To: Bobm193 Might read this from the archives by Peter Easton:
To: Bobm193 Might read this from the archives by Peter Easton:
Making the choice: RP, homograft, mechanical, tissue
A new member here, facing the fabled decision about valve type and surgery whereabouts. I benefitted from reading thread posted by Peachy.
I am a 59 year old male, congenital aortic stenosis type who has been aware of the impending condition since my sister first had her surgery some 10 years ago. (My Mother actually had a related and successful surgery as well, at the age of 86, no less.) My cardiologist said to hold off till I was symptomatic. Symptoms commenced two months back, more or less. They have worsened, but aren't really very severe -- yet echocardiogram (standard, not TEE) reveals that I am down to 0.6 square cm of aperture, which is, in the official lexicon, just above comatose, I gather. So not too much time to twiddle the thumbs.
I have been considering and studying up and asking about the same question that concerns everyone: which valve, which surgeon? Other things being equal, which they never are, I would prefer avoiding Coumadin. I also gather that there is a small but cumulative failure rate with mechanical valves that makes the likelihood of some sort of mishap appreciable over a period of 10-20 years or more -- and that malfunctions with mechanical valves tend to happen all of a sudden, with little advance warning, unlike deterioration of tissue valves.
The options seem to be (a) Ross Procedure -- not often done with folks my age (though cardiac and general health are more of a consideration than chronological age), due to cross-clamp time and complexity of procedure, but not unknown in the over 55 group either; (b) homograft; (c) new improved bovine or tissue grafts, like Cryograft-S (sp?); and (d) the mechanical ticker. I am intrigued by the RP and its potential for long Coumadin-free function and have found folks on the RP listserve very congenial and supportive (doutless just like those on this one), but it is evidently a borderline call. The rule of thumb that one should go, whatever the procedure, with those who have done a LOT of it would probably mean my traveling out of State (Florida) to, e.g., Cleveland, Beth Israel, Elkins' shop in Oklahoma or the IHI in Missoula, Montana. Other valve replacement options could probably be handled in Tallahassee.
Any advice, happy or horror stories or other viewpoints on the issue would be appreciated. One thing that complicates the quest -- and that I see reflected in other people's postings -- is that both the cardiologists and the surgeons seem to be divided into several camps on these issues and it is rare to get what one might call an objective overview, even when one eliminates the occasional turkeys and blow-hards. Well, it's all what those in my own field of adult education would call a "teachable moment"! Look forward to the lessons you might want to share, with excuses for the length of this posting!
Well, I'll keep you all posted on it and hope everyone is doing well. Hopefully my VR sweatshirt will be here in time to take it to the hospital...which I always feel is too cold. Take care everyone! 
