Homograft bad?

[jjputz]

I am now scheduled for OHS on Feb 7th for an ARV and ascending aorta. I?ll be 45 on Jan 30th, whoopee. I?m having it performed at the Cleveland Clinic. The Surgeon there told me he would put in a homograft. I asked him about the Dacron and magna valve but he said that the next time I needed the valve replaced it would be difficult with the Dacron.
I wasn?t worried until Arlyss posted this info from Cedars-Sinai ?not that I don?t appreciate the knowledge ? I don?t want to be blissfully ignorant.
"Homograft Technique
Homografts are the most resistant to infection, making this the preferred technique for the treatment of aortic root infection and endocarditis at Cedars-Sinai. The major disadvantages of a homograft include issues with the longevity, the size and the length. Since homografts depend on human donor availability, there is no assurance that there will be a sufficient quantity of the different sizes and lengths that may be needed. Regarding the longevity of this solution, chronic rejection causes severe calcification of the aortic wall (which becomes like a "lead pipe") in 13 years. To a lesser degree, the aortic valve leaflets also degenerate. Homografts may be considered for use in an elderly patient with a life expectancy less than 15 years for treatment of a heavily calcified (porcelain or egg shell) aorta in lieu of aortic valve replacement and endarterectomy of the aorta. "

As outlined above, for someone young, who does not have any infection issues threatening their life and has a life expectancy beyond 15 years, the homograft solution does not have the longevity needed. For someone not expected to live long enough to develop a "lead pipe" it might be the right thing
I also thought I would add the other test results which my influence your opinions.
The aortic valve is bicuspid 3+ regurgitation no stenosis
1+ tricuspid regurgitation valve normal 1+ Mitral regurgitation valve normal
EF = 50 +/- 5%
The Aortic sinuses measure 3.6 cm sino-tubularjunction measures 3.7 ascending aorta measures 4.6 cm.
I know the ascending Aorta and Valve are bad I don?t know about the rest of the test results mean, they said I have no plague buildup in my veins. I have bad veins on my right lower leg from a motorcycle accident and -oh yes let?s not forget about arthritis
Before I start E-mailing my surgeon with my concerns I was hoping to get your feedback.
THANK YOU

 

[geothoix]

Not one we are picking

Not one we are picking

In discussions with Drs and through research, your extract is consistent with what we are hearing. The Dr said that with calcification it becomes hard to replace and did not recommend this for someone younger.

The options remaining in our case are mechanical, biological and Ross. One thing that was made clear is that the needs of each patient are different and that only with all the facts can they offer options.

Perhaps a second opinion?

 

[tobagotwo]

Multiple opinions are valuable, although you don't have much time for them by your op-date.

Different surgeons have different opinions as to what is difficult, and about what is worth doing. Sometimes remarkably different. One won't do a particular surgery. Another will do that surgery without batting an eye.

I guess you need to determine if you want to continue the surgeon search, or if your need to get it done right away must supercede your desire for choice. You're in a tough spot. Your stats aren't good. I wish I had a better suggestion for you.

You are in my thoughts. I don't know surgeons, but if there's any information I can help get to you, I'll try.

Best wishes,

 

[d-mac]

Hello JJ

I concur with Bob in my limited lay opinion - Different surgeons say different things. My surgeon was happy to use an allograft (homograft in American language) and has been using them for 25 years. He cited several patients who are now in their 50's and still going strong on surgery done in the late 1970's early 80's. Incidentally he was prepared to use porcine or mechanical valves but his preference for my circumstances was an allograft. I always knew though that I might wake up with mechanical due to the size of my aortic root. Fingers crossed, make the best decision you can for YOU in YOUR circumstances in consultation with one or more surgeons. Ask about the track record your surgeon has with homografts. If you take an allograft you must accept that one day you may go back for another AVR as with porcine and bovine valves. Don't assume that with a mechanical you will never need a re-op though..

Ciao

 

[jjputz]

Thanks D-Mac

Thanks D-Mac

Thanks for the info - I was trying to find some information about the homograft lasting longer than 15 years - I couldn't find any and was begining to worry.
I was about to go to Vegas with my retirement money for a last fling.
That makes me have a better atittude. I was already prepared for a second operation anyways. I was hoping for a little longer time between cuts is all.

 

[perkicar]

I am now scheduled for OHS on Feb 7th for an ARV and ascending aorta. I’ll be 45 on Jan 30th, whoopee. I’m having it performed at the Cleveland Clinic. The Surgeon there told me he would put in a homograft. I asked him about the Dacron and magna valve but he said that the next time I needed the valve replaced it would be difficult with the Dacron.


So who is doing your surgery? The same guy who told you you didn't need it anytime soon? Or did you pick someone else?
Carolyn (still waiting to hear back on her second opinion from CC)

 

[jjputz]

Same guy

Same guy

Yes the same guy. The Doctors name is Nicholas Smedira. He actully did tell me at the time that he could do it now or wait but if it was him he said he'd wait. The vlave has been leaky and the Aorta enlarged for a while and I was living o.k. with it.
Looking at the Cleveland clinic doctors list he looks good at their website. When I was at CC for my post op another patient told me I'd have to wait 3 months if I picked another Doctor for surgery. I only met him once. I don't now how to tell if he is good or not. Perhaps someone else at this forum has been operated on by him?

 

[jjputz]

CC for me

CC for me

Besides time being an issue - so is money. I feel lucky enough that my insurance covers Clevland Clinic - flying to Texas is a little out of my league.
The only other option I would like over the homograft would be a Dacron tube with a CEPM valve. But if another Doctor said that is better would he be right?
I agree with the practice makes perfect concept and Smedira appears to have plenty.
I wish that sheylathomas could send me a link to were she found the info she posted, It makes me fell like I'm probably doing the right option.

 

[tobagotwo]

Some homograft resources, if you're interested...

Patient Outcome and Valve Performance Following a Second Aortic Valve Homograft Replacement:
http://circ.ahajournals.org/cgi/content/full/100/suppl_2/II-42

and from another:

"6. What are the expected late results with homograft aortic valve replacement?

"O'Brein and his colleagues have recently reported their results with cryopreserved aortic valve replacement of the aortic valve (Ann Thorac Surg 1995;60:S878-91). The operative mortality for 146 aortic root replacements was 1.7%. Patient survival was 85% and actuarial freedom from structural deterioration of the allograft valve was 86% + at 8 years. Actuarial freedom from structural deterioration of 534 cryopreserved non-root replacement aortic allograft valves was 77% at 18 years. This is the largest series that has been reported with long-term results of cryopreserved allograft aortic valve replacements. Comparison of the root replacements and the intra-aortic implants at 8 years has shown no statistical difference, although possible advantages of the root replacement may be demonstrated with longer follow-up."

This discusses advantages and reasonings for homograft use:
http://www.chdinfo.com/aa/aa061597.htm

This one compares homografts to Toronto stentless valves:
http://www.shvd.org/file/6969_1.htm

Best wishes,

 

[jjputz]

Thanks Bob

Thanks Bob

Your links help - looks like a homograft for me and probably a valve down the road. - great forum

 

[tobagotwo]

Always be somewhat wary of study dates and number of subjects, as old or miniscule studies can get on the web, too.

Also, don't get downhearted at some of the stats for any type of valve, as your personal odds are really heavily dictated by your age, general health, and your heart's condition.

It's hard to find good data on homografts, but I know it's out there. I didn't leave out any negative finds.

Best wishes,