Hi Guys, Boy this site is a great help to all of us who face heart surgery. I will be having AVR in the near future and am trying to find out all I can about the different valves and procedures available. I guess in the end from what I have been reading it really is your surgeon that makes the real decision. I have gotten a second and a third opinion on my condition. Second was Dr Pat McCarthy from the Cleveland Hear Institute which is ranked # 1 in the nation. He recommended homograft using minimally invasive surgery. Has anyone else out there had this particular procedure and valve?? Dave
AVR Surgery
- Thread starter [email protected]
- Start date
Help Support Valve Replacement Forums:
Ross
Well-known member
Dr. McCarthy saved my hyde the first time around for me. The man knows his stuff. As far as the Homograft, I'll let others comment on that. I just had my AVR and I chose the St. Jude Mechanical. My first encounter was a ruptured ascending aortic aneurysm and I think McCarthy tried to do something similar to the Ross procedure. It lasted for 7 years and then the replacement had to be.
I'd be interested in hearing what the first and third opinions were.
I'd be interested in hearing what the first and third opinions were.
AVR Surgery
Hi Ross, Thanks for your expeditious reply. First was by my cardiologist who initially diagnosed my condition 7/01. Then in Jan 02 he guessed I had 3-5 yrs before surgery. 6 mos later he tells me I need it NOW. That was in July. 3rd opinion was about a month ago by Dr Isom from Weill-Cornell Med Center in NYC. He basically just agreed that it was time for the surgery. No mention yet as to procedure or type. Because of HMO rules I guess he will be the one to do the surgery. They say if I want ins to pay it has to be done "in house". Dave
Hi Ross, Thanks for your expeditious reply. First was by my cardiologist who initially diagnosed my condition 7/01. Then in Jan 02 he guessed I had 3-5 yrs before surgery. 6 mos later he tells me I need it NOW. That was in July. 3rd opinion was about a month ago by Dr Isom from Weill-Cornell Med Center in NYC. He basically just agreed that it was time for the surgery. No mention yet as to procedure or type. Because of HMO rules I guess he will be the one to do the surgery. They say if I want ins to pay it has to be done "in house". Dave
Ross
Well-known member
Insurance Companies pretty much own you, however, you do have the right to choose who does your surgery. I fully understand your situation. Whatever valve you choose will be a good choice. I have reservations about the Homograft myself, but I'm sure others will disagree with me. There are many who are doing just fine with it. Please wait for those people to respond and don't take my word as gospel.
Ross
Ross
RobThatsMe
Well-known member
Hi Dwilli,
There are many posts here regarding valve types. Do a "search" on valve selection, or valve types and see what you find.
Also, the choice of valve incoporates many variables. Your age is an important one, as well as your life style and medical reason for the surgery. All of these factors help in making your valve selection choice.
Here is some information from the Harvard Medical School Web site.
Mechanical heart valves that have been approved by the U.S. Food and Drug Administration rarely fail. However, even in patients who are taking adequate doses of anticoagulants, a small number develop blood clots on the valves. Each year, 1.3 percent to 2.7 percent of patients who have a mechanical heart valve experience an episode of severe anticoagulant-related bleeding.
Biological valves tend to fail over time ? requiring replacement in 30 percent of patients by ten years and 50 percent by fifteen years. However, the risk of blood clots is very low.
Biological Valves
Biological valves can be made of either human or animal tissue. Options include:
Autograft valves ? In this case, the replacement valve is made from another valve within the patient's own heart. For example, the patient's pulmonary valve may be removed and used as an autograft to fix the aortic valve. The missing pulmonary valve is then replaced by a donated human homograft or an animal heterograft (see below).
Homograft valves ? This replacement valve is taken from a deceased human donor.
Heterograft valves ? In this case, the replacement valve comes from an animal donor, either a pig (porcine heterograft) or a cow (bovine heterograft).
In general, biological valves are less durable than mechanical valves. They wear out faster and need to be replaced sooner.. Because of this need for earlier replacement, biological valves are more commonly used in people age 65 to 70 or older, where predicted lifespan is often a factor in valve choice. Since the long-term risk for thromboembolism is lower for biological valves than for mechanical valves, the patient doesn't normally need to take anticoagulants for more than three months after surgery.
Currently, 71,000 to 79,000 heart valve replacements are performed each year in the United States.
Hope this is helpful,
Rob
There are many posts here regarding valve types. Do a "search" on valve selection, or valve types and see what you find.
Also, the choice of valve incoporates many variables. Your age is an important one, as well as your life style and medical reason for the surgery. All of these factors help in making your valve selection choice.
Here is some information from the Harvard Medical School Web site.
