Foldax Continues

[pellicle]

but perhaps at least get a zoom consult from someone in another clinic.

I'm not sure but perhaps Dr Walter Bishop would be the right guy.

However all gags aside I think he's meaning a mechanical mitral into the Aortic position; but that's speculation on my part.

 

[pellicle]

I don’t think that’s a reasonable goal that meshes well with staying alive.

well as there are people here who've had 5 (I think 7 was the record) lets just leave it at the quotation from the Matrix :
where the architect states that "... there are levels of survival that the machines are willing to accept. "
Besides, we don't know if the fella has a genuine contra-indication to warfarin or not.

 

[ATHENS1964]

Abbot has 31mm aortic valve

Aortic Valve Replacement with 31- and 33-mm Mechanical Prostheses: Early Results

The mean aortic diameter of Indian adults is 25–31 mm, yet fewer than 1% of worldwide heart valve procedures involve a 31-mm aortic heart valve. Of the 72 large prosthetic aortic valves (31-mm) implanted in the Asia Pacific region during ...

www.ncbi.nlm.nih.gov

 

[Lucker]

I've never heard of such a thing. Is this someone in the medical field telling you this? Hopefully someone with more specific knowledge of this can chime in, but here are my thoughts.
-It is not uncommon for patients to have annulus at 29mm and larger. It is the high end of the range, but not uncommon.
-They make prosthetic valves 29mm diameter. So, having a 29mm annulus should not be a problem.
-I've never heard of replacing an aortic valve with a patient's mitral valve. In the Ross Procedure, the pulmonary valve is transplanted to the aortic position, but this valve is a tricuspid valve with similar function as the aortic. The mitral is significantly different than the aortic valve. It is bicuspid and has strings attached to it, which play a vital role in its function. Moving this valve would also need to involve removing and re-attaching the strings. That would seem to really complicate things.
-If you did that, now you need to get a prosthetic mitral valve as well.

Anyway, if this is a medical person telling you this, get another opinion. I don't know if that is possible in Russia, but perhaps at least get a zoom consult from someone in another clinic.
I really can't see how having a 29mm annulus is a problem, but perhaps someone who knows more than I do can give comment.

Of course not the human mitral valve, but the mitral mechanical prosthesis.
Here's example Use of an inverted On-X mitral valve in the aortic position in a resource limited setting - PubMed
They call 30mm annulus "excessively large".

@pellicle
Yes, backward facing.

 

[Lucker]

So far Foldax only has valves up to 27mm. Only mitral are bigger.

 

[Chuck C]

Of course not the human mitral valve, but the mitral mechanical prosthesis.
Here's example Use of an inverted On-X mitral valve in the aortic position in a resource limited setting - PubMed
They call 30mm annulus "excessively large".

@pellicle
Yes, backward facing.

That is interesting. I will note a couple of things.

The title of the publication, involving one patient:

"Use of an inverted On-X mitral valve in the aortic position in a resource limited setting"

"A 46-year-old male with severe aortic insufficiency underwent aortic valve replacement during a surgical outreach program in Tegucigalpa, Honduras."

Put another way, "We did not have the right sized parts available, so we used a part designed for something else instead." Points for creativity for sure. I would imagine this individual from Tegucigalpa is much better off now than if he did not get the surgery, even if this is not ideal.

Good hemodynamics reported, but there is zero long term data on how a mitral mechanical valve does when put in backwards in the aortic position. It was not designed for this.

As noted, there are larger aortic prosthetic valves on the market. So, to avoid the need to use a backwards mitral valve in the aortic position, I would suggest not getting aortic valve replacement done in Tegucigalpa Honduras, or in any other setting in which the resources are limited. Consult with the clinic where you plan to get your procedure well ahead of time and make sure that they have the right sized aortic valve available for you.

 

[erricojj]

I've never heard of such a thing. Is this someone in the medical field telling you this? Hopefully someone with more specific knowledge of this can chime in, but here are my thoughts.
-It is not uncommon for patients to have annulus at 29mm and larger. It is the high end of the range, but not uncommon.
-They make prosthetic valves 29mm diameter. So, having a 29mm annulus should not be a problem.
-I've never heard of replacing an aortic valve with a patient's mitral valve. In the Ross Procedure, the pulmonary valve is transplanted to the aortic position, but this valve is a tricuspid valve with similar function as the aortic. The mitral is significantly different than the aortic valve. It is bicuspid and has strings attached to it, which play a vital role in its function. Moving this valve would also need to involve removing and re-attaching the strings. That would seem to really complicate things.
-If you did that, now you need to get a prosthetic mitral valve as well.

Anyway, if this is a medical person telling you this, get another opinion. I don't know if that is possible in Russia, but perhaps at least get a zoom consult from someone in another clinic.
I really can't see how having a 29mm annulus is a problem, but perhaps someone who knows more than I do can give comment.

My 6-month-old aortic Inspiris Resilia model 11500A is 29mm. Hopefully, my surgeon measured twice and cut once.

 

[nobog]

A valve is a valve - mitral and aortic prosthetic valves are the same except for the cuff and the way they are mounted on the valve holder (what the doc uses to help implant the valve). Cuffs are available up to 35mm. The largest On-x valve is a 25mm then they use bigger cuff's to make up the difference.

 

[Springdogg]

If you’re getting a new bioprosthetic valve every 10 years then you’re gonna need to have 4 more OHSs in your lifetime. I don’t think that’s a reasonable goal that meshes well with staying alive.

I’d recommend changing your path before it’s too late. Just my opinion so take it for what it’s worth … maybe nothing.

Most definitely not my plan. This is my last tissue valve. Next up is mechanical unless something like the Foldax valve was available.

 

[Chuck C]

A valve is a valve - mitral and aortic prosthetic valves are the same except for the cuff and the way they are mounted on the valve holder (what the doc uses to help implant the valve). Cuffs are available up to 35mm. The largest On-x valve is a 25mm then they use bigger cuff's to make up the difference.

Interesting to know. Thanks

 

[Lucker]

In case of polymeric flexible valves I can see why there may be a difference in engineering between aortic and mitral valves. For example wider and/or shorter valve may require more strength in the flexible cusps.

 

[nobog]

In case of polymeric flexible valves I can see why there may be a difference in engineering between aortic and mitral valves. For example wider and/or shorter valve may require more strength in the flexible cusps.

It's unlikely that a manufacturer would go down this path as this would require 2 separate engineering endeavors and FDA (as well as every other governing body) submissions.

 

[Lucker]

Actually Foldax aortic valve has the cuff outside diameter of up to 36mm, so a large annulus should be covered, and intra-annular implantation should be possible too, which gives annulus size of 36mm. Good.