Written By: Adam Choose, Affected person Advocate, Creator & Web site FounderMedical Knowledgeable: Ismail El-Hamamsy MD, PhD, Cardiac Surgeon, Mount Sinai HospitalPublished: April 23, 2024
I simply acquired an awesome query from William concerning the Ross Process, a complicated type of aortic valve substitute that strikes the affected person’s pulmonary valve into the aortic place.
A Wrapped Pulmonary Valve Used Throughout Ross Process
William requested me, “Hello Adam, I’m at present 37 and looking out on the Ross Process for substitute 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 methods throughout the Ross Process. Appears everybody agrees that the brand new aortic (previous pulmonary) valve must be strengthened however the surgeons all appear to have their very own desire on how one can 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 could have any perception the professionals/cons of every method or conscious of any information evaluating the totally different choices? I do know good Ross outcomes are extremely depending on the method so attempting to assemble all the knowledge earlier than selecting between two surgeons. Thanks prematurely!”
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 rapidly 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. The query is a crucial one. The overarching objective of the Ross process is to have a residing aortic root performing all the conventional capabilities of a standard aortic valve. A standard aortic root is a extremely dynamic construction that modifications form and kind repeatedly to adapt to totally different situations. This optimizes coronary circulate, reduces the stresses on the valve cusps and minimizes the workload on the ventricle. The primary concern with wrapping the aortic root inside a Dacron graft is that it prevents this dynamism altogether.
Dr. Ismail El-Hamamsy
It encases the foundation throughout the stiff graft. Whereas it positively prevents root dilatation in the long run, it takes away a lot of the advantage of the operation within the first place. So how can we then stop root dilatation whereas preserving root dynamism? That is the place meticulous surgical method 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 change into an aortic root. Final yr on the AATS, I introduced our 10-year outcomes from my first 455 sufferers. Observe-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 have been very steady in dimension, with no circumstances 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 consider it would negatively influence the outcomes in the long run. I hope that is useful. Have an awesome 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 medical experiences and analysis particular to the Ross Process!
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Carry on tickin!Adam