anyone here with a human tissue valve replacement?

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Angel

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May 26, 2010
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Is there anyone here with a human tissue valve replacement or do you know of anyone with such? Just trying to gather a bit more information on this. I do know that the human tissue valves come with the aorta which makes for a little longer and more complicated surgery. I don't think I'd want to replace the aorta unless I had to, and at this point, I'm not sure yet if my aorta will have to be replaced or not. Anyway, any information anyone may have on the human tissue valve would be greatly appreciated!
 

Luana

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Hi Angel,
I asked about this, too, was told they're difficult to obtain and have about the same shelf life as porcine valves.
 

vtbecca

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My son has one, it's a homograft conduit. He is on his second one. The first lasted 17 months (it became highly calcified) but he's now 9, so going on 7 1/2 years with the second one. It looks like replacement will be in the next year or two (I think probably on the sooner end of that). The valve is working well (his is for his pulmonary artery. His own aorta is intact but leaky). It's moderately leaky but fairly stable. I know someone who has Gabe's condition and had a homograft/valve combo last about 20 years. A few years back he was able to get a valve put in through cath. He is in the UK, it wasn't available in the US yet. Not sure if any of that helps!

Becca
 

Lynlw

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Most of the people I know with homografts have them for pulmonary valves/conduits and for the most part valves last quite a bit longer on the right side then left. Many people with the Ross procedure have a Homograft to replace their native pulm valve, that is now their aorta valve.
I don't know of many who have them as their Aortic valve.
From what I know, homografts USED to last longer than tissue valves, but with the anti-calcification treatments for Bovine and porcine valves, they last about the same (or maybe longer) and as others have said, it is harder to find the right size homograft.
 
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daveguy14

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I had one. They were very popular in the late 90's/early 2000's because they were thought to last longer than other tissue valves. They don't, and insertion and removal are both more complicated, and you lose your aortic root in the process. I just had mine taken out after 7 years (was young at time of insertion, 18) due to structural valve deterioration. Because of the added complexity and no added benefit, they are typically now reserved only for patients with endocarditis, because they have been found to work well at preventing re-infection. The long and short of it is that unless you are infected, there is probably almost no center in the U.S. that would give you a homograft now, even the Cleveland Clinic, which used to push them hard. I've also cut/paste from the Cleveland Clinic website:

An aortic valve homograft is a human valve transplant. It had been our hope since the late 1980's and early 1990's that aortic valve homografts would last longer than heterografts. Unfortunately, that has not turned out to be the case. They appear to wear out at about the same rate. The disadvantages of homografts are that the operation to put one in is a primary operation and is bigger than the operation to put in a heterograft. The re-operation for a homograft is also considerably more difficult than a re-operation for a heterograft. Now, fortunately, in experienced hands, we've found that the risk of doing those homograft re-operations has been relatively low, but they are bigger operations than the re-operation of a heterograft. Therefore we do not choose to use homografts, except in a couple of very specific circumstances. One is in the treatment of valve infections, where homografts represent a very good option and have a very low rate of re-infection. The second is to treat situations where the original valve that was put in appears to be a bit too small for the patient, since homografts are a very efficient valve and relieve the obstruction across small valves extremely effectively.​
 

ottagal

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I had one. They were very popular in the late 90's/early 2000's because they were thought to last longer than other tissue valves. They don't, and insertion and removal are both more complicated, and you lose your aortic root in the process. I just had mine taken out after 7 years (was young at time of insertion, 18) due to structural valve deterioration. Because of the added complexity and no added benefit, they are typically now reserved only for patients with endocarditis, because they have been found to work well at preventing re-infection. The long and short of it is that unless you are infected, there is probably almost no center in the U.S. that would give you a homograft now, even the Cleveland Clinic, which used to push them hard. I've also cut/paste from the Cleveland Clinic website:



