Homograph valves?

[jeangoat]

Having come back to the Forum after a couple of years, I think I am seeing fewer and fewer people selecting tissue valves. I had a homograph in '00 and love it. It is not causing a bit of problem. My cardio says they don't know how long they will last because they are so new yet...20+ a few yrs. When I first chose mine, the experts were saying 15 yrs. life span now I see 20-25. Just curious what new research says and why so few are choosing them. I have never tried to push that choice on anyone; just curious.

 

[Bad Mad]

Having come back to the Forum after a couple of years, I think I am seeing fewer and fewer people selecting tissue valves. I had a homograph in '00 and love it. It is not causing a bit of problem. My cardio says they don't know how long they will last because they are so new yet...20+ a few yrs. When I first chose mine, the experts were saying 15 yrs. life span now I see 20-25. Just curious what new research says and why so few are choosing them. I have never tried to push that choice on anyone; just curious.

I suppose most people want the "one valve for life" scenario, thus more people under 55 or so choose mechanical. Perhaps it has to do with the improved results and changed perceptions and easier (self) management of anti-coagulation.

I was told in 2001 when I had my AV replaced with a homograft that 10-15 years was the ball park figure. Unfortunately they forget to mention the fact that 50% of homografts in the aortic position fail within 8 years in patients under 30 years old I had mine replaced again with a mechanical 10 weeks ago. Of course, the longetivity prospects of homografts in older patients are much better.

It wouldn't have changed my decision though, as my motivation to choose tissue was to continue contact sport.

 

[Adrienne]

Plus, with the xenografts, you don't have to worry about the graft tissue carrying infection into the recipient's body, because the bovine or porcine tissue is treated with chemicals to "sterilize" it in a way that is not possible with a homograft.

Just out of curiosity, why can't they treat a homograft in the same way that they treat a xenograft?

 

[tobagotwo]

I'm surprised you would say that it looks like more people are choosing mechanical valves now. The swing seems quite the other way. The surgeons are more often recommending tissue valves these days, and for younger and younger people.

Best wishes,

 

[Superbob]

I'm surprised you would say that it looks like more people are choosing mechanical valves now. The swing seems quite the other way. The surgeons are more often recommending tissue valves these days, and for younger and younger people.

Best wishes,

This is my strong impression, too, just from reading hundreds and I guess thousands of posts on here the past three years. Of course, there remain pros and cons, pluses and minuses, for each type of choice. I'm not getting into that. But I agree with Bob H. about what seems to be the swing.

 

[Superbob]

I don't pretend to know much at all about homografts, but I found this article by a Cleveland Clinic surgeon that may explain at least part of the reason they aren't more widely used. He refers to a "bigger" operation being necessary, which I assume means a somewhat more complicated one. I offer this link just for further information:

http://www.clevelandclinic.org/heartcenter/pub/guide/surgery/transcript_avr.htm

 

[Bill Hall]

Jean,

I also have a homograph in the aortic valve position from 2001. They are definitely out of favor these days and Bob's article is good information. From my readings I think they can last more than 20 years, but the mean lifespan is still much lower.

Bill

 

[Adrienne]

I wonder what it is about a human valve that makes it more complicated to put in. You would think intuitively that it would be easier and just fit in their the way it is supposed to. Although this thread does not concern me personally, I find it interesting and would love to know the reason for the greater difficulty.

 

[jeangoat]

Valve Choices

Valve Choices

Thanks for the info; I was just curious. Very good article from the Dr. at the Cleveland Clinic.

 

[Bradley White]

I got an aortic homograft 14 months ago at the Mayo Clinic. From what I understand they aren't used very frequently anymore. Most often when a tissue valve is used, an bovine/procine valve is preferred particularly in older patients where good durability has been demonstrated.

