M
Mary
Response from doctor
Response from doctor
Chris,
I sent off a portion of your post to Dr. Stelzer this morning and just received this reply. I'm going to try and copy it here, but if it doesn't work, I'll forward it to you as an email message. I think it will be of interest to several.
Mary
His response:
Thanks for the question about the potential for trouble in the homograft department. I think most of the homografts shrink a little bit after surgery and there is certainly scarring that occurs at the ventricular end that narrows them somewhat as well. I have made a habit of oversizing to try to overcome these problems. I also keep folks on Motrin for about a month to decrease the inflammatory response to the surgery and the homograft.
The question of immune response is one which is difficult to prove, but there probably is some of this going on as well. The majority of antigenic stimulation is eliminated by the freezing process, but there is always a little leftover for the recipient to respond to. Like Peter Skillington in Australia, I have never had to remove a pulmonary homograft for reason of stenosis, but I have one young fellow who may come to that because of a very high gradient across his. We've been watching it for several years with echo and even MRI. Once, we tried to dilate it with a balloon, but it didn't do much.
If a problem is going to develop of the stenosis variety, it will always begin rather early. That means, if there is no gradient of significance at two years post op, it won't happen. The major long term issue is slow degeneration with regurgitation to be expected after many years. That is very well tolerated by the right ventricle and can go on like that for many more years. The long term results are so good that it is impossible to justify giving anti-rejection drugs to make it better. We'd get more problems from the drugs... I don't think anybody matches blood type because it has never been shown to make a difference. The issue of limited supply makes this a rather moot point. For a while, we were trying some special homografts called "Synergraft" from Cryolife in Atlanta. These were homografts from which all the donor cells have been removed to minimize immune responses. The theory was good and the initial animal and human studies were encouraging, but the FDA (in its twisted wisdom) has restrained Cryolife from releasing this tissue for the last two years. I don't think there is a really good reason for this, but the bottom line is that we can't get these grafts for the time being. I was intrigued by the possibilities of the concept, but a bit cautious that there might be other unforeseen problems. It's hard to give up on something as good as we already have without a very good reason. I think in someone who clearly "rejected" his homograft, the Synergraft is the right choice for replacement parts.
Response from doctor
Chris,
I sent off a portion of your post to Dr. Stelzer this morning and just received this reply. I'm going to try and copy it here, but if it doesn't work, I'll forward it to you as an email message. I think it will be of interest to several.
Mary
His response:
Thanks for the question about the potential for trouble in the homograft department. I think most of the homografts shrink a little bit after surgery and there is certainly scarring that occurs at the ventricular end that narrows them somewhat as well. I have made a habit of oversizing to try to overcome these problems. I also keep folks on Motrin for about a month to decrease the inflammatory response to the surgery and the homograft.
The question of immune response is one which is difficult to prove, but there probably is some of this going on as well. The majority of antigenic stimulation is eliminated by the freezing process, but there is always a little leftover for the recipient to respond to. Like Peter Skillington in Australia, I have never had to remove a pulmonary homograft for reason of stenosis, but I have one young fellow who may come to that because of a very high gradient across his. We've been watching it for several years with echo and even MRI. Once, we tried to dilate it with a balloon, but it didn't do much.
If a problem is going to develop of the stenosis variety, it will always begin rather early. That means, if there is no gradient of significance at two years post op, it won't happen. The major long term issue is slow degeneration with regurgitation to be expected after many years. That is very well tolerated by the right ventricle and can go on like that for many more years. The long term results are so good that it is impossible to justify giving anti-rejection drugs to make it better. We'd get more problems from the drugs... I don't think anybody matches blood type because it has never been shown to make a difference. The issue of limited supply makes this a rather moot point. For a while, we were trying some special homografts called "Synergraft" from Cryolife in Atlanta. These were homografts from which all the donor cells have been removed to minimize immune responses. The theory was good and the initial animal and human studies were encouraging, but the FDA (in its twisted wisdom) has restrained Cryolife from releasing this tissue for the last two years. I don't think there is a really good reason for this, but the bottom line is that we can't get these grafts for the time being. I was intrigued by the possibilities of the concept, but a bit cautious that there might be other unforeseen problems. It's hard to give up on something as good as we already have without a very good reason. I think in someone who clearly "rejected" his homograft, the Synergraft is the right choice for replacement parts.
when we can gather and compare information.
