Best tissue valve?

[RickH]

I am 50 and scheduled for a May 4 aortic valve replacement. I have chosen to go tissue and to go with the Edwards perimount magna. The hospital uses Medtronic mosaic but they will use the Edwards if I choose to use it. My surgeon stated there is no proven data that shows differences in durability. I am looking for comments and data on what tissue valve is considered to be current best. I would appreciate any help with this. Thank you.

 

[ALCapshaw2]

The following is based on 'my' limited research and NON-professional opinion:

The *original* Bovine Pericardial Tissue Valves have a track record of 90% "freedon from explant" at 20 years when implanted in patients over age 60.

The 'new and improved' versions have an anti-calcification coating that is hoped to extend that lifetime so technically the surgeon is correct that there is no data to clarify a difference between Bovine and Porcine (which is a stretch of the truth IMO).

Untreated Porcine Tissue Valves (straight from the pig) have a history of failing in 8 to 12 years. The 'new and improved' versions will hopefully last longer but have not been out long enough to know how long they will last. Some members have reported Porcine Valves failing in 4 or 5 years.

The 'new and improved' Porcine Valves have Very Low Pressure Gradients which is why competitive athletes like them so much. The Pressure Gradients of Bovine Pericardial Tissue Valves are higher than either Porcine or native -disease free- human valves.

 

[susiesknight]

My surgery: the AV medtronic freestyle with a vascular graft for the aortic root on 3/11/09.I went to the company's web sight to research and later looked elsewhere, ran across info about the medtronic being superior (i.e. the "cadillac" of valves was one opinion). I believe it depends on what your surgeon/hospital may prefer. When I was considering a mechanical valve I was leaning towards the ON-X and the surgeon said they used the St. Judes but would get me the ON-X valve if I so desired it. Apparently the hospital stores the one type of valve and gets a better quantity price. However, the doc made it clear that both valves were equal. Ultimately, I went tissue since the doc said I could.

 

[palmaceae]

I am 50 and scheduled for a May 4 aortic valve replacement. I have chosen to go tissue and to go with the Edwards perimount magna. The hospital uses Medtronic mosaic but they will use the Edwards if I choose to use it. My surgeon stated there is no proven data that shows differences in durability. I am looking for comments and data on what tissue valve is considered to be current best. I would appreciate any help with this. Thank you.

I have that same valve, but I am only 5 weeks post op. Both my cardio and surgeon said this is the best tissue valve out there and will last 20 years or more. The valve is new so I am not sure if they are guessing it will last that long because it has not been out there for 20 years so time will tell.

 

[mmarshall]

I had my surgery just shy of 4 years ago at the age of 31 and there are no signs of the valve or root having any issues or declining. I went with the Medtronic porcine valve...details in my signature. I'm not sure if one is better than the other...I think it has to do with which one the surgeon uses. I think you will find that after researching both types of valves, they both have come a long way and both do not have concrete data to support some of the estimates that they both make. It's just logical data being used right now but hopefully it will prove to be successful.

I am not one to put everything into stats. There have been people that had their tissue valve replaced in 4 to 5 years and then there are people like me that are going strong with their valve. If I am that 1 out of 10 that had to have it replaced in 4 to 5 years, I could care less about stats. But if I am not that 1, I would love the stats.

 

[JeffM]

The 'new and improved' Porcine Valves have Very Low Pressure Gradients which is why competitive athletes like them so much. The Pressure Gradients of Bovine Pericardial Tissue Valves are higher than either Porcine or native -disease free- human valves.

...which is why my surgeon went with porcine. I spoke with one of the techs at Medtronic and he echoed what you said, Al, that the previous (2nd) generation of the Medtronic porcine valve was performing well in 65+ year olds for 15 - 20 years and that the latest (3rd) generation uses the anticalcification treatment that they hope will get 25+. But here's the catch: I'm 53. Am I better off having a 2nd AVR when I'm 68 or when I'm almost 80? I guess it depends on how they're implanting them at that time and what kind of shape I'll be in. Everything's a gamble. We all have to consider the available data along with the kind of lifestyle we plan to lead.

 

[corrineinwa]

I've just managed to find time to read through the wad of paperwork we were given when they discharged Peter yesterday afternoon.

It says his aortic valve was replaced with a "25mm Edwards Perimount Magna bovine pericardial valve" - even gives me the model number. For the aneurysm they used a tube graft replacement "38mm Hemashield Platinum Woven Double Velour vascular graft".

 

[escargome]

Here we go again

Here we go again

Mark,
I believe that Rick has already decided to go with a tissue valve and was asking for opinions on either bovine or porcine. While mechanical was the answer for you, not everyone shares your point of view and I only hope this thread doens't become one of those that goes on and on about tissue vs mechanical.

I have a bovine valve and my surgeon and I discussed both pros and cons about tissue vs mechanical. I chose what I chose for my own personal reasons and I wouldn't expect to have to justify my decisions to anyone. So let Rick come to his own conclusions and leave it at that.

 

[abbanabba]

It's also worth remembering that a mechanical is not an option for everyone. As someone with a tissue valve, this thread has been incredibly interesting (even if a little too late).