However, my surgeon told me that in his opinion for someone my age (23 at the time) getting a tissue valve, the homograph was a better bet to last a long time (>15 years) than a bovine/porcine valve. I don't know whether he actually had any data to back this up or if it was just anecdotal, but I decided to trust him. He replaced both the valve and the root with a homograph. He told me it used to more difficult to take out a homograph because of calcification, which causes the valve to turn into a "leadpipe." However apparently, he did something called a "button" that will make it much easier to replace. He was really excited about this and kept pointing it out in the pictures of my heart they took before and after.

Actually, I should upload those pictures. They are quite amazing. They did a before and after of my heart. An actual photo of the heart after my chest was opened. You can easily see my aneurysm in the before picture. It is quite astonishing. I'll try to scan and upload them.

Brad

 

[Debbie]

brad

brad

Dear Brad, I hope you'll be able to get those photo's up, I'd like to see them Debbie

 

[harleygirl528]

Interesting....I just went through aortic valve surgery 4 weeks ago and I consulted with three different surgeons. I am only 41 years old and all of these surgeons recommended tissue valves, despite my relatively young age. I was NEVER even offered the option of a homograft? Logic would point toward a human valve being a better replacement than a bovine or porcine but there must be other considerations?
The surgeon that I eventually went with said he hasn't used a mechanical valve in almost ten years on anyone! Apparently there is research that points to a correlation between mechanical valves and strokes...something to do with valvular strands that form and break off, causing stroke? Not sure exactly but I know there have been other posts about this. So, in my most recent experiece, I would agree that tissue valves are much more often recommended than mechanical, even for younger folks. Also, the technology for percutaneous valve replacements is looking very promising so perhaps that is part of the recent shift to tissue valve recommendations.
Fortunately for me, I did not have to deal with either since my valve was repaired but I was going with bovine in the event replacement was needed. Wonder why homograft was not even an option at any of my consults?

 

[Debbie]

valve

valve

I just got a tissue valve 3 weeks ago and my surgeon said in the next 5 years he was certian he would be doing the re-op's percutaneously. When this one wears out in 15 or so years no more ripping the chest open!! Debbie

 

[Karlynn]

Percutaneous replacements do seem promising. But I feel that many physicians are jumping on this band wagon too soon and making it seem like a "done deal" procedure for anyone needing a valve replacement in the future. Currently the trial percutaneous replacements being done are on those who they believe would not survive an open chest procedure. There is discussion on whether the percutaneous replacements will last as long, or allow the heart to perform as well as the "old-fashioned" replacement. There must be years and years of study on this new procedure before it is given the go ahead for broad use.

It's my Cautious Mom opinion that it's too soon for doctors to be promising or hinting at a promise that someone's next replacement is going to be percutaneous, particularly for those people who are, because of their young age, given a tissue valve life expectancy of 10-15 years or less. Would anyone, who is otherwise healthy, be comfortable in 5 or 10 years having a percutaneous replacement without solid data that it will last and perform as well as the standard method used today?

Percutaneous replacements are a promising procedure - but are being explored in the high risk arena right now, on aortic valves (I don't believe it's been done yet on mitral). I would hope people aren't making decisions today with this procedure given a lot of weight. It's interesting and hopeful, but way too soon to be putting too many eggs in that basket.

As far as strands - yes this is a concern, for a small percentage of people. I believe the stroke data would work into the general stroke data for mechanical valves which, depending on who you are talking, to is 3% or less. But strands are also an issue for tissue valves failing, I don't know how it would add to their stroke risk. A surgeon who hasn't performed a mechanical replacement in 10 years because of strands, is most likely using it as a reason to justify his many other biases. A mechanical valve replacement is still a very excellent option with low risk statistics and as Coumadin management is pushed into the 21st century the risk continues to decrease.

Please don't take this as a "mechanicals are good, tissue valves are bad" post. That is not my point at all. My concern is the over-promising by physicians (IMHO) of percutaneous replacements to those people receiving or considering tissue valves now. I think it's very premature for a doctor to dangle this carrot in front of a 30 year-old as a promise of their next valve replacement. Speaking to someone who is 55 may be a different story.

