Durability of tissue valves in younger patients

[RCB]

Ben and Bonnie from Bob

Ben and Bonnie from Bob

Ben,
1. I replied- thank you!
2. I understand and Both my wife and I were impressed
with Dr. Grimm.

Bonnie,
Creatine is a type of protein and it measure kidney function. As kidney function becomes less efficient, some of these protein "leak" in urine. Normal range is between
1.2--1.9. It is like most stats- you aren't aware of them
till the dr. tells you have a problem.

 

[johnbelloh]

Dr. Pettersson

Dr. Pettersson

RCB

I am a Pettersson graduate. Tell me what you would like to see in a PM. I always thought a PM was post mortum and I am very much alive!

 

[John & Joann]

It think that we should start a Dr. Petterssen Fan Club! He is THE BEST!

We all need to be thankful that our treatments have, for the most part, been a huge success.

John & Joann

 

[RCB]

John and Joann

John and Joann

I'll let you know about that Fan Club idea in a
couple of months- By the way, your first on my hello list
for the good drs. at CC.

 

[alan_delac]

Thank you for your answers.

It seems to me that getting some reliable data on durability of tissue valves in younger patients (say 45-55 years) will be hard if not impossible to find. I searched Internet and found one study following women of child bearing age with the first generation Bovine Pericardial valves. The valves had to be replaced after 5-10 years. That is quite a short time. I would go with a tissue valve if I can get at least 10-15 years (I hope 15) before a replacement is required. I found one study that claims that risk of second OHS is equivalent to 10-15 years on Coumadin. Unfortunately, I failed to save the link. The study in related to a particular hospital, so it shouldn?t be taken as a general rule.
I use to be quite keen on the Ross procedure. Unfortunately, where I live (Brisbane, Australia) the Ross in not often used because it is such a complex procedure. I found lots of contradictory data on Ross and don?t know what to think about it. A lot of confusion comes from difference in age between typical Ross patients (very young) and typical one valve replacement patients (usually more mature individuals). Survival rates for Ross is much better ? of course younger patients. Freedom from re-operation similar to some tissue valves ? again tissue valves in older patients are quite OK. Does anyone know, in case of Ross procedure, if the pulmonary valve in the aortic position stays living tissue and only one that requires further work is homograft (or similar) in the pulmonary position?

Regards

Alan

 

[Bryan B]

Allen,

There are no definites, but yes the pulmonary valve placed in the aortic position remains living tissue and "may" never need replacing. Again I read on a Ross site (and didn't save the link) that both the pulmonary valve in the aortic position and the homograft in the pulmonary position have about an 82% rate of no reoperation at 25 years. Of course that average includeed all people who have ever gotten the Ross. I think I got that info off of the Ross Registry (you can probably google and find that). I have also heard that if the homograft in the pulmonary position needs replacing that it is a much simpler procedure and may be done via the "keyhole" method. I'm not trying to sway you to have the Ross, but I did a lot of studying before choosing to have the Ross. I felt that it was a little riskier to have done, but could pay off in the long run with longer times before reoperation than regular tissue valves but still having the benefit of not having to take anticoagulants.

 

[valveman1]

Valves in younger people

Valves in younger people

Consider the ON-X Bioprosthetic Heart Valve (www.MCRITX.COM). It is currently involved in an "Aspirin Only" study in Europe in the aortic position, normal sinus rhthym. Although aspirin is not yet approved for use in this country, the superior hemodynamics of this valve promise possibilities for the future. Look into it.

 

[Ross]

Valveman1 has ON-X come up with a model yet that has a graft sleeve attached to it, Aortic position for aorta repair along with valve replacement?

 

[RCB]

Superior?

Superior?

Superior to what? I have seen no study that compare all the newest generation valves to each other. The newest studies are put out by the manufacture and compare their
newest generation to their competitor's last generation. If you look at the man. specs., there is very little statistically
difference in all their data for the newest valves. Each will
make subject statement about superior design, but so do used car salesman. Since they all use the latest carbon
Pryrolite(RT) coating they all face about the same clotting
problems.
If you can cite a study that show a valve to valve comparison of the latest generation of valve, I would love
to see it- could you hurry because I have to make up my
mind shorty!

