R
Robt Z
I read what seemed to infer that homografts can last a lifetime on the Lenox Hill Hospital web site. Has anyone heard such a thing? I have not.
Help Support Valve Replacement Forums:
K
Kevin M
Homografts cannot last a lifetime unless you get one when your 95 
They typically do not last more than 15 years from everything I've read.
My ran out of gas after about a decade and had to be replaced.
A lot of it has to do with the age of the patient, since homografts typically stiffen from calcification. They supposedly last longer in patients that are a little older. The older the individual, the slower the calcification process.
If they could find a way to make one last forever, I'd be elbowing my way to the front of the line because homografts have excellent hemodynamics and do not require much of a change in lifestyle.
There are others here who could probably give you more scientific information.
Kev
They typically do not last more than 15 years from everything I've read.
My ran out of gas after about a decade and had to be replaced.
A lot of it has to do with the age of the patient, since homografts typically stiffen from calcification. They supposedly last longer in patients that are a little older. The older the individual, the slower the calcification process.
If they could find a way to make one last forever, I'd be elbowing my way to the front of the line because homografts have excellent hemodynamics and do not require much of a change in lifestyle.
There are others here who could probably give you more scientific information.
Kev
You're 100% correct Robt
You're 100% correct Robt
Take a look at this page from the Lenox Hill Hospital website:
http://hvi.lenoxhillhospital.org/pr...e Replacement&detail=mitralaorticvalvereplace
I think they left a word out of the following quote:
"Mechanical valves are made from a very strong metal with a carbon coating. They never wear out but require patients to take a blood thinner (anticoagulant) for the rest their lives. This is necessary to minimize the risk of forming blood clots on the prosthetic, mechanical valve.
Tissue valves are specially treated animal or human (see Homograft) valves. They are quieter than mechanical valves but may last as long. Patients do not need to take an anticoagulant for life although anticoagulants might be needed for a short period of time following surgery. "
Maybe it you brought it to their attention, they'd give you a suite!
You're 100% correct Robt
Take a look at this page from the Lenox Hill Hospital website:
http://hvi.lenoxhillhospital.org/pr...e Replacement&detail=mitralaorticvalvereplace
I think they left a word out of the following quote:
"Mechanical valves are made from a very strong metal with a carbon coating. They never wear out but require patients to take a blood thinner (anticoagulant) for the rest their lives. This is necessary to minimize the risk of forming blood clots on the prosthetic, mechanical valve.
Tissue valves are specially treated animal or human (see Homograft) valves. They are quieter than mechanical valves but may last as long. Patients do not need to take an anticoagulant for life although anticoagulants might be needed for a short period of time following surgery. "
Maybe it you brought it to their attention, they'd give you a suite!
M
martha
At the time I was considering what type of valve I wanted. My cardiologist told me of people in europe with homographs. That had lasted thirty years or longer. Don't think this is the norm however. As the years go on, I do belive that the years one of these lasts will improve. I have had my homograph now for a little over two years. I'm sure by the time I'm ready to have it replaced there will be huge changes. martha
J
John Cochran
Several of us here, including me, have tissue engineered homografts, known as the Cryolife SynerGraft (SG). These differ from conventional homografts in that all the donor's cells are stripped from the valve. This leaves behind a fully functional collagen matrix that eventually repopulates with the recipients own cells, making the valve your own living tissue. This is thought to significantly reduce calcification, and may result in a lifetime fix. However, since this process is relatively new, there is no long-term data yet.
These valves are only available through the Mayo Clinic at this time (as far as I know). They are not experimental, and are covered by most insurance. If you would like more information, please feel free to e-mail me directly.
Best,
--John Cochran
These valves are only available through the Mayo Clinic at this time (as far as I know). They are not experimental, and are covered by most insurance. If you would like more information, please feel free to e-mail me directly.
Best,
--John Cochran
M
Marie
I also am considering a homograft valve. I understand the homograft may not last the rest of my life (I am 53) but the possibilities of even better valves in the upcoming years makes me optimistic. It is a hard decision. My father had a bicuspid valve and had a mechanical valve replacement at age 62. He struggled with the coumadin a little, but in the end he died of cancer.
C
chastecl
Hi Marie,
As John Cochran said, there are several people on this forum who have had a Cryolife SynerGraft (SG) homograft valve replacement. I think John has perhaps done the most extensive research on this newer technology. I would urge you to take him up on his offer and email him directly for further information. You may also email us at [email protected] for any support we can provide.
