Ross-Homograft

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Response from doctor

Response from doctor

Chris,
I sent off a portion of your post to Dr. Stelzer this morning and just received this reply. I'm going to try and copy it here, but if it doesn't work, I'll forward it to you as an email message. I think it will be of interest to several.
Mary

His response:

Thanks for the question about the potential for trouble in the homograft department. I think most of the homografts shrink a little bit after surgery and there is certainly scarring that occurs at the ventricular end that narrows them somewhat as well. I have made a habit of oversizing to try to overcome these problems. I also keep folks on Motrin for about a month to decrease the inflammatory response to the surgery and the homograft.

The question of immune response is one which is difficult to prove, but there probably is some of this going on as well. The majority of antigenic stimulation is eliminated by the freezing process, but there is always a little leftover for the recipient to respond to. Like Peter Skillington in Australia, I have never had to remove a pulmonary homograft for reason of stenosis, but I have one young fellow who may come to that because of a very high gradient across his. We've been watching it for several years with echo and even MRI. Once, we tried to dilate it with a balloon, but it didn't do much.

If a problem is going to develop of the stenosis variety, it will always begin rather early. That means, if there is no gradient of significance at two years post op, it won't happen. The major long term issue is slow degeneration with regurgitation to be expected after many years. That is very well tolerated by the right ventricle and can go on like that for many more years. The long term results are so good that it is impossible to justify giving anti-rejection drugs to make it better. We'd get more problems from the drugs... I don't think anybody matches blood type because it has never been shown to make a difference. The issue of limited supply makes this a rather moot point. For a while, we were trying some special homografts called "Synergraft" from Cryolife in Atlanta. These were homografts from which all the donor cells have been removed to minimize immune responses. The theory was good and the initial animal and human studies were encouraging, but the FDA (in its twisted wisdom) has restrained Cryolife from releasing this tissue for the last two years. I don't think there is a really good reason for this, but the bottom line is that we can't get these grafts for the time being. I was intrigued by the possibilities of the concept, but a bit cautious that there might be other unforeseen problems. It's hard to give up on something as good as we already have without a very good reason. I think in someone who clearly "rejected" his homograft, the Synergraft is the right choice for replacement parts.
 
Mary, thank you for posting your surgeon's response! I have my Ross scheduled for the 29th and my surgeon and I briefly discussed the rejection issue and he said something very similar.

Stephanie
 
Stephanie,
I was glad to post his response. It's a good thing :) when we can gather and compare information.
How is the waiting going for you?
Mary
 
Hi Mary,

Well everyone keeps talking about getting to the "other side of the mountain," but right now it feels more like a roller coaster. I've known this operation was coming for all my life and I am not sure that has made it any easier on me or my family. But I am learning how to manage it and I can tell you I am looking forward to getting past the operation and being healthier! These forums have helped me tremendously and I can't imagine what life would have been like without all of the fine people on here touching my life.

Warm Fuzzies for all! Stephanie :D
 
Stephanie,

A roller coaster is a good analogy. When you wake up from surgery, you will think that a train somehow got onto that roller coaster track and ran smack into you.

By the time you're home from the hospital, though, you will feel like you have climbed a mountain, planted the flag at the top, and are merrily skiing all the way down the "other" side. And it gets better from there.

Best of luck to you as you make the final preparations. Please keep in touch with us here.
 
Thanks Mary!

Thanks Mary!

Sounds like you have a great surgeon. It's so reassuring to know you are in brilliant hands. I'm impressed that he also gave you such a quick response. His thoughts seems to parallel my surgeon's. It's great that you are finding out about all of this, because I wasn't aware of this possibilty until after surgery and it was a bit of a shock. Upon saying that though, I think it's good to keep in mind (and for Stephanie too!), that this is a really rare scenario, so try not to dwell on it too much as I'm sure it won't occur in your cases. I'm expecting a perfect outcome for both of you!
Regards,
Chris
 
Dr. Stelzer is amazing and IMHO the best Ross Surgeon going. He is just one of the most remarkable doctors I have ever known. His response to Mary is an example of why I don't ultimately rely on cardios. Anything my PCP or cardio tells me I either call or e-mail to Dr. Selzer and ask his opinion and I get a fast reply. We stay in constant touch.
 
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