[HSF] AI and ASC AO Aneurysm s/p Ross procedure

[Ani Anyanwu]

Hal
 
I also do not think a third AVR is an operation with such prohibitive risk as to mandate mechanical replacement. Remember too that his third operation will hopefully be in 10 to 20 years and surgical risk will likely be even lower or even percutaneos rereplacement may be feasible.
 
For a patient in his 40s I would not persuade against a second tissue valve. Depending on his lifestyle, avoiding warfarin for another 10 years may be of great utility. Remember that regardless of what you do - even mechanical valve - it is likely at this age  that he will require another operation. Having said that, if you do a mechanical aortic valve in a bid to prevent need for future surgery, what would you do with the pulmonic valve? Another mechanical valve? His pulmonic valve will be a potential source of reoperation independent of what you do to the aortic.
 
We have seen a few young patients having their second AVR who also wanted (and got) tissue valves and I think in most instances it is a reasonable thing to do. Certainly if I were the patient I would not want a mechanical valve. I think he has gone so far (in having the ross which is the most drastic of tissue valves) that its not that easy to go back (to the easy mechanical option he avoided 12 years ago). 
 
Ani



> To: OpenHeart-L at lists.hsforum.com> Subject: Re: [HSF] AI and ASC AO Aneurysm s/p Ross procedure> Date: Sat, 8 Sep 2007 09:48:18 -0400> From: tdmartin2000 at aol.com> CC: > > Hal> I wasn't suggesting that tissue valves were the only way to go. In fact I too would strongly suggest a mechanical valve in this situation. However if the pt was adamant that they didn't want a mechanical valve for whatever reason, then various tissue valves/techniques should be considered. In young pts which this pt would still be at his 3rd op, if the cardiac function is still good and there are no other really bad comorbidities then the M&M in our hands doesn't seem to be that much worse.> > Tom> > > -----Original Message-----> From: Hgrmd at aol.com> To: OpenHeart-L at lists.hsforum.com> Sent: Fri, 7 Sep 2007 6:54 am> Subject: Re: [HSF] AI and ASC AO Aneurysm s/p Ross procedure> > > > Tom and Carmi,> I have to agree with Dr. Salerno that the patient should strongly consider > getting a mechanical Bentall. At his tender age, it is almost guaranteed > that he will outlive a tissue valve. The 3rd time in will carry a hefty M and > M. > BTW, I was thumbing through the September issues of Annals last night and > came across Tirone David's group's report of redo stentless valves. Most > were SPV's, though a few were Freestyles. The thrust of the article was that > this is a technically difficult, high risk procedure that usually entails root > replacement. To me, that's just another reason that one should think long > and hard before implanting a stentless valve, particularly full root. To me, > it just doesn't seem justified to take out a normal root in the quest to > implant a stentless valve.> > Hal> > > > ************************************** Get a sneak peek of the all-new AOL at > http://discover.aol.com/memed/aolcom30tour> _______________________________________________> OpenHeart-L mailing list> > Send postings to:> OpenHeart-L at lists.hsforum.com> > To UNSUBSCRIBE, to CHANGE email address, or to view archives:> http://mmp.cjp.com/mailman/listinfo/openheart-l> > All messages transmitted by the OpenHeart-L are subject to the policies and > disclaimers posted at:> http://www.hsforum.com/listdisclaim> -----------------------------------------> > > ________________________________________________________________________> Email and AIM finally together. You've gotta check out free AOL Mail! - http://mail.aol.com> _______________________________________________> OpenHeart-L mailing list> > Send postings to:> OpenHeart-L at lists.hsforum.com> > To UNSUBSCRIBE, to CHANGE email address, or to view archives:> http://mmp.cjp.com/mailman/listinfo/openheart-l> > All messages transmitted by the OpenHeart-L are subject to the policies and > disclaimers posted at:> http://www.hsforum.com/listdisclaim> -----------------------------------------
_________________________________________________________________
Celeb spotting – Play CelebMashup and win cool prizes
https://www.celebmashup.com