We first learned of the Cryolife SynerGraft (SG) homograft valve replacement option when Dr. Kenton Zehr responded to a blind email that Jerry sent to Mayo Clinic in which he asked if anyone there was performing the Ross Procedure. This seemed to be the most promising option 6 years ago when Jerry was first diagnosed with severe bicuspid aortic stenosis and most of our research on the Ross Procedure lead us to the Cleveland Clinic website. Since we thought it a long way to travel, Jerry contacted Mayo. Here is a portion of the email response he received from Dr. Zehr.
?There is another option of a tissue engineered human valve called a Synergraft. These human homografts have the cells enzymatically washed out leaving behind the collagen framework. Experimental evidence shows that the recipient repopulates the conduit with their own cells. I am the principle investigator of a systematic look at this valve conduit at Mayo Clinic.
The Synergraft recellularization data has been shown in animals and there has been two human explants of the aortic valve for patients who died of valve unrelated causes. Both have been nicely recellularized. The Synergraft is FDA approved and thus not experimental. The study that I am principal investigator on is to follow the immunological response of patients to the Synergraft conduit. Regular homografts cause a significant immunological response which is thought to contribute to their limited durability of 10-15 years. We are following 12 patients thus far and 9 of 12 have shown no immunological response to the Synergrafts, the other 3 have had intermediate reactions. All are perfectly functioning. Therefore the valve is promising and most of the patients that have been interested in the Ross have chosen this option as opposed to the two valve operation for one valve pathology Ross option."
We also want to add our personal assurance to you that the SynerGraft homograft is not experimental and it has been FDA approved. Your insurance will probably cover it as ours will. Of course, we did verify the coverage first. As John said, there is no long term data as yet but studies show promise that this may be a one time fix. Jerry is participating in the study Dr. Zehr is conducting on imunilogical response.
Best of luck to you as you make your decision on a valve choice and prepare yourself for surgery. This forum is a great resource for learning what to expect and everyone is so supportive. That really helps. Jerry is now 11 days post op and doing just great!
P.S.
I don't know where you live in Minnesota, but Jerry and I were both born and raised there. I grew up in Minneapolis and Jerry in Mankato. We moved to Wisconsin about 15 years ago when Jerry took a job here. Prior to that, we lived 10 years in blizzard prone Slayton (between Marshall and Worthington). Jerry is still an avid Viking and Twins fan!
As John Cochran said, there are several people on this forum who have had a Cryolife SynerGraft (SG) homograft valve replacement. I think John has perhaps done the most extensive research on this newer technology. I would urge you to take him up on his offer and email him directly for further information. You may also email us at [email protected] for any support we can provide.
We first learned of the Cryolife SynerGraft (SG) homograft valve replacement option when Dr. Kenton Zehr responded to a blind email that Jerry sent to Mayo Clinic in which he asked if anyone there was performing the Ross Procedure. This seemed to be the most promising option 6 years ago when Jerry was first diagnosed with severe bicuspid aortic stenosis and most of our research on the Ross Procedure lead us to the Cleveland Clinic website. Since we thought it a long way to travel, Jerry contacted Mayo. Here is a portion of the email response he received from Dr. Zehr.
?There is another option of a tissue engineered human valve called a Synergraft. These human homografts have the cells enzymatically washed out leaving behind the collagen framework. Experimental evidence shows that the recipient repopulates the conduit with their own cells. I am the principle investigator of a systematic look at this valve conduit at Mayo Clinic.
The Synergraft recellularization data has been shown in animals and there has been two human explants of the aortic valve for patients who died of valve unrelated causes. Both have been nicely recellularized. The Synergraft is FDA approved and thus not experimental. The study that I am principal investigator on is to follow the immunological response of patients to the Synergraft conduit. Regular homografts cause a significant immunological response which is thought to contribute to their limited durability of 10-15 years. We are following 12 patients thus far and 9 of 12 have shown no immunological response to the Synergrafts, the other 3 have had intermediate reactions. All are perfectly functioning. Therefore the valve is promising and most of the patients that have been interested in the Ross have chosen this option as opposed to the two valve operation for one valve pathology Ross option."
We also want to add our personal assurance to you that the SynerGraft homograft is not experimental and it has been FDA approved. Your insurance will probably cover it as ours will. Of course, we did verify the coverage first. As John said, there is no long term data as yet but studies show promise that this may be a one time fix. Jerry is participating in the study Dr. Zehr is conducting on imunilogical response.
