the operation) he could organise an operation by Dr Cosgrove at Cleveland clinic. Apparently Dr Cosgrove is able to repair-reshape bicuspid aortic valves. In his opinion Dr Cosgrove is the best surgeon in the World.
I hope some of you find this info useful.
Alan