An aortic valve homograft is a human valve transplant. It had been our hope since the late 1980's and early 1990's that aortic valve homografts would last longer than heterografts. Unfortunately, that has not turned out to be the case. They appear to wear out at about the same rate. The disadvantages of homografts are that the operation to put one in is a primary operation and is bigger than the operation to put in a heterograft. The re-operation for a homograft is also considerably more difficult than a re-operation for a heterograft. Now, fortunately, in experienced hands, we've found that the risk of doing those homograft re-operations has been relatively low, but they are bigger operations than the re-operation of a heterograft. Therefore we do not choose to use homografts, except in a couple of very specific circumstances. One is in the treatment of valve infections, where homografts represent a very good option and have a very low rate of re-infection. The second is to treat situations where the original valve that was put in appears to be a bit too small for the patient, since homografts are a very efficient valve and relieve the obstruction across small valves extremely effectively.​

Good synopsis DaveGuy14. When I had my surgical consult for AVR and I was discussing options with the surgeon, his response to a homograph was: "if you want a homograft go elsewhere as I won't do them". Now I know why. Thanks
 

vtbecca

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Interesting insights! One other thing Gabe's surgeon had mentioned last time as a drawback to the human conduits is that your body makes antibodies to them. So the more you have (gabe has now had 2) the harder any organ transplant would be later. Unfortunately the pig valves he had weren't sized right so he got a second human one.

Becca
 

BlindFaith

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Grafton, MA
My Dad had the aortic valve homograft several years ago at Mass General in Boston at age 80. He had been on his his 2nd new valve which was a mechanical (first was a pig valve) and developed endocarditis. The disease disturbed too much of the aorta and the surgeon decided he needed a full replacement. He is still kicking today, although he has never fully recovered from where he was before the endocarditis...
 

gadoty1

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I had the Ross Procedure in 2000 and had a homograft put in for my pulmonary valve. My aortic valve (which was my original pulmonary valve moved into the aortic position) wore out after 8 years. My homograft pulmonary valve is still going but like others have said a pulmonary valve replacement tends to last longer anyways. My surgeon told me in 2008 that my pulmonary valve should last another 20 years or so.
 

rib305

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Jun 12, 2010
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Hi Angel, ive been following this site for a while but have just joined today, im based in the uk, when i was 16 i had endocarditis which distroyed my aortic valve and damaged my mitral valve, due to the late stages for me and the infection was so advanced i had a homograph valve, not through my choice as i was so ill, and quite frankly didnt understand, but through my surgeon the late MR PARKER ST GEORGES HOSPITAL LONDON.(probably the best surgeon in the uk at the time)
this is what i can tell you with regards my experience, 24 years on i still have the same homograph which is only now showing signs of wear, my mitral valve was re-repaired 7 years ago 100% which was not possible 24 years ago so advances are happening all the time.
The information here (uk) is that if your very lucky with tissue matches they call it the 5%ers -your homograph can last a long time, i no from reading this site im in that 5% group,
I think my next surgery will be mechanical and ats open pivot looks the best in my opinion and is highly regarded at st georges hospital in london
everyone raves the onx which i have a demo valve of and and ats demo valve and the ats valve just make sense with open pivots to me when you look at the 2 together.
As for your choice get as much info as possible talk through the pros and cons with your surgeon and then go with what seems right to you,
Homograph worked out well for me and i do also like the ats 3f latest tisue valve if i were to choise a tissue vale again.

good luck and if i can be of any further help drop me a line

rb
 

rib305

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Jun 12, 2010
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uk london
st georges

st georges

Hi rib

Mr Smith from St George's put in my two ATS valves five years ago, I don't know who you have now as your surgeon but he was great in my eyes.

I do no Mr smith, he was going to do my mitral valve repair, but once he looked at it more closley, mt sarsam done the job, he specalised it tricky mitral repairs

outstanding hospital

rb
 

Kathy McCain

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Jan 9, 2008
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Texas
I talked with my surgeon about a homograft valve. He said it was a much more difficult surgery, and did not think it would last longer than porcine, or bovine valve. Also, they are much harder to obtain. I chose a Medtronic tissue. That was Feb 2008. So far, so good!
 

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