[MUSIC PLAYING]
JOSEPH DEARANI: The challenge with treating aortic valve disease in children centers around the low probability of being able to repair, save the child's own valve versus the need for replacement.
ELIZABETH STEPHENS: We don't have a durable, long-term option for them, and that's in contrast to adults. And there are two main reasons for that. One is that the children are not full grown, so anything that we put in them will not grow with them. It becomes too small basically just like outgrowing their clothes. And the second is that the options that we use in adults, in terms of valve replacement, aren't good for children.
JOSEPH DEARANI: The survival curve that is the very best is with the Ross procedure, which came about after Donald Ross, who was a European surgeon, who took the pulmonary valve, which anatomically is nearly identical to the aortic valve, and he moved it into the aortic position and then replaced the pulmonary valve with a human pulmonary homograft.
ELIZABETH STEPHENS: The aortic valve is a very important valve in terms of the heart function. And so, if a patient has a good pulmonary valve, this is a valve that we can use in that location that grows with them, that is overall durable, that doesn't require blood thinners. And once you have that in place, then we use a homograft where the pulmonary valve was. And that's a more replaceable valve. And over time, we do replace that valve.
The durability of the Ross does vary quite a bit. And that depends on the age of the patient when they first had their Ross as well as the institution. Overall, if the Ross was not reinforced, it's about a 85% 10-year durability for the Ross itself-- so in other words, their new aortic valve. But certain centers have shown well over 90% 20 years. And so this just points to the level of expertise in the procedure itself.
JOSEPH DEARANI: I emphasize right up front that this is the first of a series of interventions and operations. And the quality of life in between these points of intervention is really good. And the ability to participate in sports, and go to school, and do all the things that other children are doing is overwhelmingly on their side.
And that's the message that I think the parents need to hear and just come to terms with the fact that they're going to be sporadic points in time where they're going to be visiting with a cardiologist and a surgeon, but the risk of that procedure, if it's done in the right institution and in the right hands of a surgeon that's doing it all the time, it will be very low.
ELIZABETH STEPHENS: The other thing that's really special about Mayo is the strong collaboration between specialties-- so the ICU team, cardiology team, imaging team, OR team. And that's something that's really required for the Ross procedure.
JOSEPH DEARANI: The importance of a procedure like this being performed in an environment where it's performed frequently is critical.
ELIZABETH STEPHENS: We're actually able to work pretty seamlessly with your home cardiologists or your home doctors to try to either provide some counsel if that would be of help or provide some opportunities for you to come here for surgery.
JOSEPH DEARANI: The story is almost all positive. The quality of life that the overwhelming majority of patients will experience and great longevity with near normal, if not normal, life spans for many, many lesions that we deal with. That's the message that patients and families need to hear. It's hope, and it's positive. That's what they need to know.
