immune suppressants question

[tigerlily]

Hello everyone,

I'm really new to valve selection and so far, it is driving me crazy. How does anybody ever decide? It seems like a professional health care provider should be able to sit down with you and take into account your medical history, medications you take, suppliments you take, medical problems now, lifestyle and age, etc. etc. and help you decide.

Anyway, here's my question. Do you have to be on an immune suppressant if you get a homograft valve replacement? If not, shouldn't you be? Why wouldn't your body reject someone else's tissue?

What about bovine and porcine valves (hope I have my terms right). If you have a these tissue valve replacements, do you not have to take any medicine at all?

Thanks for your help.

 

[tobagotwo]

No, there are no immunosuppressants involved.

It would seem like homografts should require them, but they don't. Apparently the foreign human tissue doesn't have more than a negligible inflammatory effect on the body's defenses in the aortic position.

There has been some effort more recently to match blood types for aortic and pulmonary homograft valves (PHVs are frequently used for the Ross Procedure), due to some immune-related issues that do show up, primarily at the less fast-flowing pulmonary site. Apparently, the valve is the only thing really affected when that happens, and the issue frequently stabilizes on its own.

Homograft aortic valves routinely last 12-15 years in middle-aged and older patients. In the pulmonary position, homografts can last twenty years to indefinitely.

The bovine and porcine valves, collectively called xenografts, don't seem to trigger autoimmune responses in any typical sense. Their demise seems to be more related to the chemistry of their surfaces, which can register as damaged or dead tissue to the body's chemical message system. The body's response is often to attempt to coat them with calcium to protect and isolate them. Recently developed treatments for xenografts delay the chemical recognition, and "lock out" many of the sites on the valve leaflets' surfaces that would be chemically receptive to calcium. Untreated valves averaged 15 years for porcine, and 18 years for bovine in middle-aged patients. Anticipated lifespans are now 18-22 and 22-25. We won't know for 20+ years if that's gospel, though.

I have a porcine valve and take no meds other than a beta blocker (atenolol), which has nothing to do with tissue rejection.

Best wishes,

 

[Lynlw]

Hi, I knwo it is so confsing, you'll get alot of help here. my son Justin has a bovine and doesn't take any meds, Lyn

 

[Lynlw]

I don't know your so if this applies, but one of my first questions would be if you plan on having children, Lyn

 

[mbfleth]

Two factors to consider concerning your physician/surgeon (in another words WHY SECOND OPINIONS ARE IMPORTANT):

1. His/Her skill level. You may only be presented with surgical options that the Dr. feels comfortable performing. The surgeon may steer (no bovine pun) you towards a surgery that he can perform and be paid for. Especially if you are self insured (which means that you are not on any sort of public aid...medicare/medicaid) and the reimbursement is assured.

2. Financial Partnerships. Your Dr. may have certain "benefits" provided to him by a certain manufacturer of mechanical valves. Some of these are in the form of donations to his hospital or funding a reserach assistant.

Example:
My first opinion was from a surgeon at a community hospital where the only choice is mechanical. Bovine/porcine/homo and Ross are not offered. The surgeons there naturally gravitate towards the surgeries that they can perform.
My insurance allowed me the ability to get a second opinion from a university hospital that offered the full range of AVR options. I was able to get a Ross and avoid the coumadin life sentence. Now I am 100% drug free and completely active. My mother had a St. Jude and died on the table during her third replacement in twenty years at that community hospital. The long term effect of the anti-coagulant is something that I would not wish on anyone.

Shop around and ask!!!

 

[catwoman]

2. Financial Partnerships. Your Dr. may have certain "benefits" provided to him by a certain manufacturer of mechanical valves. Some of these are in the form of donations to his hospital or funding a reserach assistant.

Where did this claim come from? Do you have information to back it up?