Best of luck to you as you make your decision on a valve choice and prepare yourself for surgery. This forum is a great resource for learning what to expect and everyone is so supportive. That really helps. Jerry is now 11 days post op and doing just great!
P.S.
I don't know where you live in Minnesota, but Jerry and I were both born and raised there. I grew up in Minneapolis and Jerry in Mankato. We moved to Wisconsin about 15 years ago when Jerry took a job here. Prior to that, we lived 10 years in blizzard prone Slayton (between Marshall and Worthington). Jerry is still an avid Viking and Twins fan!
M
Marie
Thanks for your reply Carol. Good to hear Jerry is doing so well and not even 2 weeks. How long was he in the hospital?
The new homograft valve sounds very interesting. I will call my surgeon tomorrow and ask if he does those. I was planning on having my surgery at Abbott Northwestern in Mpls. I am not sure my insurance will let me go to Mayo. I would have to check.
Marie
The new homograft valve sounds very interesting. I will call my surgeon tomorrow and ask if he does those. I was planning on having my surgery at Abbott Northwestern in Mpls. I am not sure my insurance will let me go to Mayo. I would have to check.
Marie
C
chastecl
Marie,
Jerry had his surgery Thursday, 3/27 and was back home the following Monday 3/31. I was amazed that he was released so soon!
I kind of doubt that anyone at Abbott Northwestern is doing SynerGraft valve replacements but it's worth asking. I know it is being done at Mayo and possibly the University of Oklahoma. When Jerry completed the paperwork for the immunological study which Dr. Zehr is heading, we were told the University of Oklahoma is also planning to participate with 25 cases. Since it's so new, it would be a good idea to find a surgeon who has a good track record of previous experience doing this type of surgery.
Keep us all posted on what you decide.
Jerry had his surgery Thursday, 3/27 and was back home the following Monday 3/31. I was amazed that he was released so soon!
I kind of doubt that anyone at Abbott Northwestern is doing SynerGraft valve replacements but it's worth asking. I know it is being done at Mayo and possibly the University of Oklahoma. When Jerry completed the paperwork for the immunological study which Dr. Zehr is heading, we were told the University of Oklahoma is also planning to participate with 25 cases. Since it's so new, it would be a good idea to find a surgeon who has a good track record of previous experience doing this type of surgery.
Keep us all posted on what you decide.
R
Rick W
homograft
homograft
Hi Robert Z
As one surgeon explained to me, a homograft will last 15-20 years where a porcine or bovine might last 8-10 years. Incidently as I understand it a homograft is a valve from a HUMAN donor(a human cadaver)whereas a xenograft is from a ANIMAL of some type. At 55 years old I am still inclined to go with the homograft, as surgery for me is nearing, maybe sometime this summer. The doctor explained there are also differences in sugical complexity between these valve types as well.
Hope this helps you in some way.
Rick
homograft
Hi Robert Z
As one surgeon explained to me, a homograft will last 15-20 years where a porcine or bovine might last 8-10 years. Incidently as I understand it a homograft is a valve from a HUMAN donor(a human cadaver)whereas a xenograft is from a ANIMAL of some type. At 55 years old I am still inclined to go with the homograft, as surgery for me is nearing, maybe sometime this summer. The doctor explained there are also differences in sugical complexity between these valve types as well.
Hope this helps you in some way.
Rick
J
John Cochran
Marie,
My surgery was done at North Memorial Hospital in Minneapolis by Dr. Michael King. However, this is a rare exception because the SynerGraft aortic homografts only became available in January, 2002 at a couple places in the country (Mayo and Oklahoma).
My "exception" was due to the fact that I had been in contact with CryoLife management for quite a long time (my educational background includes biomedical engineering) and because my selected surgeon, Dr. King, is Mayo trained and well known by both Mayo and CryoLife. However, only Mayo has a substantial bank of these valves on hand, and my surgery was delayed waiting for one.
Dr. King is one of the top heart surgeons in the midwest, and has performed over 1000 valve procedures. I picked him because I was able to get both the SynerGraft valve AND a mini-sternotomy (smaller incision and faster recovery). I picked North Memorial because of not only their great track record, but because they have an unusual but wonderful model for cardiac care: After surgery, you go to the cariac intensive care unit, and remain there for the entire stay. No changing rooms, and you keep the almost 1-on-1 nurse to patient ratio. Only two hospitals in the country have this model, and patients rave about it, including me. Talk about world-class care!
