Ok I think I want to replace with Porcine

[HarryG]

Ok I need to make my final decision in a few hours on what type of valve I would like to replace with, I have I think decided to go with a porcine vavle.

Has anyone replaced lately with such and what are you hearing about this type of valve for replacement for durability and length of lifespan of such.

Thanks everyone on VR you folks are the BEST......! I love you all.....!

 

[Glenda]

I had one put in on June 2 so it's probably too early to tell you too much about it. I can hear it beating in my ears sometimes especially after I've done my walking. My heart surgeon told me it should last about 15-20 years. I chose the porcine because I couldn't take Coumadin because of the cancer medicine I take for my leukemia. It wouldn't mix. But I'm 61 and 20 years is long enough to live and by then they may come up with an easier surgery.

My valve is rather small (19.) The surgeon said he put in a 24 but it was way too tight and he had to take it out. I'm a rather large person so he just knew I would take the larger one. My cardiologist told me the other day that I have very petite organs. Boy, that's the only thing about me that's petite. (ha) I told him I always knew there was a petitie person in this old body trying to get out. He almost fell out of his chair laughing.

Harry, good luck with your surgery and choice. I think you made the right one.

 

[tobagotwo]

I'm 51, and about 14 weeks out from receiving a Medtronics Mosaic porcine valve. This is the premiere porcine valve on the market at this time. I have been delighted with its performance so far, and expect to continue to enjoy it for about 20 years (plus or minus two or three years).

The technology on these xenograft valves was just improved over the last year, so the longevity is a projection, based on someone over 45 years old. My backup choice would be the Edwards Perimount Magna bovine valve, which would likely have a couple of years longer of useful life. The prior version of the porcine valve had a lifespan usually ranging from 15-18 years for the over-45 age group, significantly - sometimes startlingly - less for younger recipients.

I have been working since six weeks out, and am as physically capable now as someone who has not had the surgery. It feels like my heart is just coasting now. My only prescription is 25mg Atenolol in the morning and evening. I also take daily aspirin, by my own choice, just because I am over fifty.

Medtronics also has porcine valves built into configurations with root and/or with aortic sections included, designated the Freestyle and Hancock series valves. The Freestyle series definitely has the same technical updates enjoyed by the Mosaic. I haven't researched the Hancock series as much, so I haven't verified it with that series.

If you want to peruse them: www.medtronics.com (you will have better results viewing the products if you click on the physicians' side, rather than the patients' side). I am not intending to be an ad for them, but in my humble opinion they do appear to be technically more advanced than their competition at this time.

The echo tech was excited and very impressed with the action and profile of the valve, saying that she would not have been able to tell that it was a replacement, if she had not been told. She actually pulled me aside to look at my videotape from the scan. As she had been very careful not to show me any of my results before I had the surgery, I have to assume she was genuinely surprised.

I would definitely choose this valve again. Who knows? I may get the chance to in twenty years...

Best wishes,

 

[Susan BAV]

I have the same type of valve that Bob H has and I have no complaints at this point, nine months post-op. I did have a wild bout with a-fib a week after the surgery and I had to take some heavy-duty medication and Coumadin for three months. So if you choose a tissue valve just because you don't want Coumadin, remember that there are no guarantees on that. I have a paternal uncle that has been in a-fib with bad valves for twenty years and has taken Coumadin for that length of time.

My surgeon has done 10,000 heart surgeries, and came highly recommended. That was the first step for me and a very important one at that. I told him that I did not want to be on Coumadin and that I wanted a good tissue valve that would last a long time (don't we all?) and I told him that I'd read some about the Edwards (fancy) bovine valve and thought that sounded pretty good to me. But I told him that I trusted his opinion and would go with his recommendation.

That was a bit of good advice I read on this site: find a great surgeon that you trust and explain your preference and go with what he's the most comfortable with. But, that may sound too simplistic to some. You may have greater appreciation for the informative details that Bob H wrote.

My husband thought that the surgeon said the valve could/would last 15-20 years, but I was rather disconcerted a few weeks after the surgery when a big package of info arrived from Medtronic (I called them and asked them to send the information to me on the valve) that said the valve was lasting 8-15 years. HOWEVER, that may have been because it's a new valve and that's all the longer the various patients have had them (installed).

I asked my cardiologist about that 8-15 year statistic and how I could get the maximum length of time out of my valve to prevent failure. He told me to take care of my teeth (and gums), because this is a huge reason why (replaced) valves go bad early.

 

[ALCapshaw2]

Are you talking about a STANDARD PIG Valve?
Those typically last 8 to 12 years. The surgeon who did my ByPass told me he would NEVER recommend a Standard Porcine Valve.

Or are you talking about one of the New and Improved Pig Valves? (Stentless, others?) As others have indicated, they are 'hoping' to get 20 years.

