Homograph valves?

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Bad Mad,

I have been getting a cardiac MRI every 6 months due to a pseudo aneurysm that formed within my heart sometime after the surgery 8 years ago. Over time it continued to enlarge and needed to be fixed as well. Dr's believed the false aneurysm was an offshoot from a stitch-gone-bad around the root from the first surgery. Every check, homograph remained in good shape with mild regurgitation. After this surgery, surgeon who removed told the homograph was badly calcified and in fact was torn which left the valve wide open. When it tore is unknown. I just know things happened quickly in about a week to two week interval. I am blessed everything could be fixed and I am now good to go another 100K miles.

Matt
 
My cardiac surgeon is primarily a transplant surgeon. The way he put it about homografts, was that if the aortic and pulmonary tricuspid valves are good to harvest from a cadaver, chances are that the heart is in good enough shape as well to use in an organ recipient. So, finding the perfect size and condition for implant into my aortic position (or pulmonary had I decided to travel to Calgary for the Ross) was taking a chance, were it my surgeon's choice to make, that he wouldn't decide on.

I chose the porcine stentless because I didn't want lifelong coumadin use as a certainty. I mentioned it first and Dr Modrey was stunned and pleased that I'd already done the research and was prepared to make an educated decision based on what I knew, not what he recommended.

Maybe this is another reason xeno-tissue grafts are so prevalent. There are infinite size choices available. They have developed new cryo procedures and washes to sterilize and prepare both the valve and the root so as to give a longevity to the valve graft that is (hopefully) as longlived as a native valve in the same position.

Take heart...
 
This has turned out some really interesting conversation. A lot of good things to consider.
My cardio does a echo every year. This past fall (8 yrs. post op) he showed me where the valve is doing great... no calcification and doing great. Because of the sad state of my heart prior to surgery (my family dr. kept trying new inhalers for my asthma) my heart was enlarged. That has now gone down to normal size. Cardio told me this fall that he was so happy with my outcome. He truly thought I would eventually need a heart transplant if I was to live.
I always say my operation was not so painful and just feeling as good as I felt immediately afterwards was such a thrill that it got be over any pain there was.
Also I have a friend whose brother has had a porcine valve for 23 yrs now and still going strong. My cardio says the official stance now is if there is no trouble in the first 5 years, statistically you're good for 20 to 25. That is about as long as they have been doing these.
Anyway after 8 yrs. I am still a happy camper. Thanks for all your replies.
 
This has been an interesting thread, with a variety of information and I found what your cardio said about tissue valves interesting. Glad you're doing so well. It's amazing what a properly functioning valve can do for a person!
 
Maybe I could relate my tissue experience?

Twas a replacement of a mechanical aortic valve, due to endocarditis, so had to be tissue. I went to theatre expecting pig and woke up in intensive care with human inside. :confused:

A donor valve and root had suddenly become available in a neighbouring town so the surgeons went for it. Their view was homograph had a longer lifespan than porcine and would cause less problems later on.

Ten years later the valve is failing. When it was plumbed in some inventive Dacron use was needed. A Teflon suture between Dacron and tissue has failed. The valve itself is in fairly good shape. It's surroundings aren't however.

The homograph is a little calcified. I believe some significant calcification happens in the first couple of years after implant. It then plateaus and stabilises for many years.

When do they give up the ghost? How long is a piece of string??:)
 
