Early degenerative change in my Hancock valve

[Cem]

Dear Folks.

On November 18 2008, I had AVR with Hancock No 23 bioprosthesis at Florence Nightingale Hospital in İstanbul, Turkey. The surgery was done by full sternotomy and at the same time a CABG was also performed. 1 week after I was discharged from the hospital. Everthing seemed to be fine until the mid-summer 2009 following which I began to experience the same kind of symptoms as pre-op conditions: Difficulty climbing up the ladders, occasional shortness of breath. The echocardiology indicated that my mean gradient jumped up to 78 therefore my cardiologist advised me to check with my surgeon at the hospital. My surgeon concluded that the bioprosthetic valve must have undergone structural deformation with annular part thickening. Now I am waiting for TEE (transesophageal echocardiogram) for a final diagnosis. I am extremely upset about such unexpectedly rapid failure of my artifical valve. The surgeon now reccomends that I undergo another AVR and suggests its replacement with a mechanical valve. Now my questions:
1) What are the risks of a second surgery after such a short time span (9 months) given that I also had CABG along with AVR ?
2) My Surgeon was extremely confused about such a rapid wear of Hancock, for it was him who had suggested this product. He added that I might think about suing the producer company (Medtronic). Any suggestions as to how could I go about this ?
3) I feel extremely down after all the hardships I had gone through and even think of postponing the reoperation out of fear that it might be riskier than the first one in such a short time. Has anyone heard about such an early degenerative change (not attributable to either pannus, trombus or thromboembolysis) in Hancock no 23 protheses?
Thanks for any reply.
Cem.
Age:52, AVR +CABG Florence Nightingale Hospital, İstanbul Turkey Nov, 18 2009.

 

[netmiff]

first of all, welcome to the forum, glad you found us, but I really am sorry for the reason you had to seek us out! I am not much help as far as your situation goes, but, if it was me, I would be angry and upset, and probably deeply depressed, too. However, I would wait for the results of the TEE, and I would also ask for those results and see if I could get a second opinion from a doctor/surgeon that is not connected with the hospital or your current doctors' practices. I am not sure how your health system works in Turkey, or even if what I suggested is possible.

If you need to seek help for the depression/mental aspect of things, you should. This is not a situaton that most people have to face.

If you need to vent some more, go ahead, we've all got thick skin and can take it.

 

[briansmom]

My son had a 3rd OHS 9 months after the 2nd. He came through the surgery fine. He has permanent heart damage but that occurred before the first surgery.

 

[TXWildflower]

WOW! That is some story. I can see why you would be feeling all the emotions that you are. It sure isn't fair. I would definitely seek out second opinions. If you get more information on why the short failure time I sure would be interested in knowing. Maybe you just got very unlucky and got what we would call a 'lemon'. If you haven't already, but sure to see someone about helping you manage your depression - you need to get that under control.

You are in my thoughts and prayers and I hope you get the best possible outcome nad have a rousing success the second time around.

 

[Cem]

Thank you all for your replies.
I guess everything will depend on what will come out from the TEE. According to net resources I have collected and my surgeon's advice, TEE seems to have superior ability vis-a-vis TTE for final diagnosis as it can have close-up view of the problematic bioprosthesis. Afterwards, my surgeon, the cardiologist and I will sit down together for a final evaluation. If the need arises, I will surely be seeking a second professional help although I suspect whether he/she would be having a radically different view based on TTE and TEE results. To which extent I could be able to postpone a probable second surgery would be good news for me.

 

[Johan]

I am deeply distressed by your situation! Having just received a new tissue valve myself, I am acutely aware of the emotional stress you must be enduring. When we get these valves the optimistic 20 years lifespan is constantly held up by the surgeons, so it is not fair that structural damage should occur after such a short time. I am with you in thought and please keep us posted as to the TEE. Johan

 

[marie]

I have a medtronic mosiac porcine valve.

I had my surgery in January 08 and it appears mine is failing as well.

 

[tobagotwo]

I've just had my Medtronic Mosaic replaced after only five years. I am beginning to hear of others as well. While the bulk of Medtronic's products seem to be doing fine, there seems to be a trend of early failures for the "fortunate few" among us. We should see if we can find similarities between the failures, for two reasons:

1 - To ensure that any pattern that could be caused by manufacturing faults is noted, to affect changes in the manufacturing, so others don't suffer

2 - If the problems cross-match, possibly to give argument strength to any who wish to also pursue legal recourse.

Medtronic's response has been that pannus (scar tissue) was responsible for the early failures in most cases. However, it was definitely not the case with mine. Two of the leaflets were glued together with an "unknown substance," and this was the direct cause. We are still waiting the report as to what that substance might be. Obviously, it wasn't calcification, as they see that all the time.

