Dale--
I've only been on this forum a week; there are some great people on here.
I'm your age--had my aortic valve replaced last December. I, too, had always been asymptomatic--so much so that I didn't even KNOW I had a bicuspid valve until I got infective endocarditis--in other words, REALLY sick, during which illness my valve was destroyed, which led to the replacement. My doctors have said, based on what they saw while they were in there, that the valve was also probably mild to moderately stenosed (narrowed), but again, I have a hard time believing that since I was always very athletic--big bike rider, bodybuilder, etc., and never noticed much shortness of breath or any of the usual symptoms. Maybe since I had always had it I was just used to it, I don't know. (I will say that what the doctors predicted is true--I might not have had any concrete "symptoms" of heart trouble before, but now, seven months post-op, I feel 1000 times better--I have more energy than ever before, I feel like Superman compared to the way I've always felt.
I had the Ross Procedure. They replaced my diseased aortic valve with my own healthy pulmonic valve, (structurally, nearly identical to the aortic), and replaced my pulmonic valve with a human cadaver homograft.
Homografts are known to last longer in the pulmonic position than the aortic. Apparently, the best known replacement for an aortic valve is another living tissue valve, which is why your pulmonic apparently makes a good replacement. My surgeon put it this way: Tissue valves wear out soonest, mechanical valves last forever, Ross replacements probably fall somewhere in the middle. Upsides are, decent length of time before re-operation (my surgeon threw around numbers like 20-25 years, vs. 10-15 for tissue valves) and no coumadin. (Which, as people will tell you , for most people isn't a problem--but if you're athletic at all apparently there are all sorts of contraindications to what you can participate in--for risk of bleeding, external and internal. I wouldn't know, cos I'm not on it...) Downsides are, it's a longer, more complicated procedure, you need a surgeon that's got a lot of experience doing it, it turns a single valve replacement into a double valve operation; and down the road, truth is, you've got two valves that might need replacing later. Tho, any data I've been able to dig up suggests the autograft in the aortic position will last; it's the homograft in your pulmonic that might need to be replaced. This still isn't a bad situation to be in--when your aortic valve goes, you need a new one, no questions asked. There are case histories of patients with stenosed, insufficient, or MISSING pulmonic valves living normal lives. (i.e. if that valve fails, it's not as big a deal...) When my surgeon put it to me that way, there was no question--I didn't want an aortic tissue valve that would definitely need replacing, vs. my own re-implanted neo-aortic valve that would probably be ok with the cadaver implant on the pulmonic side that isn't as big a catastrophe if it fails.
I've all but decided I'll never be able to go balls-out full-throttle on the weightlifting again (so says my cardiologist), a fact I'm getting used to, but I have every intention of completing my 575 mile bike ride next summer and the Ironman Triathlon in Honolulu after that. My doctors say these are not unreasonable goals, with my Ross homograft, but that I probably wouldn't be able to consider it if I had a mechanical valve/coumadin.
I've seen lots of Ross naysayers--people who had one and needed re-operation sooner than expected, etc. To tell the truth--the surgery was a SNAP. Couple of days on heavy drugs then released. Sure, there's a couple of months of recovery and all that, but it didn't bother me. If I need another surgery, all that means to me is another six months off work to relax. I was so sick in the hospital I didn't have time to weigh all the options--but in retrospect, even in light of all my research since, I'm glad I got the Ross Procedure. In someone our age, who hopes to maintain any semblance of an athletic life, it's the only thing that makes sense to me. Had I had all of this information, I would have decided on the Ross myself, anyway. It's like this--you get one shot at a Ross--see if it works. If it does, you get a possible 25 years before re-operation, free of anticoagulation worries and the prospect of resuming your previous athletic lifestyle. If, later, it turns ot not to last that long and you end up needing, say, a mechanical put in, you're not out anything (much).
I know there are people on here who had a Ross and didn't have good results but it surprises me that nobody has mentioned that for a 35 year old asymptomatic patient who is a weightlifter and otherwise athletic, the Ross Procedure was practically TAILOR MADE for patients like you...
I'd say ask your doctor about it, at the very least, and see what he says.
Scott
, waiting for the anti-Ross backlash now, unless this forum is significantly different than the others I'm on...