My son, who had a valve repair a year ago, has had a couple of ablations performed at Aabott Northwestern, which is also an excellent hospital, but it has the "traditional" model of moving you around after surgery.
My understanding is that the surgical technique for the SynerGraft is virtually the same as for a conventional homograft...the trick is getting a valve if you are outside of Mayo at this time.
Best,
--John
P.S. Rick's comment about the durability of homografts is in line with what I've heard; however, the SynerGraft in theory should last a lot longer, and at the very least, just as long as a conventional homograft.
My surgery was done at North Memorial Hospital in Minneapolis by Dr. Michael King. However, this is a rare exception because the SynerGraft aortic homografts only became available in January, 2002 at a couple places in the country (Mayo and Oklahoma).
My "exception" was due to the fact that I had been in contact with CryoLife management for quite a long time (my educational background includes biomedical engineering) and because my selected surgeon, Dr. King, is Mayo trained and well known by both Mayo and CryoLife. However, only Mayo has a substantial bank of these valves on hand, and my surgery was delayed waiting for one.
Dr. King is one of the top heart surgeons in the midwest, and has performed over 1000 valve procedures. I picked him because I was able to get both the SynerGraft valve AND a mini-sternotomy (smaller incision and faster recovery). I picked North Memorial because of not only their great track record, but because they have an unusual but wonderful model for cardiac care: After surgery, you go to the cariac intensive care unit, and remain there for the entire stay. No changing rooms, and you keep the almost 1-on-1 nurse to patient ratio. Only two hospitals in the country have this model, and patients rave about it, including me. Talk about world-class care!
My son, who had a valve repair a year ago, has had a couple of ablations performed at Aabott Northwestern, which is also an excellent hospital, but it has the "traditional" model of moving you around after surgery.
My understanding is that the surgical technique for the SynerGraft is virtually the same as for a conventional homograft...the trick is getting a valve if you are outside of Mayo at this time.
Best,
--John
P.S. Rick's comment about the durability of homografts is in line with what I've heard; however, the SynerGraft in theory should last a lot longer, and at the very least, just as long as a conventional homograft.
M
Marie
Thanks for all the information. This site is great. I have a call into the surgeon I have been talking to. I'll let you know what I find out.
Marie
Marie
S
srwieland
Hi John and everyone else.
As some of you know, I was the first on this site to receive a SynerGraft valve, at the University of Florida in May 2001, so I am now nearly 2 years out.
My experience with it has been somewhat mixed as I've reported before on this site.
Recently, my cardiologist was extremely optimistic that, even though I am having symptoms of mild to moderate leakage, more than I should have after getting a new valve, it may very well last me much longer than a regular homograft and he still has hopes that (if I take good care of my health which I've been trying to do!) I might not ever need surgery again.
In any case, despite some problems, I would still recommend homografts, particularly the SynerGraft, for anyone who prefers risking another surgery over having to take anti-coagulants the rest of their life. I just hope that the FDA and CryoLife can cooperate to ensure that this great scientific breakthrough is implemented in a manner that is commensurate with the idea behind it.
I will of course be among those who are followed with great interest to see how long one of these lasts.
By the way, I highly recommend Dr. Zehr at Mayo who gave me a second opinion regarding the complications in my case and who was very helpful to me and my surgical follow-up team in Florida.
As some of you know, I was the first on this site to receive a SynerGraft valve, at the University of Florida in May 2001, so I am now nearly 2 years out.
My experience with it has been somewhat mixed as I've reported before on this site.
Recently, my cardiologist was extremely optimistic that, even though I am having symptoms of mild to moderate leakage, more than I should have after getting a new valve, it may very well last me much longer than a regular homograft and he still has hopes that (if I take good care of my health which I've been trying to do!) I might not ever need surgery again.
In any case, despite some problems, I would still recommend homografts, particularly the SynerGraft, for anyone who prefers risking another surgery over having to take anti-coagulants the rest of their life. I just hope that the FDA and CryoLife can cooperate to ensure that this great scientific breakthrough is implemented in a manner that is commensurate with the idea behind it.
I will of course be among those who are followed with great interest to see how long one of these lasts.
By the way, I highly recommend Dr. Zehr at Mayo who gave me a second opinion regarding the complications in my case and who was very helpful to me and my surgical follow-up team in Florida.
S
srwieland
Rick W asked me in a private messate about the FDA approval of the CryoLife Synergraft valves, and I though it might be helpful to this discussion if I posted my response to him here as well.
