Transcatheter Minimally Invasive Aortic Valve Replacement

[deck1434]

I've been keeping up with the studies being done at various hospitals on this procedure, but I can't seem to find the answer to one question. Since the "stent valve" consists of bovine pericardial tissue and a stainless steel frame, does that mean this new type of valve will have to be replaced in the same time frame as a bovine valve used in a traditional aortic valve replacement?

I wondered if anyone knew...thanks, Dianne

 

[tobagotwo]

They don't know yet. They haven't been out that long, and there aren't that many out there. Also, there are several types, some porcine.

Currently in the US, they are mostly being placed in people who are too ill to withstand surgery, so there's a high likelihood that they will outlast the patient's lifetime. Also, over-60 patients are less apt to calcify them quickly. Elsewhere, they are starting to be used on others. It's a wait-and-see proposition, how long they will last.

My understanding of these valves, as they exist now...

- My best guess is that they will not last as long as a standard bovine valve (that may not be a problem at all for some, but may be for others)
- I believe that they do not have as large a valve opening as a standard, surgically-implanted valve
- There is a mortality rate associated with them during placement (they are not risk-free)
- They can slip after placement
- The catheter setup used to place them is very large in diameter, and can lead to damage and complications with the blood vessel used (usually in the groin area of the leg)
- Placing them requires a lot of training and practice for the interventional cardiologist, and there's not a lot of experience out there yet at all

They can certainly be a blessing to those who are ill, but they are not a free ride.

Best wishes,

 

[Lily]

I'm only posting something I recall reading here previously, as best I can recall the info so you would want to research this for yourself to be sure it's accurate and current, but at least some percutaneous valve replacements are or were not recommended for those with bicuspid disease. There is a member here who wasn't able to get one from Cleveland several months ago because of her bicuspid valve.

 

[ottagal]

I'm only posting something I recall reading here previously, as best I can recall the info so you would want to research this for yourself to be sure it's accurate and current, but at least some percutaneous valve replacements are or were not recommended for those with bicuspid disease. There is a member here who wasn't able to get one from Cleveland several months ago because of her bicuspid valve.

Lily,
Was that Dawn-Marie that you were thinking about? I don't recall the details, but was she 'declined' because she was going to be part of an FDA study on minimally invasive AVR and the study did not include bicuspid aortic valves?

 

[Lily]

Lily,
Was that Dawn-Marie that you were thinking about? I don't recall the details, but was she 'declined' because she was going to be part of an FDA study on minimally invasive AVR and the study did not include bicuspid aortic valves?

Yes, it was Dawn-Marie and I don't recall the details either so hope my earlier reply isn't incorrect. I haven't tried to do any vr.org searches for old posts since the site went on the new format, so didn't look up her details.
I can add an edit to my earlier reply if necessary; I don't want to misdirect anyone .

 

[deck1434]

Thank you to all. I was told last week by a heart surgeon that (as was mentioned above) this procedure is only being done on patients too ill to have open heart surgery. He also felt it was much too soon to make a determination as to its safety and longevity.

Best, Dianne

 

[Ross]

Thank you to all. I was told last week by a heart surgeon that (as was mentioned above) this procedure is only being done on patients too ill to have open heart surgery. He also felt it was much too soon to make a determination as to its safety and longevity.

Best, Dianne

I don't forsee that changing anytime time soon. It's becoming more promising, but it's just not tried, true, tested, enough to put into everyday play yet.

 

[neil]

agree with ross,besides personally i would drather have them open me up,at least there can get there hands in,and have a good look around,just my opinion

 

[Lynlw]

As others have said, they are too new to know how long they will last, but since they are tissue they will need replaced like other tissue valves. And as bob said since the great majority of people who can be part of the trials are elderly, they most likely will out live their valve, so it will be even longer to find out how long the valves will last in younger people. I do know for the pulmonary valve, they have replaced percutaneous vales with new percutaneous valves.
I'm not sure that they don't have the same size opening as a surgically implanted valve, from talking to different doctors and what i've read, since they are sewn to the stents and don't have a ring, the opening is pretty much the same.

I don't want to be picky, but since people looking for info on min invasive surgery will find this, I might be wrong but I don't think percutaneous valve replacement is considerred surgery, since they only incison is for the cath.

 

[deck1434]

Transcath Update: Saw my Cardiologist Friday March 19th and he was very excited about this new procedure. Exciting news is that my Doc expects FDA to approve new transcatheter heart valve replacement technique in November 2010 at the American Heart Association Meeting.

This technique allows the surgeon to get the new valve into the heart via the leg, rather than having to cut open the chest cavity. Eight years of study/trials in this technique are currently wrapping up with very positive results. Patients in the studies have been only those who are too ill for open heart surgery, however the surgery itself is meant for ANY patient, not just those who are to ill for the traditional procedure.

For those in NJ-He also expects Englewood Hospital to be first NJ hospital to be FDA approved for this procedure, with Jock Mc Cullough as the surgeon. He just completed 3 months training at Cleveland Clinic Heart Center to learn the new technique.

The flaps of the valve used are bovine, with the ring made out of steel. According to my Doc, the flaps can last indefinitely even though they are bovine. He said when the ring is bovine is when the valve wears out more quickly. Coumadin is used with this particular valve.

Best regards,
Dianne

 

[Lynlw]

Transcath Update: Saw my Cardiologist Friday March 19th and he was very excited about this new procedure. Exciting news is that my Doc expects FDA to approve new transcatheter heart valve replacement technique in November 2010 at the American Heart Association Meeting.

This technique allows the surgeon to get the new valve into the heart via the leg, rather than having to cut open the chest cavity. Eight years of study/trials in this technique are currently wrapping up with very positive results. Patients in the studies have been only those who are too ill for open heart surgery, however the surgery itself is meant for ANY patient, not just those who are to ill for the traditional procedure.

For those in NJ-He also expects Englewood Hospital to be first NJ hospital to be FDA approved for this procedure, with Jock Mc Cullough as the surgeon. He just completed 3 months training at Cleveland Clinic Heart Center to learn the new technique.

The flaps of the valve used are bovine, with the ring made out of steel. According to my Doc, the flaps can last indefinitely even though they are bovine. He said when the ring is bovine is when the valve wears out more quickly. Coumadin is used with this particular valve.

Best regards,
Dianne

I'm a little confused, since as far as I know traditional bovine valves only have bovine leaflets/flaps (part of the cows pericardium) and the silicone sewing ring is coverred with a knitted material. and it is the leaflets that calcify.