homograft

[avshalom]

hello everyone,
i need to pass AVR because I have severe AR.
in addition to my heart problem i have mild VWF deficiency (coagulation abnormality) it means that i can take mech valve but it is more risky.
my surguon suggested me to take homograft.
I will be happy if someone here who knows something about homografts vs other options (like freestyle) gives me some details.
avshalom

sorry about my english i am not an english speaker.


p.s if someone here knows similar problem i will happy to here about.

 

[Kate]

Hi Avshalom!
I got a bovine AV myself, so I'm not an expert on homografts, but I'll share what little I know and hopefully someone with more expertise will be online shortly to add. My understanding is that the homografts are less prone to infection than other valve choices but are otherwise very similiar to pig and cow valves - no need for anticoagulent but also a fairly short lifespan (8 - 20 years depending on your age and luck). Has anyone mentioned the Ross procedure to you? I know everyone isn't a candidate for this and it's a more complicated surgery but might be a good choice in your situation.

Best of luck (and no need to apologize for your English - I think it's pretty impressive that you are able to communicate so well in a second language as my command of German is limited to counting to 10 and about six phrases I've managed to remember from 9th grade.) Kate

 

[avshalom]

hi kate

hi kate

thanks for your help.
unfortunately, i cant do Ross procedure, because i have conective tissue disorder called mild OI.

 

[Kate]

Drat! I was unable to have the Ross for the same reason.

 

[avshalom]

what a coincidence!

what a coincidence!

you mean you also have OI or another connective tissue disorder?

 

[Kate]

Sorry - another connective tissue disorder. I'm not sure it has a specific name, but like many people with a bicuspid aortic valve, I also had an aortic aneurysm which is believed to be caused by an underlying connective tissue disorder that weakens the wall of the aorta and (perhaps) other blood vessels.

 

[parker04]

I have a homograft

I have a homograft

in the aortic positon. I have had it for 3 years now, and now I am pregnant which is putting a lot of strain on it. It has some stenosis already and after my pregnancy, im not sure how long its going to last. But before the prgnancy it was good. So we will see, if you have any more questions you can send me a private message.

 

[Lisa]

I have a homograft!

I have a homograft!

I had an AVR 03/19/04. I haven't had any complications from the surgery and feel much better than prior to surgery. My surgeon estimates that my valve will need replacing somewhere between 10-20 years. There just any way to know exactly how long the valve last. In some people, the valve may need replacing around 7 or 8 yrs post op. Once you decide to have a homograft, there may be a waiting period for the valve as they have to find a match. It's also a bit morbid to think about, but they try to get the youngest valve possible. Best of luck with your decision.

 

[ridergk]

I have a homograft and am about to replace it after 7 years

I have a homograft and am about to replace it after 7 years

Hi,

I have a homograft and am about to replace it after 7 years. I was told they can last 10 to 20 but 7 is what I got out of mine. Dr. Vaughn Starnes did my surgery at USC University hospital. I am 40 years old and even though I always knew I was going have the surgery again, it is somewhat of a disappointment to have to do it so soon. The longevity estimates are all based on statistical data and to be honest I don't know how much of that data there actually is. A company called Cryolife supplied the valve used in my homograft. You might check out their website and even call them (like I did) for more information.
I have the same decision to make as you do, what do I use for an aortic valve this time? The surgeon who is going to do my AVR this go around is Dr. Miller at Stanford. In speaking with him he gave me, if I remember correctly, a 20 year guesstimate on the latest porcine valve. But again, that valve hasn't been around for long and the statistical data isn't rock solid on that 20 year figure. The diameter required for my replacement valve was rather large (21mm if I remember correctly which isn't guarenteed) and that may have played a part in why it didn't last as long. All in all I the homograft has been trouble free for 7 years. No drugs except for an aspirin a day and I carried on with my very active lifestyle (swimming, surfing, etc.). It's decline was gradual and easily observable with a very little chance of catastrophic failure. It isn't a bad choice if you don't mind doing the surgery again sometime down the line.

 

[ridergk]

Slight correction to my earlier post

Slight correction to my earlier post

I mentioned I thought the diameter of my replacement valve was 21mm that that was large. Actually it was 29mm.

