Thanks for your thoughtful reply, Karlynn. Clearly, valve choice is a very personal decision.. I'm just posting my thoughts, which may or may not have any relevance to anyone else's situation.
Yes, the risk goes up with re-dos, but it is still minimal. This was mentioned to me in an e-mail I received this morning from a surgeon in Germany. I've copied and pasted it below, including my original e-mail to him. The paper he mentions is at
https://www.stretchphotography.com/avr/SieversOnRoss.pdf
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Dear Charles ?Stretch" Ledford
Thank you for your e-mail. Ross or not is a question of attitude of the
surgeon and the patient. For the surgeon Ross is difficult, putting a lot of
responsibility on him. But the surgeon will very rarely get a follow-up call
telling that his patient is on the neurosurgical unit with brain bleeding due
to warfarin as an anticoagulant that is necessary with mechanical valves. But he will sometimes get back a patient for a redo especially on the homograft in the Ross. Long term results are scarce, we have 12 years experience (the paper is attached: Sievers HH. A Critical Reappraisal of the Ross Operation. Circulation. 2006; 114[suppl I]:I-504 ˆ I-511.) on 430 cases with 15 redoes now all of these went home after 10 days. To make it short, if you don't care taking warfarin and if you can keep the anticoagulation level constant, and if you are not disturbed by the click noise of the mechanical valve and if you are not afraid of getting a major bleeding or thromboembolism (risk of 1-2% per patient year) than take a mechanical valve. If you like near physiological hemodynamics but don't
care getting a redo (risk around 1% per patient year for Ross, about 0.3 for
mechanical valve) try to get a Ross.
However, a Ross is not always possible in every patient (in 5% anatomy of
aortic root or pulmonary autograft prevents a Ross). There is only one paper
with longer-term Ross patients (see Chambers JC. Pulmonary Autograft
procedure for aortic valve disease. Long-term results of the pioneer series.
Circulation. 1997; 96: 2206-2214 ). What is outstanding with Ross is no
medication, normal life expectancy, normal hemodynamics, almost zero risk of
bleeding and thromboembolism, no noise but the increased risk of redo.
I am working (or in your words burning) since 25 years developing mechanical
valve without the necessity of taking warfarin which would be a real progress
in valve surgery. We are now on a good way in the project, but not ready for
clinical implant. If you are interested and probably have an idea to support
this work please contact me.
If you like more information on the Ross please specify.
Sincerely
Hans H. Sievers
>Betreff : Ross Procedure
>Gesendet: 30.08.06 06:46:30
>An : "sievers@xxxxxx"
>Von: "Charles \"Stretch\" Ledford <
[email protected]>"
>----- Original Message -----
>Hello, Dr. Sievers. I found your e-mail address on CTS Net. Dr.
>Oury in Montana mentioned your name and your work to me during a
>telephone conversation this afternoon.
>I am a 43 year old male with congenital aortic stenosis. I have a
>bicuspid aortic valve. I am otherwise healthy- non-smoker, moderate
>drinker, very active, 6'4" tall and weigh 189. (Up from 155 about 3
>years ago!)
>My heart disease has been followed yearly since I was an infant. I
>have been asymptomatic until recently, when I gradually began to
>experience shortness of breath.
>A cardiac catheterization a few weeks ago indicated that it is time
>for me to have my valve replaced.
>My cardiologist, Dr. George Vetrovec, has recommended that my native
>aortic valve be replaced with a mechanical- probably a St. Jude. The
>surgeon here in Richmond, Virginia, Dr. V. Kasirajan, concurs.
>I am very interested in the Ross Procedure, and have spent way too
>many hours online researching it. Neither Drs. Vetrovec or Kasirajan
>are very enthusiastic about the Ross.
>Although the short and mid-term results of the procedure seem to be
>promising, I've not found much data (I don't know if it exists) on
>the long term prospects of the Ross.
>If you have any thoughts on the Ross, and especially any data on long
>term outcomes of your surgeries, I'd be very grateful if you'd share
>them.
>Thank you for your time.