Here it is:
Hi Rick,
Yes, it was and is FDA approved, as far as I know and I've been following the situation fairly well. However, the FDA temporarily suspended some of its tissue production last year because of contamination problems. That was not specific to the SynerGraft, but to many of CryoLife's tissue products.
My experience with it has been mixed.
The new valve is leaking some and should not be at all, or at least not anywhere near as much as it is for me. I regularly have edema around my ankles and am on medication (Diovan and aspirin), with occasional flutterings, none of which symptoms I should be experiencing with a new valve. Obviously, something is defective with the particular valve that I got.
On the other hand, my body seems to have been able to remodel it enough to stabilize it at an endurable level, and that might not have been possible if it were not a SynerGraft valve. Who knows!? If I endure at this level without degradation, that will be a plus for the SynerGraft, and if not, well then, back to the cutting board!
I think the first issue in valve choice is between a mechanical and a tissue valve, and that is mostly a trade-off between a lifetime of anti-coagulation drugs or more surgery down the road. I think you should first be comfortable with the decision of an ordinary homograft over a mechanical valve before you consider the SynerGraft, which it was in my case.
Then, if you are willing to take the chance, you should consider the choice between an ordinary homograft and a SynerGraft treated valve.
Best of luck and Godspeed with you choice and your surgery. I will try to stay tuned on vr.com for updates and please feel free to contact me at any time for further input.
Steve
Here it is:
Hi Rick,
Yes, it was and is FDA approved, as far as I know and I've been following the situation fairly well. However, the FDA temporarily suspended some of its tissue production last year because of contamination problems. That was not specific to the SynerGraft, but to many of CryoLife's tissue products.
My experience with it has been mixed.
The new valve is leaking some and should not be at all, or at least not anywhere near as much as it is for me. I regularly have edema around my ankles and am on medication (Diovan and aspirin), with occasional flutterings, none of which symptoms I should be experiencing with a new valve. Obviously, something is defective with the particular valve that I got.
On the other hand, my body seems to have been able to remodel it enough to stabilize it at an endurable level, and that might not have been possible if it were not a SynerGraft valve. Who knows!? If I endure at this level without degradation, that will be a plus for the SynerGraft, and if not, well then, back to the cutting board!
I think the first issue in valve choice is between a mechanical and a tissue valve, and that is mostly a trade-off between a lifetime of anti-coagulation drugs or more surgery down the road. I think you should first be comfortable with the decision of an ordinary homograft over a mechanical valve before you consider the SynerGraft, which it was in my case.
Then, if you are willing to take the chance, you should consider the choice between an ordinary homograft and a SynerGraft treated valve.
Best of luck and Godspeed with you choice and your surgery. I will try to stay tuned on vr.com for updates and please feel free to contact me at any time for further input.
Steve
J
John Cochran
It should be noted that CryoLife has temporarily halted processing of SynerGraft valves while the FDA decides whether or not the process should be regulated as a medical device. This has no bearing on the benefits or safety of this technology; rather, it is a regulatory issue pending resolution. In the mean time, Mayo continues to supply these valves from its existing bank of SynerGraft homografts.
Steve (Srwieland) was a real pioneer for all of us. The aortic SynerGraft homografts only became available in January of 2002. Steve's surgery was prior to that, and he received a pulmonary SynerGraft valve placed in the aortic position (they also do this in the Ross Procedure, but in that case it is your own pulmonary valve, with that valve then replaced with a pulmonary homograft).
Whether or not the fact that his valve has a pulmonary origin has contributed to his problems is impossible to say.
All of those who have received the aortic SynerGraft valve are, as far as I know, doing very well.
Steve, I hope you continue to see improvement! We are all cheering for our "earliest adopter"!
--John
Steve (Srwieland) was a real pioneer for all of us. The aortic SynerGraft homografts only became available in January of 2002. Steve's surgery was prior to that, and he received a pulmonary SynerGraft valve placed in the aortic position (they also do this in the Ross Procedure, but in that case it is your own pulmonary valve, with that valve then replaced with a pulmonary homograft).
Whether or not the fact that his valve has a pulmonary origin has contributed to his problems is impossible to say.
All of those who have received the aortic SynerGraft valve are, as far as I know, doing very well.
Steve, I hope you continue to see improvement! We are all cheering for our "earliest adopter"!
--John
S
srwieland
Thanks, John, as always !!!
!!!