 

[avshalom]

freestyle

freestyle

thank you all , after i red your replies i wonder maybe i should take stendless valve like "freestyle" for an option.
what do you think?
it seems to me that this is a better option than homograft.

 

[tobagotwo]

I am not a medical professional, but if I understand correctly, your issues are that...

- You are 33 years old, and will likely burn up a tissue valve, homograft (human) or xenograft (animal) in about 8-12 years.

- You are not a candidate for the Ross Procedure, due to a connective tissue disorder.

- You are not a good candidate for a mechanical valve, due to a coagulation disorder which would raise your risk profile for Coumadin use unacceptably.

- Having a connective disorder makes having multiple reoperations more risky as well. You may risk developing myxomatous (weakened) tissue over time that may pose a risk of not anchoring a replacement valve as well after future operations.

There are two issues that I would condsider discussing with the surgeon and the cardiologist, both relating to problems that might accompany the connective tissue disorder.

One would be to express a desire to have the aortic root surgically stabilized or replaced during the OHS, if reasonable. If the root expands after the surgery (which it has done for some here), it can deform the valve and cause it to leak (i.e. regurgitation, also known as insufficiency). This could cause a reoperation long before the valve would have worn out on its own.

The other issue would be to ask to be tested for aneurisms. In my opinion, there is no future value to leaving an expanding blood vessel in place after an OHS. It makes no more sense than leaving a blocked coronary artery, which a surgeon would not willingly do. If there is an aneurism, and it progresses, the surgeons may have to go in again to repair it long before your valve wears out.

It is difficult to think about these things, much less discuss them with your doctors, but if it might save you an unnecessary surgery later, it would seem worth the discomfort.

I also agree with you that in your circumstances, a xenograft valve would be a reasonable choice.

Homografts are fine valves, and there is nothing wrong with them. However, it is my belief from posting observations and readings that they no longer show any significant advantage in longevity or bloodflow profile to current-generation Edwards bovine valves, Medtronics Mosaic valves, or Medtronics Freestyle valves.

I don't know if you are expecting to have more than just the valve replaced, but if you are, the one-piece Freestyle porcine would likely be a good choice. If only the valve is to be replaced, an Edwards Perimount bovine valve might last the longest. It is worth considering, as you will be living with the results.

Here are some links:

http://www.edwards.com/Products/HeartValves/PericardialCategory.htm

http://www.medtronic.com/cardsurgery/therapy/valve1.html

A search on "myxomatous" or "BAV" will find posts with information and links regarding connective tissue disorders.

I am sorry if this seems to be a harsh or clinical-sounding posting. It's not intended to be. Many of the decisions and actions we must take when faced with valve surgery are harsh and difficult by their nature. Most of us have had to face at least some of these unfortunate considerations, much as you are now. Please know that I wish you a satisfying surgical outcome, and a rapid and full recovery.

Best wishes,

 

[Perry]

homograft

avshalom,

Greetings. Best wishes to you and the other posters. This is my first post. About me? I am 42 and was diagnosed with severe aortic regurgitation in 2001 and my number has come up - I will be fixed within 6 months and will likely call John Hopkins today to set a March 2006 date for the Ross Procedure. If all goes as planned, I will receive a homograft pulmonary valve.

I feel all we can do in our positions is research and be knowledgeable on what the medical experts provide. Procedures and parts are changing somewhat rapidly. Our 6 year old son (severe aortic stenosis diagnosed prior to birth in 1999) had two catheterizations and then a homograft in 1999 followed by the Ross Procedure in 2000. His aortic homograft lasted months. We met with his surgeon at JHU last week (12/2005), who will likely be my surgeon, and he told us that catheter valve implants are on the way. Maybe, maybe not. But technology moves forward. Our son could outgrow or wear out his homograph in the near future and we are hopeful that open heart surgery may not be required.

What does all this mean. To me it means you grab hold of life and accept what can be done at the time. To me it means we live our lives up to and after surgery - but we have little control over the surgery. But for the next 10 to 20 years, or whatever duration is touted, you keep up with technology and hope that a return to surgery will be less invasive and possibly more effective. What will a car look like in 7 or 15 years? Where will heart valve technology be in 7 or 15 years?