On-X Replacement

On-X Replacement

I had my procedure completed 3 weeks ago this coming Friday. Im 42 and my heart was in perfect health other than my aortic valve which had pretty severe stenosis. I had one of the leading Surgeons in the Clinic (Gosta Pettersson) perform my procedure and when we talked through options (bovine, homograph, mechanical, and Ross procedure) he strongly urged the mechanical, specifically the On-X. He has done over 50 replacements with this valve type thus far and felt that for someone at my age, and health (very good overall), that this was really a no-brainer. He said that if he were having this procedure, he would want the On-X. He was point blank in that I would probably be facing 2 or 3 re-operations if I didn't go mechanical. I realize that in 20 years that procedure my very well be done without a chest crack but for me it just didn't seem to be worth the risk. Knowing that mortality rates increase with each re-operation scared me and now that I have been through it once I can say that I really don't want to do that again. I could, but certainly Im not looking to sign up again. I did my research on the On-X valve it and seems that it has a great chance of lasting me 30 or 40 years. Obviously I have to be careful with meds, diet, and activities, but if I can't have machete fights in the backyard anymore or go on a 3 day bender then I think I can live with it. I've spoken to alot of folks with mechanical and who are on thinners and they seem to be living healthy and full lives. And there are studies ongoing with folks who have the On-X valve using lower Coumadin levels and even just baby aspirin. Im not ready to blaze that trail yet but Im hoping within 5 years or so I can ditch that medication or at least go to a lower dosage and lower the risk if bleeding out with a significant injury. Everyone will tell you that its an individual choice and it certainly is. Im only 2+ weeks post op, I may feel completely different in 6 months or 6 years.

I wish you the best of luck on whichever way you choose.
 
Ctyguy, that's quite an endorsement that Petterson said he would choose the On-X himself.
 
Karlynn. Im an analytical type of thinker and I had probably 2 pages of questions for him when we met. When we talked about the On-X valve and its design at length and he felt that it was the best on the market because of the flow rate and the fact that the leaflets don't completely shut. It is technically more difficult to put in due to the profile of the valve (its higher) but with that the chances of it coming loose is also signficantly lower. And its 100% carbon and they feel that an all carbon valve reduces some clotting risks, hence the studies for reduced Coumadin.l When I had my Echo prior to surgery my gradient (rate of the blood flow through the valve) was about 115 which is pretty darn high. Four days after surgery it was 25 and everything else about my heart appeared completely normal. I can't hear the click (my wife can though which is odd), but I can certainly feel my heart working when I lay down, doesn't seem to bother me as of yet. Its impossible for me to know how this will all workout, only time will tell. But based on his reputation and resume I went with his overall assessment and advice.
 
I had a homograph and root replaced for a failing 11 year bovine valve, and aoritic anuerysim done at va indy. 14months later I have been diagnosed with severe aortic stenosis, va still thinking what to do with me, already having 2 valve surgeries, scar tissue etc. i am 64 years old. last week preliminary consult , 2 possible procedures mentioned. Apical aortic conduit, which va tampa can do and Percutaneous aoritic valve repair, which va does not preform. Im not to confident after last repair only lasting 14 months. i also have medicare. I am asking for any help regarding either of these two procedures. i cant believe i will have to go through heart surgery again so soon.
 
Sam,
I hope you will repost your reply as a new thread, possibly mentioning percutaneous aortic valve repair in the thread title. I'm afraid that since you've posted to an old thread, one from 2008, your reply will get lost in the shuffle. I'm sorry to read that your homograph failed so soon after replacement.
 
samk said:
I had a homograph and root replaced for a failing 11 year bovine valve, and aoritic anuerysim done at va indy. 14months later I have been diagnosed with severe aortic stenosis, va still thinking what to do with me, already having 2 valve surgeries, scar tissue etc. i am 64 years old. last week preliminary consult , 2 possible procedures mentioned. Apical aortic conduit, which va tampa can do and Percutaneous aoritic valve repair, which va does not preform. Im not to confident after last repair only lasting 14 months. i also have medicare. I am asking for any help regarding either of these two procedures. i cant believe i will have to go through heart surgery again so soon.
Click to expand...

I am sorry to read this. i thought it was too early when mine failed at 12 years. Knowing that wasn't long enough helps me to understand how frustrating 14 months must be. My recommendation is to get with a surgeon that is really good with scar tissue and re-ops. I only know of one and he is in Cleveland. I am sure there are many more.

Scott
 
I must agree with tobagotwo,
i am 36 year old female and opted for porcine valve, hoping that in 10 - 15 years medicine will be so advanced that my own valve will be grown in a lab from my own stem cells. I think thats the way to go in the future. Luckily i had min invasive surgery, recovery was really really smooth.
 
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