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St. Jude Pig valve vs. Edwards Cow valve

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  • St. Jude Pig valve vs. Edwards Cow valve

    Which of these valves is better?
    Why do some hospitals use one over the other?

    My understanding of the St. Jude Pig valve is that two pig valves are manufactured into one valve. Apparently a fully intact pig valve is not ideal because one of the three leaflets does not work great due to a thick muscle or thick tissue area. Therefore, good leaflets are harvested from two pig valves and manufactured into one valve.

    My understanding of the Edwards Cow valve is that an actual cow valve isn't used at all. Rather, heart tissue from the cow is harvested and manufactured into a valve somehow.

    Before meeting with two surgeons, I just assumed or envisioned that they would just take the actual intact cow or pig valves and use those to replace our valves. I was taken aback a bit to learn otherwise. So, which is better? It seems to me that there is more of a likelihood of something going wrong with a Cow Valve because an actual cow valve isn't even being used. Both surgeons I met with are of the opinion that both cow and pig valves perform nearly identically. One of the surgeons prefers Pig because technically it is easier for him to manipulate during the surgery. The other surgeon prefers Cow and I don't remember exactly what his basis was.

    Do different surgeons use different valves based upon their preference or is their a contract between the manufacturer and the hospital?
    Birth - diagnosed with BAV with Regurgitation.
    September 2010 - Eccho reveals worsening BAV.
    December 2010 - Endocarditis

  • #2
    It depends who you ask which of the 2 are the "best"
    I don't know about which pig valve you are describing,(do you know the name of it?) but the CE bovine, (perimount) is made from the pericardial sac and its pretty tough/study tissue. I think many hospitals (like Cleveland) that use the Perimount use it because it has a pretty long track record (they've been using them in trials since around 82).

    I personally wouldn't care as much which valve is "easier' for the surgeon to put in, I would be more concerned in how it will function and last the years it is in you. I "think" but not completely sure more people seem go use the bovine Perimount in the US at least.

    Which valve does the surgeon you picked prefer? I'd probably go with that. but thats just me.

    PS IF the pig is the biocore(but I'm pretty sure it is mixed cow/pig), it has been used in Europe as long as the Perimount has been used, but just recently been used in the US. (mainly because St Jude was promoting their mechanical valve and why they are better, but as more people were choosing tissue valves, they decided to get more behind their tissue valves

    editted to add
    looking at st judes site, it may be the Epic.. http://www.sjmprofessional.com/Produ...sue-Valve.aspx
    Last edited by Lynlw; April 6th, 2011, 01:00 PM.
    Lyn
    Mom to Justin 25 TGA,VSDs, pulmonary atresia/stenosis ect, post/Rastelli, 5 OHS, pacer in and out ... and surgery w/muscle flap for post op infection (sternal osteomyelitis with mediastinitis) [url]www.caringbridge.org/nj/justinw[/url]

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    • #3
      The surgeon I picked (Pat McCarthy at Northwestern in Chicago) uses Bovine. The other surgeon I met with uses Pig. So, naturally I started wondering if one really was better than the other or if certain hospitals just had contracts with different manufacturers....the impression I got from both surgeons was that they were virtually identical as far as how long they will last and their function.
      Birth - diagnosed with BAV with Regurgitation.
      September 2010 - Eccho reveals worsening BAV.
      December 2010 - Endocarditis

      Comment


      • #4
        I added more to my post above about the different pig valves..I thought Mccarthey might be the one to use the Bovine since he was at CCF and they were 1 of the centers using them since the early 80s with much success.

        As for why, its a little of both, depending on the hospital they might just offer 1 or 2 of each kind of valves they are contracted with, but other hospitals the surgeons get what they want and think it best for each patients
        Last edited by Lynlw; April 6th, 2011, 01:07 PM.
        Lyn
        Mom to Justin 25 TGA,VSDs, pulmonary atresia/stenosis ect, post/Rastelli, 5 OHS, pacer in and out ... and surgery w/muscle flap for post op infection (sternal osteomyelitis with mediastinitis) [url]www.caringbridge.org/nj/justinw[/url]

        Comment


        • #5
          Originally posted by Lynlw View Post
          It depends who you ask which of the 2 are the "best"
          I don't know about which pig valve you are describing,(do you know the name of it?) but the CE bovine, (perimount) is made from the pericardial sac and its pretty tough/study tissue. I think many hospitals (like Cleveland) that use the Perimount use it because it has a pretty long track record (they've been using them in trials since around 82).

          I personally wouldn't care as much which valve is "easier' for the surgeon to put in, I would be more concerned in how it will function and last the years it is in you. I "think" but not completely sure more people seem go use the bovine Perimount in the US at least.