Mechanical heart valves that have been approved by the U.S. Food and Drug Administration rarely fail. However, even in patients who are taking adequate doses of anticoagulants, a small number develop blood clots on the valves. Each year, 1.3 percent to 2.7 percent of patients who have a mechanical heart valve experience an episode of severe anticoagulant-related bleeding.
Biological valves tend to fail over time ? requiring replacement in 30 percent of patients by ten years and 50 percent by fifteen years. However, the risk of blood clots is very low.
Biological Valves
Biological valves can be made of either human or animal tissue. Options include:
Autograft valves ? In this case, the replacement valve is made from another valve within the patient's own heart. For example, the patient's pulmonary valve may be removed and used as an autograft to fix the aortic valve. The missing pulmonary valve is then replaced by a donated human homograft or an animal heterograft (see below).
Homograft valves ? This replacement valve is taken from a deceased human donor.
Heterograft valves ? In this case, the replacement valve comes from an animal donor, either a pig (porcine heterograft) or a cow (bovine heterograft).
In general, biological valves are less durable than mechanical valves. They wear out faster and need to be replaced sooner.. Because of this need for earlier replacement, biological valves are more commonly used in people age 65 to 70 or older, where predicted lifespan is often a factor in valve choice. Since the long-term risk for thromboembolism is lower for biological valves than for mechanical valves, the patient doesn't normally need to take anticoagulants for more than three months after surgery.
Currently, 71,000 to 79,000 heart valve replacements are performed each year in the United States.
Hope this is helpful,
Rob
Last edited:
W
wlaldridge
One of the best and most extensive "threads" on valve selection is not posted under valve selection. I found it most interesting and informative as well as well though out:
Heart Talk: Making the choice: RP, homograft, Mechanical
A very interesting thread to follow.Started 7/19/2001
Hope this might help you.
Bill
Heart Talk: Making the choice: RP, homograft, Mechanical
A very interesting thread to follow.Started 7/19/2001
Hope this might help you.
Bill
Poll?
Poll?
Ross, Since you are retired..how about starting a poll..age (within 10 years) as 20, 30, 40, 50, ect...Valve type?......Would like to see my group ..as..60-70...Mech., pig, cow???? Bonnie..This retired cheerleader is not smart enough. Bonnie
Poll?
Ross, Since you are retired..how about starting a poll..age (within 10 years) as 20, 30, 40, 50, ect...Valve type?......Would like to see my group ..as..60-70...Mech., pig, cow???? Bonnie..This retired cheerleader is not smart enough. Bonnie
Ross
Well-known member
I could do age and ask what valve type or vice versa, but the poll won't let me do both. 
Do a Poll
Do a Poll
I am so confused Nicole is 19 and me 62 and we have Mechanicals...My friend who lives up here. he is my age and has a human donor.. I would like to see a poll with age..vs. valve type..Start a new thread under Valve selections. Please and thank you..Bonnie
Do a Poll
I am so confused
Nicole is 19 and me 62 and we have Mechanicals...My friend who lives up here. he is my age and has a human donor.. I would like to see a poll with age..vs. valve type..Start a new thread under Valve selections. Please and thank you..Bonnie
J
John Cochran
Dave,
I have a homograft that was implanted with minimally invasive surgery--a mini-sternotomy. Many surgeons are hesitant to do both, since homografts are relatively large. Make sure you have a surgeon who is experienced with both if you choose this route.
The minimally invasive part is great. I had a lot less pain, and was back doing "normal" things pretty fast. Plus, my incision is much shorter than with a full sternotomy. I can wear a tank top and the incision is not visible.
My homograft is a special one, the CryoLife SynerGraft, which has had the donor cells stripped from it. This is new for aortic valve replacement (available only since January of this year). The theory is that this valve will last much longer than a regular homograft for two reasons: first, the body doesn't attempt to reject the valve as much as a regular homograft, hence less calcification; second, your own cells repopulate the valve within a year, making it your own living tissue. There is a handful of us here who have these valves, and all their hearts seem to be doing quite well. I know that the Mayo Clinic does these valves, but I don't know if Cleveland does them yet.
As others have said, there is no "right" answer in valve selection, just what is right for you based on your anatomy, age, physical condition, surgeon, hospital, etc. Good luck with whatever choice you make.
--John
P.S. Ross, maybe instead of doing a poll you could do a swede?
I have a homograft that was implanted with minimally invasive surgery--a mini-sternotomy. Many surgeons are hesitant to do both, since homografts are relatively large. Make sure you have a surgeon who is experienced with both if you choose this route.
The minimally invasive part is great. I had a lot less pain, and was back doing "normal" things pretty fast. Plus, my incision is much shorter than with a full sternotomy. I can wear a tank top and the incision is not visible.
