homograft longevity

[Jim_Bowker]

I've not been able to post much lately--but I "lurk" and have been learning so much from the experiences of others. Awhile back I had posted some questions about the fatigue I've experienced due to my aortic insufficiency, and I got some excellent feedback both about others' experiences with fatigue as a symptom of AI and about how to deal with a cardiologist who seemed not to be hearing me lately.

Anyway, later this week I'll be scheduling my own AVR surgery, and I'm dealing with the issue of which type of replacement to consider--the Ross Procedure was eliminated from contention due to the dilation of my aortic root. So it's mechanical or homograft ...

I've avidly read the thread (begun by Peter Easton) dealing with the major alternatives for AVR, but I have a question that has not been answered as part of that discussion. Although a homograft is expected to last 10 or 12 or 15 years before a second surgery will be required, I've suffered from a lot of fatigue over the past 10 years, and I'm wondering if anyone can comment (from their own experiences or based on what they've been told by doctors) as to whether the expected lifetime of a homograft exceeds the time in which one might begin experiencing fatigue as a symptom of valvular calcification. Or, put another way, although a homograft might last me 12 to 15 years (if I'm lucky) is it likely that it'll only be 6 or 7 or 8 before the onset of fatigue due to the homograft beginning to wear out.

Any input people have on this issue would be greatly appreciated. My surgeon has informed me that I don't necessarily need to make a decision between mechanical or homograft too much before the surgery, but he's also hoping to be able to schedule me for surgery in 6 to 8 weeks, and I do want to make this decision sooner rather than later.

 

[srwieland]

Hi Jim,

Been lurking more than contributing lately myself. It's hard to keep up sometimes.

Unfortunately, I can't help with your question but it's a great one and, being a recent recipient of a homograft myself, share your concern about it.

A related question I have is: Does anyone know of anything that can be done to slow down the calcification process, either by mainstream or alternative medicine?

Hope we got someone out there who's had a homograft long enough to help us on this or who is privy to some enlightening information on it.

Thanks,

Steve

 

[Peter Easton]

Homograft poop-out?

Homograft poop-out?

Is the homograft different in this respect from other tissue valves? My sister just got her second valve replacement. The first was porcine, the most recent mechanical. She encountered symptoms toward the end of the 10-year life of her pig valve, but they were neither earlier in onset (relative to time of operation) nor more severe than those she had gotten the first time around. I believe they started about six months before she ended up having the replacement.

Peter

 

[Jim_Bowker]

Others here have spoken more intelligently than I could about the process of making different tissue valves viable for implantation. All I know is that a homograft is human tissue (as opposed to porcine or bovine valves which come from pigs and cows). Hope that isn't just insights into the obvious.

From what I've read on PubMed and elsewhere, docs seems to think that homografts are less likely to cause clotting (and certain other types of problems), but I don't know that there's overwhelming evidence that homografts are better than other kinds of tissue implants.

 

[Mara]

Hi guys

Hi guys

Well- my "original" aortic valve was calcified when they yanked it. I think some calcification is inevitable...my bro the doctor told me that. The surgeon told me the hope with the CryoValve SG --I got one for my pulmonic and Steve, didn't you get that for your AVR? is that it will not calcify as quickly.

If you've been lurking you know that I have been seeing an integrated medicine MD. He told me to take some of those supplements that the muscle guys take.... Cytovol and Betagen, to help with cellular regeneration and buildup...suppose to help the heart muscle grow new cells and bulk up the ones there that might have taken a beating during surgery.

Also, that old favorite Co-Q10. Plus do that heart helathy diet thing. Plus those groovy anti-oxidants...E, B, and the biggie Lipoic Acid. I do feel as though my pre-op regimine of vitamins and supplements helped me bounce back more quickly. I was out of the hospital in 3.5 days and off the vent 3 hours post op, etc. Apart from some soft tissue pain around the incision, I feel great.

That is all I know about. I am hoping to get a long while out of this Ross Procedure...

Good Luck
-Mara

 

[Peter Easton]

Pulmonary and aortic

Pulmonary and aortic

As you say, Mara, the fundamental difference between your operation and Steve's (or potentially mine) is that in the Ross Procedure the Cryolife Synergraft human pulmonary is used to replace the PULMONARY valve, whereas in the technique Steve underwent it is used to replace the AORTIC valve. As I understand it, risk of calcification is in any case much less for a valve in the pulmonary position than for the identical one in the aortic position, given the greater "traffic" and demands on the AV.