 

[Ross]

Lets stick to the topic. Enough of the tissue/mechanical speculations.

 

[mmarshall]

Sorry Ross but this rubbed me the wrong way....

Mark, you are entitled to your opinion and so is everyone else. Matter of fact, we all have opinions ( and I think we know what they say about opinions), some are just bigger "opinions" than others.

Each person has a different case and situation than the other. In your case, mechanical was the best for you. In my case, tissue was the best for me...and yes, that is what my "surgeon" told me. I'm sure that is what a majority of the people here have done...listened to their doctors/suregons. I followed the advice of a well respected surgeon and have no regrets.

Rick, like I stated earlier, I don't think you will go wrong going with either type of tissue valve. It will probably come down to what your surgeon uses. I would read previous posts or email Bob (tobagotwo) for some insight. He has some great info on this type of stuff.

And for the record, yes, this is exactly why I don't bother posting as much as I use to. Been down that road and just decided to take the high road a long time ago. I guees I just fell off the wagon this morning...but I will get back on now.

 

[Ross]

Sorry Ross but this rubbed me the wrong way....

Mark, you are entitled to your opinion and so is everyone else. Matter of fact, we all have opinions ( and I think we know what they say about opinions), some are just bigger "opinions" than others.

Each person has a different case and situation than the other. In your case, mechanical was the best for you. In my case, tissue was the best for me...and yes, that is what my "surgeon" told me. I'm sure that is what a majority of the people here have done...listened to their doctors/suregons. I followed the advice of a well respected surgeon and have no regrets.

Rick, like I stated earlier, I don't think you will go wrong going with either type of tissue valve. It will probably come down to what your surgeon uses. I would read previous posts or email Bob (tobagotwo) for some insight. He has some great info on this type of stuff.

And for the record, yes, this is exactly why I don't bother posting as much as I use to. Been down that road and just decided to take the high road a long time ago. I guees I just fell off the wagon this morning...but I will get back on now.

I realize it rubs lots of folks the wrong way. I just don't want this thread to turn ugly. I'll do whatever I have to do to make sure it doesn't.

 

[ChouDoufu]

and back on track, you're asking about tissue valves, specifically the edwards.

it's got the supra-annular design, so it's fitted on top of the aorta, rather than
inside (do i have this right al?), so allows for a larger valve size to be fitted.

 

[Bryan B]

I agree with Ross...when someone starts a thread SPECIFICALLY asking about what tissue valve is the best, obviously he is not looking for anyone's opinion on mechanical valves. While I agree that you are entitled to your opinion, that opinion should be voiced in the appropriate thread. I had a Ross Procedure and I didn't jump in and say that the Ross Procedure would make more sense than a tissue valve. Actually I didn't jump in at all because although I researched tissue and mechanical valves before deciding on the RP I don't feel as though I have the experience to give Rick any first had advice on which tissue valve is best. Personally I don't think he can go wrong with the Medtronic or the Edwards bioprosthetic valve.

Rick...I would say that at age 50 you are in that "gray" area for which valve would best suite you. Assuming you are otherwise healthy and choose a tissue valve you will probably need one more surgery during your life. At that time it may or may not be a less invasive procedure, but if catheter based valve replacement does end up becoming the standard for valve replacement you would be a viable candidate at that time. As far as I know, patients with mechanical valves would not be candidates for catheter based valve replacements if they needed their mechanical valve replaced. When I had my Ross Procedure at age 43 my "backup valve" (in case the surgeon decided I wasn't a good candidate for the RP) was the Edwards Bovine Pericardial Tissue Valve because of the available data on that valve at the time. And I'll be honest. I'm 48 now...and if I was told that I needed my autograft aortic valve replaced right now I don't know if I would select a mechanical valve (if I did it would be the On-X) or a tissue valve (either one of the 2 you are considering). Hopefully by the time I need to make that decision enough time will have passed where the decision will be an easier one to make.

 

[RickH]

Thank you all for your input. I am sticking with the Edwards Magna valve. I felt the data on durability and performance is a little more convincing than the Mosaic. I found it very helpful to talk to another valve replacement person similar in age with the same valve choice. Edwards was able to get a phone number of a person that recently received a new valve. Others may find this helpful. I am scheduled for a May 4th surgery. Now I need to educate myself on presurgery prep and post operation recovery. Take care.

 

[tobagotwo]

The Edwards Perimount Magna has the best evidence of longevity, based on its untreated twin brothers' double-decade experience on somewhat older patients. It is supra-annularly placed, so the stent fits into a natural notch, allowing it to be out of the way, not interfering with bloodflow.

The Mosaic and the Freestyle have not been out long enough to prove their worth, although many surgeons are convinced the Mosaic is superior (because it it an actual valve), or the Freestyle is superior (because it is stentless).

They're all tremendous valves, all treated and fixed by nondamaging processes. In a pinch, I would agree the Edwards valve has a slight edge. Hopefully, they'll all turn out to last longer than claimed.

Best wishes,

 

[abbanabba]

Either way it's gotta be better than the one you've got now!