 

[johnbelloh]

RCB

None of the newer mechanical valves have any track record. Until they are in use for about 15 years they won't have any believable stats. The Cleveland Clinic does have a 15 year track record for both the Edwards pericardial and the cryopreserved homograft.

John

 

[RCB]

Stats

Stats

John,
The statistics that I am citing are those of quantitative nature, (ie., EAOI, Peak Gradient, Average Gradient,
life of valve) and readily available at manufacture's website. Clinical data,
the kind that measures real life experience with a large
sample space, take time and is not available for 15 years.
Hemodynamics is quantitative. How a valve guards agianst
clotting, will only be known by a clinical study.

 

[alan_delac]

I browsed through On-X valve claims and I must say I was impressed, in particular with the South African experience with around 100 people not using Coumadin and getting away with it. It would be nice to know when could we expect first results from the German trial with Aspirin. Even if the results are positive (no Coumadin required), question of the long term performance without Coumadin will remain. We need some brave volunteers.
Thanks for the info.

 

[tobagotwo]

Porcine and Bovine

Porcine and Bovine

The basic physical difference between the Medtronics Porcine valves and the Carpentier-Edwards bovine valves is that the Medtronics valve is and actual pig valve, and the Carpentier-Edwards valve is cow pericardium that has been shaped (manufactured) into a working valve.

The generally accepted reasonable valve life expectations for the current models are about 15 years for the porcine and 20 years for the bovine. Surgeons seem to like the porcine valve because it is a real valve. However, the stats seem to lean strongly toward the bovine lasting longer.

However, the current bovine model is the Perimount Magna, whcih most hospitals do not have in stock yet. They are still implanting older models. You would have to insist on the current model, which would likely have to be delivered from CE.

The current Medtronics porcine valve is the Mosaic, not the Freestyle. Unless there is a mounting issue with the exact model/style you need, you want the Mosaic. Freestyle is their older model, and the model they still use for valves other than the aortic, or for unusual mount issues. While they are an excellent valve in their own right, don't let them use an older model just because it's "what's in stock."

There is some information, particularly associated with the ON-X mechanical, that it is much more tolerant of INR fluctuations that older models. However, I agree with prior posts that there is no long-term track record yet for it, the newest St. Judes, or the Sorin, in regards to alternative anticoagulant therapies. However, I would also have to say that there seem to be valid reasons to be optimistic about them.

In your 40s it's a really tough call. There is a lot to recommend the mechanical route for that age. A lot. I chose the Mosaic tissue valve, but I'm 51. I expect a reoperation around 65-66, and for whatever I get then to last the rest of my life. Best call is that you would likely be looking at two reoperations in your lifetime, rather than one like me.

If I were 41, and determined to go with a tissue valve, I would definitely choose the Carpentier-Edwards Perimount Magna. It is just possible you could squeak through with only one reoperation on that. However, you must be prepared not to beat up your valve. Younger people are hell on tissue valves.

Best wishes,

 

[Granbonny]

Another great post, Bob

Another great post, Bob

You will be on Medicare at age 65. Keep up the Private Insurance. Medicare does not pay for meds. Thank goodness, my Dad, age 90 has the money to buy what meds he needs . So many of our elderly forego food to buy their meds. Can you imagine what a VR. surgery will cost in 20 years. Bonnie

 

[Debrinha GT]

finally found out

finally found out

Hello everybody, All my mitral valves have lasted for different periods of time, 5, 15 and the one I have now has started to deteriorate after 8 years. I don't really know how long it will be until the next one. On my last visit to my cardio I asked him to give me a copy of my surgical chart and I've finally found out the type of valve I have, here goes ""Pericardium bovine bioprosthetic cardioprothesis valve #29. If any of you have read anything at all about it, please, let me know. Any information will be welcome! Thank you!