It would seem to stand to reason, therefore, that if the new Cryolife SG holds up even moderately well in aortic transplantation and/or has a lower rate of calcification than the alternatives, it will do famously well in the pulmonary position. All of which doesn't entirely resolve the issue for those having Cryolife SG implanted for AVR, but should greatly relieve those having the Ross Procedure.

Does this make sense?

Peter

 

[Mara]

Peter

Peter

Peter-
that make perfect sense. Any stenotic valve will get calcified. Waiting to see if the replaced AV becomes leaky and /or stenotic is kind of like sitting around watching paint peel, don't you think?

But, the CryoValve was supposed to be desinged to work like an ace on the high pressure AV side, so of course on the lower pressure side it will do as well or better. I don't think that means that it will calcify more quickly on the AV side than any other valve choice. we all have calcification on bad valves. Even those "last forever" mechanicals can get calcified. I wouldn't worry about it if and until the valve "goes bad." my 2 cents.

I hope you like your CryoValve as much as the rest of us....it's pretty high tech, don't you think?

 

[Peter Easton]

Super hi-tech. This said, I did get the impression from my surgeon that IF the cell repopulation wager did not work our for the Cryolife SG pulmonary homograft, then evidence suggested it would last a little less long than other tissue options for aortic valve replacement. He said that in general pulmonary valves per se don't do as well in the aortic position as - and calcify a bit quicker than -- native aortic ones. That's the gamble, I guess, though the evidence that Steve Wieland has cited about Synergraft valve matrix cell repopulation in sheep trials and partial results from a few Cryovalve SG beneficiaries who passed away for other reasons does at least make it seem like a GOOD gamble.

Peter

 

[srwieland]

Yeah, Mara, I got the SynerGraft valve in the AV and will be one of the earlier ones to find out how it works there. So far, so good!

Even though my surgeon, the same as Peter's, is cautious when pressed about predicting its success, he's still very optimistic about it, and my semi-retired surgeon friend, his mentor, became favorable about it after talking with the principal developers of it, even though he originally had advised me to go with the more tried and true mechanical.

I really appreciate the advice on the supplements. I tried some of those already and will try the other ones too. Every little bit helps.

 

[brenda]

I had AVR with homograph 11 years ago. Only in the past 6 months have I experienced more fatigue than usual (but could it be my age? I am 54 now). I am still active-aerobics, skiing, bicycling, but I do tire more quickly now.

After an echo in June, a new cardiologist (my old one retired) recommended surgery to replace my homograph. But when my surgeon (Dr. Pacifico at U of Alabama) reviewed the results of my echo, he disagreed.

Totally confused, I plan to visit Cleveland Clinic in October. I was able to get an appointment with an imaging cardiologist, Dr. Garcia. Anyone know him?

Also, my cardiologist, before she retired, recommended I take I take Coreg to "strengthen my heart." Anyone hear of this?

I know Kevin M had his 10-12 year old homograph replaced this summer. I would love to find some others of us with "old" homographs.

 

[LUVMyBirman]

On the subject of 'tissue valves....have a friend back home that has a tissue, not sure what type. Whatever they were using 21 years ago. She is just now necessitating replacement. The other one I heard of was tissue type with replacement in 5 years.

Unfortunatley, we cannot put an accurate time on any type of valve replacement even mechanical.

My choice for the prothesis was purely for not opting to have multiple repeats. Scar tissue is more difficult to deal with in subsequent surgeries. Along with the longevity of the prothesis comes your friend and mine Mr. Coumadin.

Whatever you choose....confident it will serve your needs well. As it is a very personal decision.

 

[Cindy]

Calcium

Calcium

Here is another angle I have not heard discussed. My dad's surgeon - Dr. Lytle (the Cleveland Clinic) discussed with him his previous intake of calcium.... My dad takes lots of vitamins/supplements. Dr. Lytle suspects that years ago when he took pretty high doses of calcium (1 gm/day) over a period of years - *may* have contributed to his calcification of his aortic artery and valve. He stated he even sees more of this in older people who are raised on dairy farms and probably ate more dairy products than the average person..... Interesting.... He cautioned my mom not to take calcium - even though her mom had a broken hip from osteoperosis.... Cindy