[HSF] Ao Wraping

[DukeB60 at aol.com]

The controversy unquestionably exists with  the Ross and the concerns are 
well founded.  Usually the decision for my  patients comes down to a minimally 
invasive partial upper sternotomy Magna vs. a  Ross.  Very few patients choose 
the mechanical valve and life long  coumadin with the one to one and a half 
percent per year risk of bleeding  or thrombotic complications which are 
cumulative over the life of the patient or  the valve.  In my personal series the 
operative mortality is under one  percent with the only death being in a 23 yo 
male redo who had an infected  mechanical prosthesis with destruction of the 
annulus who died from MOF due to  sepsis.  He could have had an allograft root 
replacement or the Ross but I  don't think it was the decision to do the Ross in 
his particular case that  resulted in the unfortunate outcome.  So far two 
have been reoperated for  autograft dilation and in those two one had his 
ascending aorta only replaced  with preservation of the neo-aortic valve and the 
other had a root including  valve replacement after a failed attempt to repair the 
autograft valve.   Both are doing fine.  Although my follow up is admittedly 
not complete and  the number of years out varies from ten years to days the 
operative  mortality is less than one percent and the freedom from reop is 98  
percent.  A few of the Ross's have involved redo's to remove  mechanical valves 
as the patients had failed valves either due to infection or  pannnus and 
wanted to get off of coumadin. One case involved the removal of a  Starr-Edward's 
ball-cage valve with the dacron covering which had  frayed that was causing 
TIAs and he elected to have a Ross for his  replacement  The Ross reops I have 
done were quite easy and both were prior  to buttressing the autograft with 
the Hemashield.  There have been no  instances of allograft stenosis or injury 
to the first septal perforator,  although one must be very aware of the latter 
to avoid it.  Our aortic root  conference next October with Sir M. Yacoub 
focuses a fair amount of attention to  the Ross and Dr. Takkenburg will look at 
the long term data for the Ross.   I'm not sure it is a dead option at all but 
it is without question a much more  demanding and controversial procedure than 
a simple prosthetic  replacement.  
 
Edward P.  Raines, M.D., J.D.
BryanLGH Cardiothoracic Surgery
BryanLGH Medical Center  East
1600 South 48th Str.
Lincoln, Nebraska 68506
Office:  402-481-8430
Cell: 402-730-9242
Fax:  402-481-8429



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