Written By: Adam Choose, Affected person Advocate, Creator & Web site Founder
Medical Skilled: Ismail El-Hamamsy MD, PhD, Cardiac Surgeon, Mount Sinai Hospital
Printed: April 22, 2024
I simply obtained an ideal query from William concerning the Ross Process, a sophisticated type of aortic valve alternative that strikes the affected person’s pulmonary valve into the aortic place.
William requested me, “Hello Adam, I’m presently 37 and looking out on the Ross Process for alternative of my aortic valve. I’ve a tissue valve that was put in once I was 25 that now has aortic stenosis. My query is across the autograft reinforcement strategies in the course of the Ross Process. Appears everybody agrees that the brand new aortic (outdated pulmonary) valve must be bolstered however the surgeons all appear to have their very own desire on the best way to reinforce it. Some use the prevailing aortic tissue with no exterior graft and a few use an exterior Dacron graft to wrap the brand new valve & aorta with all kinds of nuances between the 2. Would you have got any perception the professionals/cons of every approach or conscious of any information evaluating the completely different choices? I do know good Ross outcomes are extremely depending on the approach so attempting to collect all the data earlier than selecting between two surgeons. Thanks upfront!”
To assist William, I wasted no time contacting Dr. Ismail El-Hamamsy, a number one Ross Process surgeon at Mount Sinai Hospital in New York Metropolis and present President of the Coronary heart Valve Society. Dr. El-Hamamsy has carried out over 500 profitable Ross Procedures.
Dr. Ismail El-Hamamsy Says…
I used to be amazed at how shortly Dr. El-Hamamsy responded to William’s query. Dr. El-Hamamsy wrote in his e mail to me:
Adam, Thanks for reaching out about this. By the way, I noticed William in clinic a few weeks in the past. The query is a crucial one. The overarching objective of the Ross process is to have a residing aortic root performing all the traditional capabilities of a traditional aortic valve. A standard aortic root is a extremely dynamic construction that modifications form and type repeatedly to adapt to completely different situations. This optimizes coronary stream, reduces the stresses on the valve cusps and minimizes the workload on the ventricle. The primary challenge with wrapping the aortic root inside a Dacron graft is that it prevents this dynamism altogether.
It encases the foundation inside the stiff graft. Whereas it undoubtedly prevents root dilatation in the long run, it takes away a lot of the good thing about the operation within the first place. So how will we then stop root dilatation whereas preserving root dynamism? That is the place meticulous surgical approach as we’ve been discussing and educating for a few years comes into play (deep insertion of the autograft, trimming above the commissures, native aortic jacket and so on..). And the important thing a part of that is cautious BP management within the first 6-12 months after surgical procedure. This enables the pulmonary root to develop into an aortic root. Final yr on the AATS, I offered our 10-year outcomes from my first 455 sufferers. Comply with-up is 99% full, together with echos. At 10 years, the necessity for reintervention was 2.3% on the autograft. And on echo, the sinuses of Valsalva had been very steady in dimension, with no instances of root aneurysms.
So in abstract, the objective is to forestall root dilatation all of the whereas preserving root dynamism. Wrapping impairs the latter, which is why I don’t advocate to do it. I imagine it is going to negatively affect the outcomes in the long run. I hope that is useful. Have an ideal day! Ismail
Many Due to William and Dr. El-Hamamsy!
On behalf of our group, many due to William for his query and lots of due to Dr. El-Hamamsy for sharing his scientific experiences and analysis particular to the Ross Process!
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Carry on tickin!
Adam