Another option (my first choice actually but which I did NOT receive for other reasons) is the Bovine Pericardial Valve which has 90% durability at 15+ years. Early recipients are approaching 20 years *actual use* and counting.

ALL tissue valves will deteriorate more rapidly in younger people than in people over age 60. Something to do with metabolism and aging.



'AL'

 

[Susan BAV]

Al -

I hope you're right about the (slow) metabolism slowing the deterioration of valves; perhaps one good thing for me for having a deficient thyroid !

 

[tobagotwo]

I know that on the Mosaic, they were really looking for the 25-year mark (so is Edwards, with their excellent bovine valve). I don't think they're going to make that yet, realistically. The CEPM bovine from Edwards will come close, I think.

I was originally for the bovine valve, and did acquiesce to my surgeon's favoring of the Mosaic, as Harry is about to do, and Mark has just done. Turns out that, at that time, my surgeon had probably implanted as many Mosaics as any other surgeon in the country. He did say he would put in the Carpentier-Edwards Perimount Magna if I wanted, though.

A reoperation a couple of years earlier is in my favor, I figure. 70- vs. 70+. If this Mosaic goes the distance, the next surgery should be my last AVR.

Remember, Susan, if the information on how long it lasts wasn't segregated by age groups, it's kind of misleading to everyone. Earlier versions of porcine valves were calcified in as early as six years in people in their 30s and younger. They often lasted fifteen years or more in patients in their 70s and above. A rolling range averaged from that is not thrilling. All the current data that Medtronics can point to is from the earlier valves.

For the new valves, the surgeon's estimate is about what my own estimate would be. I believe your husband heard him right.

Best wishes,

 

[doberman]

healthy gums?

healthy gums?

I am interested in hearing more about the connection to healthy teeth and the longevity of a replacement valve? has anyone else heard of this?
JD

 

[Susan BAV]

Hi John -

It's one reason why all the heart valve patients, both pre-op and post-op, take antibiotics before we have any dental work, including dental cleanings , done -- the possibility of developing endocarditis. There's a lot more to it but I'm sure other VR.COMers will add their experiences and/or what they know about it.

 

[brendamarlene]

mechanical vs. bovine

mechanical vs. bovine

I had AVR 14 1/2 years ago with homograft. It is now "near" time for resurgery based on stenosis of my valve.

My original surgeon, Dr. Pacifico, at UAB, suggests replacement with mechanical valve so my chances of a need for resurgery will be minimized. Cardiologist at Cleveland Clinic (Dr. Stewart) suggests bovine. Have not spoken with any surgeon at Cleveland Clinic yet.

I am undecided about whether to go back to original surgeon or whether to go to Cleveland Clinic this time.

Anyone had second AVR surgery?

 

[maxximom]

I had my AVR and a triple bypass done almost 3 years ago at Duke Medical Center. I have a St. Judes Toronto Stentless Porcine Valve. My surgery was done at age 70..I figure if the valve last 20 years I will be a very happy camper If I had been much younger..perhaps I would have picked a mechanical valve..but at my age and with other medical problems (type 2 Diabetes) I felt I was on enough Medications and did not want to be on Coumidin if possible. I have my Yearly checkup coming up in Auugust and hopefully will get another good report on my Valve
Joan

 

[ALCapshaw2]

BrendaMarlene,

The Bovine Pericardial seems to be highly regarded at the Cleveland Clinic, if not their favorite valve.

A lot depends on how long you expect to live. If you are over 60, there is a very good chance (90%) that it will continue to function for another 15 and maybe even 20 years.

Ironically, I had my surgery at UAB and requested a Bovine Pericardial but was told they chose to install a St. Jude Mechanical after opening me up, probably because of the radiation damage I suffered from treatment for Hodgkins Disease many years before. Sometimes I still wish they had given me the valve I requested, especially when I consider other invasive procedures such as colonoscopy or other possible surgeries. So far, I've not had any significant 'events' from Coumadin.

'AL'

 

[Gail in Ca]

I got porcine at age 34 in '89, so I'm thinking they have been improved since then. It lasted 11 yrs, and I was told that was good as average was 8 yrs.
Had it replaced with mechanical. That 11 yrs went by way too fast.
Gail

 

[gary48]

Harryg

Harryg

I had open heart surgery overs three years ago-they ended up sparing my valve (aorta enlarged-due to trauma-car accident) but porcine would have been my choice (agreed upon with my Doctor-Deeb-at the Universtiy of Michigan) I do a lot of exercise and running-I run with a guy who had a porcine replacement and he out runs me!!! I think things have improved from a few years back-I can't help but to believe that taking care of your overall health will increase the life span of a tissue valve. You will be fine..Gary

 

[Shine_on_Syd]

I got a porcine a year ago April. I'm 56, go to the gym 5 days a week. I've done two sprint triathlons since the surgery. Just had a Thallium Myoview stress test and echo. Two thumbs up from both cardiologist and my surgeon.
I highly recommend the porcine.

