Homograft versus tissue valve

[tommyboy14]

Hello there,

the discussion with most surgeons and from reading this forum, it seems that the only choice one has is between a Tissue vs Mechanical valve (excluding the RP).
But it seems that there are also Homografts.

Somehow this seems to have gone out of fashion, but from the study that pellicle provided it seems like it would be a much longer lasting option than a tissue valve.

There was also a discussion about a new kind of Homograft, the Cyrolife Synergraft, but there is not much information on that online other than from the manufacturer, or an FDA warning that one of the products seems to have affected someone in a bad way.

Does anyone have any idea why Homografts are not so popular anymore?

Thanks
Tommy

And does anyone on this forum have a Homograft that lasted longer than 15 years (other than pellicle that is) ?

 

[Mentu]

Studies are Slow

Studies are Slow

You might read these articles for a start. By now, you are beginning to learn that the choice of heart valves can be complex. It is simpler for the young and the elderly but for those of us in the middle - well, there isn't any way to "KNOW" which is the best one for you unless you have some condition that would effect the choice. You asked about homographs. I have a bioprosthetic valve so I can't speak as a user. What I can tell you is that my surgeon believed that a homograph was less likely to last as long for me. That said, all these studies (and there are almost too many to read) can only address how a particular valve type stands up over time in studies of a large group of people. This is the way science works. Some studies will no doubt even be contradictory but over time things become more clear; this doesn't help us very much today. None of them tell us which valve is best for us as individuals in middle age who are otherwise healthy. I would point out that your heart surgeon may well be the most skilled and expensive expert you will ever hire in your life. I think its a good idea to be knowledgabe about the alternatives so you can participate in the discussion with him or her, however, you will not make this decision alone but with your surgeon.

Even then, the information our surgeons use is based on past experiences and studies. Today, many of our valves utilize relatively new technology. The designs, materials and chemical treatments have no long term studies because there has not been enough time for them to be useful if they have even been started. I think we as patients, agonize over this choice more than any other topic because it is one decision that we can be part of. Our disease has been carrying us along and we have had no way to alter its progress so when we reach a point that we can actually participate in making a choice it becomes something we focus on - even obsess upon. The most important choice we make is to have surgery which will give us back a future. My Uncle was the first in my family to receive and heart valve; it was a St Jude Mecanical. 10 years after it was put in place tissue grew over it preventing it from functioning properly so it was replaced with a porcine valve. He lived another 15 years and died from COPD caused by decades of smoking but his heart valve was still functioning well. There just aren't any certainties.

Larry

NIH Library
Report on a number of clinical studies (June, 2002):

http://www.ncbi.nlm.nih.gov/pmc/articles/PMC1767148/

Cardiac crossroads: deciding between mechanical or bioprosthetic heart valve replacements (February, 2011)

http://www.ncbi.nlm.nih.gov/pmc/articles/PMC3063655/

Durability of Bioprosthetic Cardiac Valves (February, 2008)


http://www.ncbi.nlm.nih.gov/pmc/articles/PMC2696738/

The future of heart valve banking and of homografts (2012)
http://www.ncbi.nlm.nih.gov/pmc/articles/PMC3484936/

 

[Lad]

I had a homograft valve that lasted 23 years. I now have a bovine valve since 3/4/13. Before the homograft I had a porcine valve for six months which needed replaced after having fungal endocarditis. I had bac endocarditis before getting the porcine valve. Larry

 

[pellicle]

I had a homograft valve that lasted 23 years. I now have a bovine valve since 3/4/13. Before the homograft I had a porcine valve for six months which needed replaced after having fungal endocarditis. I had bac endocarditis before getting the porcine valve. Larry

wow ... sorry to hear about the endocarditis bouts ... glad you beat my 20 years mark on the homograft How old were you when you had the homograft (if you don't mind me asking).

 

[pellicle]

You might read these articles for a start.

and thanks from me too! Some good references gone into my evernote collection

 

[Lad]

wow ... sorry to hear about the endocarditis bouts ... glad you beat my 20 years mark on the homograft How old were you when you had the homograft (if you don't mind me asking).

Thank you Pellicle, I'm also sorry to read about your infection. I feel very lucky to make it through the first operation with bac endocarditis having a 20% chance. The fungal endo was very rare, they don't know where that came from. It's a long story. Anyway I was thirty five years old. Larry

 

[ashadds]

tommyboy14 what is your final choice ? how have you been

 

[Tojomiami]

Hey Tommy, I had an aortic homograft (from Cryolife) that lasted 17.5 years. It was great, I climbed and summited Mount Rainier 4 times with it. It finally wore out. Very little calcification, but thinning of the leaflets to the point that one leaflet developed a hole, and I had severe aortic insufficiency. Just recently I had my second AVR, and now have a mechanical On-X (also from Cryolife). My surgeon told me it is very difficult to replace a homograft with another one, and both my cardiologist and surgeon recommended a mechanical for my second AVR. Good luck!