          Which valve does the surgeon you picked prefer? I'd probably go with that. but thats just me.

          PS IF the pig is the biocore(but I'm pretty sure it is mixed cow/pig), it has been used in Europe as long as the Perimount has been used, but just recently been used in the US. (mainly because St Jude was promoting their mechanical valve and why they are better, but as more people were choosing tissue valves, they decided to get more behind their tissue valves

          editted to add
          looking at st judes site, it may be the Epic.. http://www.sjmprofessional.com/Produ...sue-Valve.aspx
          Lyn, I think you are right about the St. Judes valve. The Biocor is the valve I have and Bob (Tobago) has it too. I thought it was all pig until Bob told me it was a mix of pig and cow. Of course, he knows much, much more about it than I ever would pretend to know!

          K
          #1 OHS 1980 Wolfe Parkinson White, Duke, Dr Sealy.
          #2 4/08 Tricuspid Replacement (31mm St. Judes Biocor), ASD closure with Bovine Patch, modified right sided Maze Procedure, Mayo clinic

          Comment


          • #6
            I was fortunate enough to get a tour of the Edwards facility, which they offer to any of their valve recipients. Their bovine valve is made from the pericardial tissue. The tissue is cut to be flattened out, measured for specific thickness, cut into exact sizes for leaflets. Each of the 3 leaflets in each valve is exactly the same thickness. The valves are sewn into a valve cuff by hand. Each step of the process has quality inspections. They have moved away from porcine valves, as they feel they can make a more prefect valve by hand. Hope this helps.............
            Tom Price
            AVR and one CABG 1/25/07
            29mm model 3000 Bovine Pericardial Tissue valve

            Comment


            • #7
              hi from what ive heard, read etc, there both exellent valves, depends if you wanna honk or moo ,
              had avr replacement feb 2008 tissue valve fitted have got a nice porky pig one so no bacon for me ha ha,on hbp tabs and beta blockers,

              Comment


              • #8
                I have CE bovine perimount. I left the choice of which tissue to my Mass General Surgeon once we agreed I would be getting a tissue valve. I am three years out from having it implanted and will see my cardio next week. Hopefully, another good report from him...... fingers crossed.

                Comment


                • #9
                  You can tour the Edwards Facility to see how the valves are made?! I'm gonna add that to my bucket list. Or maybe it will just freak me out? Hmmmm....
                  Birth - diagnosed with BAV with Regurgitation.
                  September 2010 - Eccho reveals worsening BAV.
                  December 2010 - Endocarditis

                  Comment


                  • #10
                    Yes you can visit!!! And I highly recommend it...they are very gracious and it is very interesting. They have a giant display of all the valves they ever made, from the very early mechanicals to today's catheter. When you make arrangements, they ask for your serial number. If possible, you get to meet the employees who made your valve! It is very emotional, for both you and the workers.
                    Tom Price
                    AVR and one CABG 1/25/07
                    29mm model 3000 Bovine Pericardial Tissue valve

                    Comment


                    • #11
                      I'm not familiar with the St. Jude's pig valve, though I got a different pig valve (see my Signature). Based on the latest studies I've seen on the durability of the oldest, most established valves -- the ones that have been used and studies long enough to have 15-year and 20-year follow-up -- I think the Edwards (or "CE) Perimount "cow" valve looks like the second best one, second only to "my" pig valve! The newest and most complete study is entitled "Hancock II Bioprosthesis for Aortic Valve Replacement: The Gold Standard of Bioprosthetic Valves Durability?" by Tirone E. David, MD, Susan Armstrong, MS, Manjula Maganti, MS, in Ann Thorac Surg 2010;90:775-781, abstract at ats.ctsnetjournals.org/cgi/content/abstract/90/3/775? . You've got to pay some bucks to get the whole study, including the part where they compare their results to those of other studies, including studies on the CE Perimount. But the abstract, with the summarized results, is free at that link.

                      Of course, many good-looking valves have come along within the last 10 or 15 years, and they can't possibly compete on the basis of proven or demonstrated durability, even though they may end up lasting longer.

                      My impression is that my pig valve came from a single pig, and was then treated in a number of ways. The "pericardial" valves, including all valves made from cows and horses, are manufactured out of the tough tissue that surrounds these animals' hearts. (I bet it's hard to find a cow or horse's heart valve that's small enough for most humans.) It's tempting to conclude that one approach MUST be better, but that kind of "obvious logic" is often proven wrong in medical studies.