 

[nickm3]

I'm 7 weeks post-op with a new mechanical valve to replace a very worn out and calcified 9 year old homograft. My undstanding is that homografts are now only considered in the presence of endocarditis as was the case for me back in 1998. The homografts are supposed to to be more resistant to endocarditis reinfection. The downside besides a limited lifespan is that the re-operation becomes much more complicated involving both the ascending aorta and the aortic root.

Since my op was a redo and because of my age (48) I was lead away from a tissue valve because I was told the risk of a 3rd operation outweighed the risk of stroke. And avoiding a 3rd op sounded pretty good to me as well.

Nick

 

[meverett99]

My Aortic Value homograph lasted 8 years

My Aortic Value homograph lasted 8 years

8 years ago, my decision was to go with a homograph. Frankly for the last 8 years I have been happy with that decision. The maximum lifetime years quoted to me were around 15 and they said many will fail earlier as they had seen failures within 4 years. I was 35 years old at that time. This past Christmas, the valve failed and by New Years, I went into heart failure. I found the surgeons at Duke this time clearly recommended mechanical. Their reason, which I did not hear 8 years ago was the mortality rate increases 10% with each reoperation. They pointed to scar tissue as the largest risk with reoperations. I researched and chose the On-x this time. Adding an ascending aorta takes about 10 minutes with On-x and the recommended INR values seem to be lower with hope that they can go lower in a few years once the study is competed. I finally settled out with Coumadin is 7.5 mg to achieve INR at recommended 2-2.5.

 

[Karlynn]

Welcome meverett99!

Did your valve fail fairly quickly, or was it a slow progression that snuck up on you to where you weren't able to ignore the symptoms by December? Most of our tissue valve members have yet to get to the end stage of their tissue valves, so it's more of an unknown area for us.

You are also one of a growing number of members who are getting the On-X. I look forward to your impressions of the valve and your life with it.

 

[Bad Mad]

8 years ago, my decision was to go with a homograph. Frankly for the last 8 years I have been happy with that decision. The maximum lifetime years quoted to me were around 15 and they said many will fail earlier as they had seen failures within 4 years. I was 35 years old at that time. This past Christmas, the valve failed and by New Years, I went into heart failure. I found the surgeons at Duke this time clearly recommended mechanical. Their reason, which I did not hear 8 years ago was the mortality rate increases 10% with each reoperation. They pointed to scar tissue as the largest risk with reoperations. I researched and chose the On-x this time. Adding an ascending aorta takes about 10 minutes with On-x and the recommended INR values seem to be lower with hope that they can go lower in a few years once the study is competed. I finally settled out with Coumadin is 7.5 mg to achieve INR at recommended 2-2.5.

Welcome Meverette

How did they let it get to that stage? Were they not following up your valve with yearly echos?

The figure they quoted you for re-operation does seem a bit high. Where I live, the surgeons work off a scoring system called the Euro Score. Seems a bit silly as surgeons will all have differing success rates. Some take on riskier op's, some don't. But anyway it goes something like: (WITHOUT ANY OTHER RISK FACTORS)

3% for an isolated valve replacement etc.
3% (additional for a re-op)
2% extra for any additional procedure
1% for every 5 years over 65 (or something like that)

As far as I understand the risk of 2nd time surgery and 3rd etc. are the same. Still cutting through scar tissue. It's just the cumulative risk of undertaking another OHS. I am not 100% sure of this, but I could nearly swear that's what my surgeon told me.

 

[kfay]

My surgeon for my upcoming OHS in April gave me a 3% mortality rate and this will be my second OHS. He then told me each time I have to come back to have the valve replaced will be about a 5% mortality rate.

 

[Susan BAV]

Material to protect the sternum

Material to protect the sternum

In anticipation of an eventual reop, my surgeon placed a material between my heart and sternum, to hopefully cut down on that potential reop scarring issue that can complicate a reop.

Thanks for your post, Meverett. Hope all goes really well now with your new valve. Take care .