My homograft is a special one, the CryoLife SynerGraft, which has had the donor cells stripped from it. This is new for aortic valve replacement (available only since January of this year). The theory is that this valve will last much longer than a regular homograft for two reasons: first, the body doesn't attempt to reject the valve as much as a regular homograft, hence less calcification; second, your own cells repopulate the valve within a year, making it your own living tissue. There is a handful of us here who have these valves, and all their hearts seem to be doing quite well. I know that the Mayo Clinic does these valves, but I don't know if Cleveland does them yet.
As others have said, there is no "right" answer in valve selection, just what is right for you based on your anatomy, age, physical condition, surgeon, hospital, etc. Good luck with whatever choice you make.
--John
P.S. Ross, maybe instead of doing a poll you could do a swede?
Last edited:
Nancy
Well-known member
Bonnie-
I'm from Glenville, not Glens Falls. But they aren't all that far from each other, 30-45 minutes, depending on whether you speed or not on the Northway, LOL.
I'm from Glenville, not Glens Falls. But they aren't all that far from each other, 30-45 minutes, depending on whether you speed or not on the Northway, LOL.
hi dave!
welcome to this wonderful site. as you can already see, everyone here is so caring, helpful, and informative.
please check out that thread bill referred to, entitled "making the choice". i think you will find it in either small talk or heart talk back in july or aug. 2001. it was started by peter easton.
i know it certainly helped us a great deal.
about dr. isom... he's got a wonderful reputation. in fact. when my dad was about to have his avr 3 yrs ago, dr.isom was one of the 2 surgeons he was deciding between ( he ended up with dr.damus at st. francis heart hospital on long island, which is nearer to their home).
as you read through some of the old threads on alternatives in valves, you will find that most folks agree that there really is no wrong choice.
it is a difficult one to make, but we found that once we decided what type of valve or procedure joey wanted, it took a tremendous load off.
please keep coming back and visiting. we would love to know how things go, what you decide on, who's doing the surgery, etc.
ask any questions, we are happy to try and answer them.
be well, sylvia
welcome to this wonderful site. as you can already see, everyone here is so caring, helpful, and informative.
please check out that thread bill referred to, entitled "making the choice". i think you will find it in either small talk or heart talk back in july or aug. 2001. it was started by peter easton.
i know it certainly helped us a great deal.
about dr. isom... he's got a wonderful reputation. in fact. when my dad was about to have his avr 3 yrs ago, dr.isom was one of the 2 surgeons he was deciding between ( he ended up with dr.damus at st. francis heart hospital on long island, which is nearer to their home).
as you read through some of the old threads on alternatives in valves, you will find that most folks agree that there really is no wrong choice.
it is a difficult one to make, but we found that once we decided what type of valve or procedure joey wanted, it took a tremendous load off.
please keep coming back and visiting. we would love to know how things go, what you decide on, who's doing the surgery, etc.
ask any questions, we are happy to try and answer them.
be well, sylvia
wweir
Well-known member
Dave,
Was reading your post today and thought I would give you my ?two cents? as I recently had AVR surgery. I had a bi-cuspid aortic valve that was in need of replacement.
My choice was the St Jude valve, for the following reasons:
1. Dr. said that due to my age, 57, he recommended the St.Jude mechanical. His reason was that I would probably live 20 or more years and if I went with the tissue valve I faced the possibility of a second or third operation. In addition a fellow I work with has lived with a mechanical valve for 30 plus years and is doing great.
2. Coumadin is or can be a big issue, but it is something that is totally manageable. You will see lots of discussion about this on the site and you will get lots of great advice. I am personally running around 2.8 and somewhat stabilized after seven weeks. I have not noticed any major bleeding problems, bruising or any other side affects. I did decide to stop drinking as it was just wasted calories and I was drinking more as a routine rather than enjoying it. I may change my mind down the road but for now it is gone.
3. I wanted a surgery that kept me on the table the shortest time. I had real concerns about the ?on-pump? time. The shorter the better as far as I was concerned.
4. I wanted a procedure that the doctor was most comfortable with. In some cases they are patients who are having a by-pass in addition to the valve job. I was fortunate in that my arteries were clear so the only issue was the valve. My total operation time was 2.5 hours. I do not yet know how much of that time was on the ?pump?.
I am also pleased to say that was able to be am back to work full time in three and a half weeks, desk and meeting person. I also lost almost 30 lbs and other than an occasional pain from twisting the wrong way feeling great. I even went to the Nebraska ? Missouri football game this weekend and enjoyed every minute.
I guess the bottom line is listening to your doctor and know what ever you decide it will be the right decision for you.