                      I place a bit more value on choosing a valve that my surgeon is comfortable with, than Lyn and several others here. I don't mind making my Doctors squirm when I'm meeting with them or talking with them on the phone, but I'd really rather they did NOT squirm while they have my heart in their hands!
                      BAV, extended ARoot, some MV damage.
                      68 y.o. (65 @OHS), keen active athlete until shortly pre-op, only symptomatic 1-2 months pre-op.
                      AVR (Medtronics Hancock II) Dec. 1 2010 w/ Dr. C.M. Feindel at UHN aka Toronto General. Also a "tuck" on the Aortic root, and a (Dacron) Medtronics Simplici-T ring on my MV. I did ACT for 3 months for the ring, and Metoprolol (BB) for 3 months for A-fib.

                      Comment


                      • #12
                        The St.Jude Biocore, CE Perimount and Hanncock II, have all been in use roughly the same amount of time, they first were used in the early 80s, so have been around close to 30 years now.

                        Studies are very good, but I also go by what different doctors experiences are.
                        For example even tho they may not write up their experience in an official study, many centers have been using these valves for a couple decades, so have about 10 years worth of patients who got their valves 20 years ago..(meaning by 2002 patients that got one in 82 had their surgery 20 years earlier and in 2009 patients that got their valves in 89 had theirs 20 years ago and everyone in between) even patients who had their valves in the early 90s are coming up to the 20 year mark.

                        I am NOT saying anyone HAD their valve that many years, or even that they are still alive (especially if they were in their 70s or 80 in the early 80s) Just that the surgeons have all that information about how long valves seem to be lasting for their patients as well as other studies.

                        Since all 3 tissue valves are still in use close to 30 years later, to ME that means they must be showing great results or not many surgeons still be using them, they would be using another valve, either one of the older ones or a newer hopefully "improved" one.

                        Also I don't ever want a surgeon to squirm when they are working on me or a loved one, which is why I said I'd go with the valve the surgeon prefers. I just probably wouldn't go to a surgeon who choose one valve over another mainly because it was easier for them to put in.
                        Last edited by Lynlw; April 8th, 2011, 05:05 PM.
                        Lyn
                        Mom to Justin 25 TGA,VSDs, pulmonary atresia/stenosis ect, post/Rastelli, 5 OHS, pacer in and out ... and surgery w/muscle flap for post op infection (sternal osteomyelitis with mediastinitis) [url]www.caringbridge.org/nj/justinw[/url]

                        Comment


                        • #13
                          Since all 3 tissue valves are still in use close to 30 years later, to ME that means they must be showing great results or not many surgeons still be using them, they would be using another valve, either one of the older ones or a newer hopefully "improved" one.

                          Also I don't ever want a surgeon to squirm when they are working on me or a loved one, which is why I said I'd go with the valve the surgeon prefers. I just probably wouldn't go to a surgeon who choose one valve over another mainly because it was easier for them to put in.


                          Exactly.
                          My thoughts,too, Lyn.

                          Comment


                          • #14
                            Thanks for all the great feedback guys! Lyn, are you secretly a cardiologist because you always have such great things to say and really are such a source of great knowledge!
                            Birth - diagnosed with BAV with Regurgitation.
                            September 2010 - Eccho reveals worsening BAV.
                            December 2010 - Endocarditis

                            Comment


                            • #15
                              Originally posted by Hockey Heart View Post
                              Thanks for all the great feedback guys! Lyn, are you secretly a cardiologist because you always have such great things to say and really are such a source of great knowledge!
                              No, Thank you tho. I've just been doing this for a while. Justin will be 23 next week and we found out about his heart defects the next day. He had his first heart surgery at 10 days and we knew he'd need at least 1 more between the ages of 18 months and 3 YO, depending how he grew, since he needed to be big enough to have a good chance of surving all the work they had to do. (it ended up 18 months - he was a good eater, even THEN his heart was about the size between a walnut and small plum when his surgeon had to pretty much rebuild his heart and reroute the blood paths that weren't much bigger than the size of lead in a pencil..it still amazes me to think of that).
                              So much was out of my control, the one thing I knew I could do was learn as much as I could about hearts and Justin's heart, so I could hopefully make the best choices. I have to say that became much easier with the internet, before that I had to go to medical libraries and read books He's had a couple surgeries without much notice, so I try to keep on top of whats going on and who is working on what, incase we have to make quick decisions.
                              Last edited by Lynlw; April 9th, 2011, 08:57 AM.
                              Lyn
                              Mom to Justin 25 TGA,VSDs, pulmonary atresia/stenosis ect, post/Rastelli, 5 OHS, pacer in and out ... and surgery w/muscle flap for post op infection (sternal osteomyelitis with mediastinitis) [url]www.caringbridge.org/nj/justinw[/url]

                              Comment

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