Ross vs Mechanical

[Pixelgrowth]

1) The vast majority do not self test, but test at the lab about every 4 weeks.
2) The amount of people that don't take their warfarin management seriously and are noncompliant is remarkably high.

Studies have shown that those who self test have far fewer events and spend a higher % of time in their therapeutic range. Even given my points #1 and #2 above, this study and others found that the stroke risk is the same with mechanical vs bioprosthetic. If one is committed to 1) self testing and 2) being serious about warfarin management and being compliant, then it is likely that the stroke risk of having a mechanical valve would be even lower than having a tissue valve.

Thank you for this information. I do find that wild that people wouldn't take their medication serious. But it does make me feel better to know. I would definitely be resting at home. And ensuring my medication is taken properly.

 

[pellicle]

I do find that wild that people wouldn't take their medication serious.

some studies
one
two

there are many more, and basically I feel that if you're here and asking questions then you probably aren't one of those 50%

 

[Pixelgrowth]

as tempting as it is, lets not do 'horror stories' here ;-)

(no career in law or fire dept on my side, I just happen to know a lot of them)

Spoke with my surgeon today. We both came to the conclusion that the Ross procedure may not be the best option. Mainly due to the two valve problem But we are still undecided on homograft vs mechanical. I asked him what he'd do in my shoes and he didn't have an answer. He's going to do some more digging for me. He said he does both all the time but my case is different. But ultimately he said once we get in there it may not matter what we pick if my roots aren't there enough for a mechanical valve then we'll go homograft.

 

[pellicle]

Hi

as you know my 2nd OHS was a homograft, I got 20 years out of that, however the current state of the art for that is very institution dependent. Some institutions get good results others 'average' (in terms of homograft vs bioprosthesis. This has led even my institution (which was among the world pioneers in this in the 1990's) to entirely get out of homografts and relinquish their tissue bank.

But ultimately he said once we get in there it may not matter what we pick if my roots aren't there enough for a mechanical valve then we'll go homograft.

I'm not a surgeon, but this is the first time I've ever heard that. I've heard the opposite in fact. So I'd double check that.

from my institution study link:

The homograft aortic valve: a 29-year, 99.3% follow up of 1,022 valve replacements.​

​

Preservation methods (4 degrees C or cryopreservation) and implantation techniques displayed no difference in the overall actuarial 20-year incidence of late survival endocarditis, thromboembolism or structural degeneration requiring operation. ​

​

Freedom from reoperation from all causes was 50% at 20 years and was independent of valve preservation.​

​

Freedom from reoperation for structural deterioration was very patient age-dependent. For all cryopreserved valves, at 15 years, the freedom was ​

⦁ 47% (0-20-year-old patients at operation), ​

⦁ 85% (21-40 years), ​

⦁ 81% (41-60 years) and ​

⦁ 94% (>60 years). Root replacement versus subcoronary implantation reduced the technical causes for reoperation and re-replacement (p = 0.0098). ​

CONCLUSION:
This largest, longest and most complete follow up demonstrates the excellent advantages of the homograft aortic valve for the treatment of acute endocarditis and for use in the 20+ year-old patient. However, young patients (< or = 20 years) experienced only a 47% freedom from reoperation from structural degeneration at 10 years such that alternative valve devices are indicated in this age group.
The overall position of the homograft in relationship to other devices is presented.



Best Wishes

 

[Pixelgrowth]

I'm not a surgeon, but this is the first time I've ever heard that. I've heard the opposite in fact. So I'd double check that.

I'm not either so I'm not sure. He made it seem like the homograft has more tissue attached so they have more to work with vice a mechanical with the synthetic tissue tubing.

 

[pellicle]

I'm not either so I'm not sure.

I'd read this
https://www.ncbi.nlm.nih.gov/pmc/articles/PMC5070343/

and double check that you didn't hear wrong because my quick read (and my many although long ago discussions about this topic with the surgeon who did my homograft) suggest that the root isn't an issue with a prosthesis.

from: https://www.ncbi.nlm.nih.gov/pmc/articles/PMC3741810/