Bovine Valves! Which is best?

[Scotty]

Hey folks,

I am new to the community and at a young 23 years of age, it appears that I will soon be under the knife for the first time. I have a BAV with regurgitation so I am looking at an AVR. My question is not Tissue vs. Mechanical, but which type of Bovine valve will last the longest. My surgeon seems to favor St Jude Trifecta (because of "better flow"), but I have also heard good things about the CE Magna. Both seem to be great valves, but my question is durability. Which one is supposed to last longer statistically? Both receive anti-calcification treatment, but one may be a better bet. Any info??

Thanks!

 

[Guyswell]

Scotty,

It seems to me that if one tissue valve was found to be clearly superior in terms of resisting calcification, it would quickly become the valve of choice for surgeons everywhere. Given that there probably aren't any that are clearly superior in that one aspect, it's a good idea to trust your surgeon. Hemodynamics and your specific situation (including the internal anatomy of your heart and your particular diagnosis) will guide your surgeon.

Good luck!

 

[ElectLive]

Scotty - Great question, but I'm sorry to report there are several factors working against you finding an answer. First, the St. Jude Trifecta is very new (little more than a year after FDA approval I think?). Second, the Magna is pretty new as well, big picture, only about 8 years or so with the current anticalcification treatments. Third, while lots of studies do exist on longevity for earlier generation predecessors (like the CE Perimount 20 year results - on their website), the bulk of the data is usually based on patients much much older than you, with much fewer results grouped into a very inconclusive age group for the "young" crowd (often only one category for age 65 and younger!).

Since you're curious about tissue valve longevity, here's a thread from last year that covered a lot of the models: http://www.valvereplacement.org/forums/showthread.php?39460-Longevity-of-Tissue-Valves that you may find a little more helpful. Hopefully your surgeon has already informed you that tissue valves just do not as long the younger you are. The same valve might last 20 years in someone over 70, but unfortunately not even approach 10 years in someone in their 20s or 30s.

But please don't let this discourage you from your valve research, it's very important to learn as much as you can and just keep asking questions of your surgeon until you've reached a comfort level. Welcome to the community, and best wishes to you moving forward.

 

[Fundy]

I think it would be hard to say which tissue valve would last longer statistically, as most being used today are different somehow than those actually installed several years ago. So for the exact valve you might get, there is no long track record. However, from my own thoughts; Carpentier -Edwards tissue valves seem to have a good track record.

When I had surgery last November, I left it up to the surgeon to choose a bovine tissue valve and definitely not a porcine tissue valve such as the Mosaic; otherwise I left it up to him. What I got was a St. Jude Trifecta. Probably if it were left to me to decide specifically, I would have choosen a Carpentier-Edwards valve most likely. Based mostly on what I perceive to be fine durabilty throughout the past without frequent early failures as I keep reading about with the Mosaic.

St. Jude definitely has a great track record with their mechanical type valves, only major issue with them was their recalled valve due to using an unapproved anti-calcification treatment. Which is definitely a major concern if you were one of the people the valve was installed in. I think it was on a mechanical valve if I remember correctly. Kind of makes me wonder about their diligence with the treatment on my valve though.

But I'm happy with the Trifecta so far anyway. Only been a bit more than 9 months though.

 

[jhusker2]

I can't say which is the best, however I chose to go with the CE Magna Mitral valve due to their 2nd generation bovine valve results. I figured the 3rd generation Bovine Magna with Anti-calcification technology had to be even better than the one before... That said, so far so good, I'm almost 2 years post op and sometimes I forget I even have an artificial valve. I only take a baby aspirin a day! I would get a 2nd, 3rd, 4th, and even 5th opinion before moving forward with one valve type or another. Good luck with your decision and please keep us posted!

Jason

Age-42
CE Bovine Magna

 

[Rebecca]

My heart valve is only 10 months old and I have a freestyle modified subcoronary valve. Check out Medtronic web page.

http://www.medtronic.com/patients/heart-valve-disease/about-surgery/index.htm

 

[epstns]

Scotty - to add a bit of attempted humor to a serious question, the bovine valve that is best for you is the one they put into your heart -- any others aren't doing you any good! All kidding aside, as the others have said, if there was one bovine valve that was significantly better than others, it would be all over the heart valve news. We would all be talking about it. But, there isn't any single valve that is "the best." In many cases, the choice boils down to which valve your surgeon is most comfortable using, or has used most often. In other cases, there may be issues of one valve fitting your anatomy better or having different fastening collars, etc.

My bottom line is that they all appear to be good choices. They all get lots of use, and once they're implanted, they all do their job. I would suggest you discuss it with your surgeon and get his/her input. Ask why they favor one valve or another, and try to gain some comfort in their advice. If you are confident in your surgeon, you can trust their advice on valves. After all, this is the person who will hold your heart in their hands.

 

[Lynlw]

Hi as you know the Perimount, not necessarily the magna, (But I personally wouldnt concern myself picking out which model I would want, Id leave that to the surgeon when he has me open and see what would fit right for me) probably has the longest track records and probably is the most used tissue valve (maybe because it has been around so long in the US) with tons of papers, as EL said the trifecta is rather new so not as much is know yet.

Probably the main thing I would ask about IF I were choosing a tissue valve today, especially at an age that most likely would need this valve replaced, would be about the possibility of having this valve replaced by cath 1 or more times.
and has it been done yet with the valves you are considerring? Alth my son had his pulmonary vave replaced even in 2005 I asked about getting one that would give him the best chance of having it replaced by cath when the time came. Part of it has to do wth hemodynamics, the larger opening for the same "size" valve MIGHT make the difference beteen wether you can have it replaced by cath 1 or 2 times. He has a perimount

I know that Edwards Sapien valves which are their "cath valves" were made with their tissue valves in mind and they have already replaced Perimount valves by cath.

But beside that I probably wouldnt have a problem getting any of the tissue valves in use today, for myself or family member, except I personally, like Fundy wouldnt want medtronics Mosaic, which pretty much was supposed to be their "new improved" Hanncock II, but it seems to me at least many people whose valves fail much earlier than expected have mosaics

 

[enkaynj]

I am one year post-op. Run 3 miles every other day. Spin classes interspersed in between. Tennis once in a while. No probleoms with my valve. (knock on wood). You can treat this as a reference for my valve. All the best in making the right choice for you.

 

[Scotty]

Thanks folks. Im 2 weeks post-op now, doing great. I opted for the CE Perimount Magna because of its good track record and the hope of long life in the new anti-calcification features. The doc kind of pushed for the Trifecta, as did the PA, but it turns out "thats what they use" at that hospital. Another surgeon there is a friend of the family and actually kind of privately recommended the Magna simply because it has been out a little longer and has a good track record, whereas the trifecta is fairly new. I dont mean to be too much of a cynic, and the trifecta may be great, but I feel like it was a little bit for political reasons they pushed the trifecta, that hospital being one that tested it before it was approved and was promoting it. At any rate, Im feeling great with the Magna. Thanks for the input everyone!