Based on the current appearance that these issues are starting to and continuing to come in, I don't think we have any way to know what the extent of any possible problem might be at this time (is it the tip of the iceberg, or just a blip?). In situations where there are other top-name options, my opinion would be to lean toward the other brands as a choice, at least until this gets cleared up satisfactorily.

Best wishes,

 

[Lynlw]

Based on the current appearance that these issues are starting to and continuing to come in, I don't think we have any way to know what the extent of any possible problem might be at this time (is it the tip of the iceberg, or just a blip?). In situations where there are other top-name options, my opinion would be to lean toward the other brands as a choice, at least until this gets cleared up satisfactorily.

Best wishes,
__________________
Bob H

I agree with this,it could end up all just being coincidence, but better safe than sorry

 

[Cem]

TEE Results Just Came Out:Reoperation Unavoidable

TEE Results Just Came Out:Reoperation Unavoidable

Thank you again to all folks who did their best to support me at least morally.

The TEE results finally came out and according to my surgeon, TEE just corrobates the TTE results. Here they are:
1. Left ventricular enlargement. 2. Mild thickening of aortic valve and gradient increase (mismatch ??). 3. Enlargement in ascending aorta (3.9 cm).
4. Mild valvular aortic insufficiency. 5. Mild tricuspid insufficiency.
6. Decrease in bioprosthetic leaflet movements.
No Vegatation, No Trombus, No Pannus. Gradient:78 (mean) /110 (max) mmHg.
All other cardiac parameters seem normal.
Obviously, the thickening of aortic bioprosthesis necessitates a second intervention as I have started to develop mild Shortness of breath.
Now, the puzzle in this story:Is the failure attributable to plain valve default (malfunction) or to an unknown substance in my blood that somewhat interacts with the bioprosthesis in such way that it causes the leaflets to thicken thus obstructing its functioning ?
The answer will come out only after the valve is throughly investigated in the company's labs. Even then I am not sure whether they will straightforward accept and disclose the truth.
Now, supposing the valve is just fine and gets problematic due to interaction with some unknown substance in my blood(metabolism):
In this case shifting to some other brand, but still bioprothesis always carries a risk.
That is why, my surgeon has convinced me to play on the safe side to avoid a potential recurring problem with bio valves.
I don't think it would be wise to postpone re-op as it helps nothing but promote further stress.
Better get it done ASAP.
Cem.
Age:52, Potential St.Jude Candidate.

 

[tobagotwo]

Make sure they study the valve when they remove it - and make sure they keep it for future study and possible legal use. Among many other possibilities, it sounds like it could be an "unkown substance sticking the valve leaflets together" like mine. That would most likely be a manufacturing fault. Other possibilities: mishandling or poor storage.

There is nothing in your blood which should react with a tissue valve or any associated bioprosthesis until it is in a damaged state and beginning to slowly calcify. I can see why you'd want to use a mechancial valve, just to be done with it, and that's fine. But the reason

Now, supposing the valve is just fine and gets problematic due to interaction with some unknown substance in my blood(metabolism):
In this case shifting to some other brand, but still bioprothesis always carries a risk.
That is why, my surgeon has convinced me to play on the safe side to avoid a potential recurring problem with bio valves

simply doesn't hold water.

I wish you well with your surgery. I know what it's like to feel that it's undeserved to have to go through it again so soon.

Best wishes,

 

[Karlynn]

Just wanted to wish you the best.

 

[Kathy McCain]

I am so very sorry to hear this. I have a Medtronic Mosaic, which seems(so far) to being doing fine. I just had another echo 2 wks ago. I had AVR done Feb 2008.

It is the very last thing you want to hear.

Good luck, with your surgery. Please keep us posted.

God bless

 

[RI Mom]

Cem,

So sorry to hear about your Hancock valve. A similar situation occurred with my son and his pulmonary homograft. It had deteriorated within 9 months. He was able to have a stent placed which gave us an additional year before he needed a replacement. It was very disappointing to say the least. His homograft was replaced with a Hancock II. Hoping that it will last longer but your news tells me that the bioprosthetics can also fail very early. Please keep us updated on the outcome of your testing, etc....

Best Wishes!

 

[tobagotwo]

Just a couple of notes for clarification...

- A homograft, such as the one that failed in nine months for you, is not a bioprosthetic. It's an actual, human valve.

- Part of what makes what happened to Cem so tragic is that it is so very unusual and unexpected. Xenografts (valves made from animal tissue) generally do very well for adults.

- The use of any material in children is fraught with problems. Homografts usually work fairly well (yours, sadly, did not). Tissue valves and conduits tend to have a limited lifespan in children, who are highly chemically reactive and tend to calcify them far earlier than their adult counterparts. However, artificial valves and shunts do not grow as the child grows, and can cause issues when being removed for replacement. There are very few really good answers, and children most often must move forward with the answers provided by educated/experienced best-guess. This is a terrible decision for a surgeon to have to make and defend, and a continuously harrowing experience for the parents.

Best wishes,