Keep us posted and read Ross?s posts, he has the best advice.
Walter
Was reading your post today and thought I would give you my ?two cents? as I recently had AVR surgery. I had a bi-cuspid aortic valve that was in need of replacement.
My choice was the St Jude valve, for the following reasons:
1. Dr. said that due to my age, 57, he recommended the St.Jude mechanical. His reason was that I would probably live 20 or more years and if I went with the tissue valve I faced the possibility of a second or third operation. In addition a fellow I work with has lived with a mechanical valve for 30 plus years and is doing great.
2. Coumadin is or can be a big issue, but it is something that is totally manageable. You will see lots of discussion about this on the site and you will get lots of great advice. I am personally running around 2.8 and somewhat stabilized after seven weeks. I have not noticed any major bleeding problems, bruising or any other side affects. I did decide to stop drinking as it was just wasted calories and I was drinking more as a routine rather than enjoying it. I may change my mind down the road but for now it is gone.
3. I wanted a surgery that kept me on the table the shortest time. I had real concerns about the ?on-pump? time. The shorter the better as far as I was concerned.
4. I wanted a procedure that the doctor was most comfortable with. In some cases they are patients who are having a by-pass in addition to the valve job. I was fortunate in that my arteries were clear so the only issue was the valve. My total operation time was 2.5 hours. I do not yet know how much of that time was on the ?pump?.
I am also pleased to say that was able to be am back to work full time in three and a half weeks, desk and meeting person. I also lost almost 30 lbs and other than an occasional pain from twisting the wrong way feeling great. I even went to the Nebraska ? Missouri football game this weekend and enjoyed every minute.
I guess the bottom line is listening to your doctor and know what ever you decide it will be the right decision for you.
Keep us posted and read Ross?s posts, he has the best advice.
Walter
You sound great Walter
You sound great Walter
You will have to take over my job as head cheerleader, As Bill likes to call me. You sound like you are doing so good at 7 weeks...and a ttending a big event like a Football game... Keep the weight off. I, too, lost, but have gained it all back..I think at 6 months post-op, I just started getting lazy about walking...Will make myself hit the paths again.. This is the nicest time of the year and we should all be out walking. Bonnie
You sound great Walter
You will have to take over my job as head cheerleader, As Bill likes to call me. You sound like you are doing so good at 7 weeks...and a ttending a big event like a Football game...
Keep the weight off. I, too, lost, but have gained it all back..I think at 6 months post-op, I just started getting lazy about walking...Will make myself hit the paths again.. This is the nicest time of the year and we should all be out walking. Bonnie
joy
Well-known member
Hi dave, I am 24, and I chose to have a C.E. Bovine pericardial valve. I had an MVR in august of 2001. I chose to have the bioprosthetic, because of my lifestyle, and I do not want to be on coumadin. I have 2 small kids, and am very active. I like to downhill ski, and I get bruises easily. I also don't really like the clinics around here for getting my INR tested and I know tricare wouldn't approve a protime. I actually let my heart surgeon make the final decision on what he thought was best after I described my lifestyle to him. As for having more kids, there was no issue, two was enough for my husband and I. I had a tubal to ensure that it never happens again. Hope this helped!
F
FredH
homograft using minimally invasive surgery
homograft using minimally invasive surgery
Hi Dave,
I had surgery Nov 2000 at Cleveland Clinic. I got a homograft using minimally invasive surgery. Everything went well during the surgery and pain was minimal after. The echo shows that the surgeon did a perfect job. I have had two echoes from different people and both said they could not even tell that I had surgery except for the cut on my chest. I have had a problem with heart rhythm and a-fib occurred about 3 days after the surgery. I am on meds for the rhythm problem. I know it is a hard decision on which valve to use. I know both my doctors wanted me to use a mechanical since I was only 58 when I had the surgery done. The doctors felt that the homograph would some day have do be replaced where a mechanical would last the rest of my life. Good Luck. My e-mail is [email protected].
homograft using minimally invasive surgery
Hi Dave,
I had surgery Nov 2000 at Cleveland Clinic. I got a homograft using minimally invasive surgery. Everything went well during the surgery and pain was minimal after. The echo shows that the surgeon did a perfect job. I have had two echoes from different people and both said they could not even tell that I had surgery except for the cut on my chest. I have had a problem with heart rhythm and a-fib occurred about 3 days after the surgery. I am on meds for the rhythm problem. I know it is a hard decision on which valve to use. I know both my doctors wanted me to use a mechanical since I was only 58 when I had the surgery done. The doctors felt that the homograph would some day have do be replaced where a mechanical would last the rest of my life. Good Luck. My e-mail is [email protected].
