One of the advantages of the aortic valve replacement using the Ross Procedure is the fact that patients do not require the use of any medications (e.g. Coumadin) following the operation. Recently, however, I learned from Lee Crowley that Dr. Ryan suggests that all Ross Procedure patients take Beta Blockers. My cardiothoracic surgeon, Dr. Vaughn Starnes, has a different opinion as I am not currently taking any medication. Yet, I found Lee’s email to be very interesting. Therefore, I thought I would post it for all you to consider. Here it is:

I am on 50 mg Toprol XL 2X/day. Dr. Ryan (William Ryan III) puts almost all of his Ross patients on a Beta Blocker, as I understand it. I actually called him a couple of weeks ago to see if I could reduce the dosage, and he recommended I not do that at this time.

He said the reason for the Beta Blocker is two-fold.

• One, it keeps my BP in check. He said Ross patients need to keep their Systolic pressure below 120 (preferably around 110). My “normal” BP well before my surgery was around 135/80. Now, it is usually around 112/70.

• Second, the Beta Blocker will reduce my heart rate, especially during activity. This is important to reduce the stress on the heart, especially while it goes through remodelling. I had significant LV Hypertrophy.

Dr. Ryan said he likes to keep his Ross patients on a Beta Blocker indefinitely most of the time. He strongly believes it will help the longevity of the valves. He said I will probably be able to reduce my dosage to 25mg 2X/day at 1-year post-op, and down to 25mg 1X/day one year after that.

I mentioned side effects in my previous post. One side effect I attribute to the Toprol XL is I feel a little sluggishness when I play tennis. I play at a pretty high level, and feel a “micro-second” slow when I play. That’s the best way I can describe it. I played tennis right up to my surgery and did not have this problem. Also, I am cold a lot more often than before, which is a known side effect.

I also occassionally have weird, vivid dreams that I did not have before. I actually enjoy this side effect.

These are not really significant in the grand scheme of things. I can definitely live with them.

I hope your recovery continues to go well. I really enjoyed your pictures of the surgery.

Lee

[Lee Crowley is not a medical professional. The information presented above is presented for discussion purposes only.]

I recently entered into an email thread with Stretch, a Ross Procedure patient that had some very interesting data to share about the statistics and data about the success of the Ross Procedure. As some of you may know, the Ross Procedure is a special type of aortic valve replacement. With his permission, I am posting it below for you to read. Also, Stretch documented his operation in a very unique set of pictures. You can see those pictures by visiting Stretch’s site. The link is below. Without further ado, here’s Stretch:

I’ll mention a few of things that should be weighed heavily by anyone considering a Ross, which I learned over the course of several months of research on the procedure, including talking with or e-mailing a number of prominent surgeons both here and in Europe:

First and most importantly, the Ross is an exceedingly complex procedure from a technical standpoint. The Society of Thoracic Surgeons rates it a more complex operation than a heart transplant, for instance. I have read in any number of places that the procedure’s success or failure is in large measure determined by the experience of the surgeon performing it, and that means experience with the Ross, not with valve replacement in general. Secondly, because of the added cutting and stitching, the Ross is a longer procedure than the more common valve replacement techniques. For an otherwise healthy individual this should not be an issue, but it can become an issue if the patient has concomitant health issues such as diabetes, kidney disease, obesity, pulmonary problems, or, especially, coronary artery disease.

Thirdly, while the Ross is generally accepted as a very good solution for very young patients, its efficacy in comparison to, for instance, a stentless porcine valve is reduced if the patient is older. The porcine valves

calcify much more slowly in older patients, so in this population the goal of one-valve-for-life may be achieved just as well with a simpler tissue valve operation as with the more complex Ross Procedure.

Fourth, the Ross is not recommended for Marfans patients, or patients whose primary pathology is regurgitation as opposed to stenosis.

Finally, I will say that I somewhat agonized over valve choice for a number of months, and, indeed, finally settled on the Ross. It has been called the “gold standard” of valve replacement surgery, and, statistically, has about an 85% chance of keeping one free from re-operation after 20 years. The hemodynamics of the native pulmonic valve in the aortic position are also superior to either the mechanical or tissue valves.

I’m feel very luck that, at least in the minds of a few surgeons with whom I spoke, I was a nearly ideal candidate for the Ross, and so far I’m thrilled with the results. The proof, of course, won’t come for another 20 years or so. So I’m enjoying the ride while it lasts.

I have posted a number of documents pulled from various source on my web site, http://stretchphotography.com/avr/images, just in case you’re interested in continuing your research about the Ross.

All the very best wishes-
Stretch

[Charles "Stretch" Ledford is not a medical professional. The information presented above is presented for discussion purposes only.]