Christopher's Journal

Hi Everyone,

My surgery is scheduled for tomorrow morning.  I just spoke to my surgeon and finally know what the options are.  I only have a short time to come to peace with one of these or to atleast give my preference.  I'll start by saying below are my options since I decided I don't want any attempt at fixing my failed pulmonary valve (installed as my aortic valve via a Ross Procedure early 2024).  I also don't want a mechanical valve or another bovine valve.  I'll spare the full analysis on why I've decided these things but they were not quickly eliminated.  Especially after seeing Cathleen Weed's past posts about going to the Edwards facility and reading how strong the Resilia tissue is.  I had an Edwards bovine valve installed in 2017 and it failed prematurely so I'm worried my body doesn't like the bovine tissue.  I also have a larger valve size which complicates things (the Edwards bovine valve I received previously was a 29mm).  

Option 1: Install an Epic Max 25mm Valve.  The hands down winner would've been the Epic Max 27mm with a stent ID of 28.4mm.  A larger stent ID than the Edwards 29mm valve I originally had.  However, this Aortic valve has not been approved for use in the United States.  It is currently being used with good results in Europe.  The Epic Max 25mm may or may not fit me well.  If it is a good fit then I want it installed.  If when the surgeon is sizing things it looks too small then I must decide between the next two options.

Option 2: Install an Epic Max Mitral Valve (size tbd) upside down.  This is apparently something that is occasionally done when they can't find the proper valve size for an aortic prosthesis.  After an initial Google search I am questioning the technique given the mitral valve has two leaflets as opposed to three.  That seems to be too close to my original God given bicuspid valve although my surgeon seemed to think this was a good option.  So more research needs to be done before deciding how I feel about this.

Option 3: Homograft valve, that is to have a cadaver aortic valve (presumably with root) installed.  I'm told this would have a similar life span to a bioprosthetic valve.  It's far less common than a Ross Procedure given they have a longer life expectancy.  However, given there may not be a great porcine bioprosthetic option it should be considered.  I'd love to hear from anyone that has had this done regarding their experience.  I am told it would offer me the most realistic experience in so far as hemodynamics.  I'm thinking it offers me the most realistic  tissue valve experience my initial concern is whether my body would be at risk of rejecting it.  I know that is always a risk and while my homograft pulmonary valve is working fine a year and a half after install it seems the aortic valve brings added risk with the higher pressures.

I'm sharing all this in hopes someone might weigh in with thoughts on option 2 or 3.  I am fairly convinced option 1 is what I want, however, it may not fit properly in which case I need to be prepared to tell the surgeon tomorrow morning what my preferred backup plan is.  If you have had either of these performed or have feelings about which you would choose please share.  I need all the feedback I can get as I spend time mediating today.


Thanks,

Chris

My beautiful wife Christina and I were blessed with a trip to Denver Colorado earlier this month.  We visited Rocky Mountain National Park.  It was such an amazing trip and will be one of the places I think about while going through my next surgery.