 

[jayahnt]

st jude valve

st jude valve

hello harry,i am a 32 year old male and i had my aortic valve replaced in feb 2002 with a st jude valve and i am having my mitral valve replaced monday august 23 with another st jude valve.i highly recommend a st jude valve because of the life of the valve.''lifetime'' thy only thing is you will have to be on coumadin the rest of your life.it was nice talking to you and looking to hear back from you.

 

[MomOfThree]

Hi. This is all new to me. I'm 43 and scheduled to have an AVR over the next few weeks. Exact date TBD. (But that's another story.) My surgeon also recommends the Medtronics Mosaic porcine valve. He said I should get 15 - 20 years. My cardiologist echos the sentiment. Good luck making your decision!

 

[tobagotwo]

I agree in general terms that a CEPM will likely last longer than a Mosaic on average. But it is entirely my opinion, based on what I believe is the likely outcome from the predecessor valves.

One of the wry twists of studying valves is that there are only historical data and animal test data, and darn little else. The Carpentier-Edwards Perimount Magna is a new valve, and has been manufactured for US sale for less than a year. It is mounted in a different way from previous Edwards valves, and has had new treatments applied to it. It is based largely on an excellent predecessor, which has long-term success data.

As such, the CEPM itself really has no long-term data, other than presumptions made from previous valves which were similarly manufactured, but differently mounted and treated.

The Mosaic has been out for a year, and thus has no long-term data either. It is also based on a successful predecessor, which averaged three to five years' less useful life than some of the CEPM predecessors.

There is certainly no actual data comparing these two, new valves in question long-term, and thus no data which could validate that the CEPM will actually last longer than the Mosaic. There is also no data that it performs better than the Mosaic. As such, there is no unequivocal statement to be made.

The studies on the Edwards Lifesciences site specifically do not address the Mosaic valve. They also do not refer to the Perimount Magna product, and are carefully only associated to the "regular" Perimount product line.

In fact, even in describing the CEPM's anticalcification treatments, the EL site states: "*No clinical data are available which evaluate the long-term impact of the Edwards tissue treatment in patients." That is not to disparage this very excellent valve or its treatments, but to show where the waters are necessarily somewhat muddy.

Each valve has been exposed to different anticalcification treatments, which the manufacturers each believe will extend their useful lives. They could possibly wind up with nearly the same life expectancies from this. That is because the main cause of loss of function has been calcification to this point, not usually the product actually wearing out.

As far as effectiveness, my echo technologist was highly excited when she tested my valve function (I have a Mosaic). In her words, she "could not tell it from a normal valve," if she had not been told it was a replacement. She showed me the video, as she was amazed by it. That is the gold standard for valve performance, as far as testing can provide.

I'm sure the CEPM would show up functioning quite smoothly on an echo as well, athough the technician might note the displacement of the CEPM valve above the usual valve seat.

I am seven months out from surgery, and just spent two, long days shovelling, spreading and wheelbarrowing over 26 tons of piled gravel around my driveway, as well as moving and resetting eleven, rot-proof 6x6x8 driveway ties that the oversized triaxle truck managed to push and torque into the garden. All heavy work, with no chest pain, no shortness of breath, and no early fatigue. Just tired arms and a creaky back. And that is the gold standard for valve performance, as far as reason can provide.

Would a CEPM perform as well? I truly believe it would. Better? Reread the previous paragraph. What would "better" look like..?

One also needs to look at results in situ to determine a product's fitness. If it is functionally sufficient or better for its purpose, then it meets or exceeds its requirement by default. If we were to look at mechanical valves and point out that there is greater flow restriction, it would be correct. But then, how could we explain the marathoners like Mark W and Les, and triatheletes like Mark U (and many other atheletes on our site), other than to agree that their carbon valves must certainly be meeting or exceeding their needs? Certainly fit for watching TV, or a brisk walk in the park!

About valve longevity: sometimes it's good, sometimes maybe not so desirable. I'd rather have my next surgery at 70+, than at 75+. I don't really want this valve to last until my surgical odds get shorter and my recovery time gets longer due to advanced age. It's something to be considered.

I greatly prefer the freedom of a biological valve. Having recovered, I live an entirely normal life now (insofar as anyone might consider me "normal" to begin with). I have no medications that have dire consequences if I fail to take them, or to worry about in relation to other medical matters. For that, I have willfully and gladly traded another surgery in xx years.

I believe that either of the two valves, CEPM or Mosaic is a fine choice, when considered within the context of one's life plans and expectations.


Best wishes,