Info on Tissue Longjevity

[ron]

Hello folks,

I listened to some info recently and wanted to pass it on. Dr. Raissi gave a webinar a few weeks ago and the topic of Bovine tissue longjevity came up. He stated the following:

In a recent study, they interviewed roughly 335 people who had Bovine tissue valves 22 years after the surgery. Of those people interviewed, only 5 of them had to be replaced in that 22 year time period. So essentially, the majority of people still had a bovine valve intact after 22 years.

I don't know the average age of the patient when the valve was first inserted, but I am going to assume that they were older, but not very old. If they were 80 when they put it in, for example, such a large number of people would not make it to 102. So I am going to assume this was for people ion their mid 50s to early 70s.

This is - to my knowledge - good news about the durability of 2nd generation valves. Most of the info that we have on bovine valves is from results gathered off of the 1st generation valves. Those who had bovines put in recently - such as myself - would have gotten 3rd generation valves, which we can only assume would last as long as the 2nd generation ones - if not higher.

My hospital said that the average age of bovine was 15 - 20 years. Will we hear that number go to 20 - 25 in the near future? This study would indicate that to be true.

Just wanted to pass this info on. It seems like good news to me. At 40 years old - and chosing a bovine valve - the implications can be daunting at times. that being said, with improving durability and the progress of TAVI technology, there is a lot of cause for optimism for those of us who suffer from this illness.

 

[nngbwh]

This is good news for people who chose to have a oink oink valve. Thanks for sharing the info.

 

[Johan]

Good news indeed. If I get 20 years out of the valve, I'll be 86 years old when it gives up the ghost. Not bad but what do we do then? At the time of the surgery my surgeon also predicted 15 to 20 years longevity for my tissue valve. In reply to my question "What then?" he confidently said "then we put in another one provided you are fit enough" He did not elaborate on what if I am not fit enough, but in the interim TAVI came along.
I am hoping that the valve companies are also working dilligently on placing trans catheter valves in old tissue valves. Unfortunately I do not see or read a lot about this possible procedure.

 

[chaconne]

Ron,

This is good news and I hope it's true for the majority of those receiving tissue valves. I chose mechanical mostly because I didn't want a re-op (but also the "cool" high tech factor), but If the surgeon had completely ignored my wishes and given me a tissue, I would be fine with it as well. It's exciting to hear all the new advancements on all fronts of valve replacement technology (better tissue, mechanical, anti coagulants, surgery). It seems that, no matter what we choose, it's a good and promising option.

Best wishes for your situation. May your valve last at least 25 years, and your re-op with a cath (if needed) last you the rest of your natural life.

-Steve

 

[normofthenorth]

The obvious problem with the sample is that it didn't "interview" the non-survivors. Some of them may have died from (or with) Significant Valve Deterioration. So it's hard to draw any conclusions from that kind of a biased sample. (Maybe that was 335 surviving patients out of an original 345, and maybe out of 33,500!! Wouldn't that change your impression?)

That's why I prefer the studies that look at all the patients from one or more centers who got the same valve -- like my fave, entitled "Hancock II Bioprosthesis for Aortic Valve Replacement: The Gold Standard of Bioprosthetic Valves Durability?" by Tirone E. David, MD, Susan Armstrong, MS, Manjula Maganti, MS, in Ann Thorac Surg 2010;90:775-781, abstract at ats.ctsnetjournals.org/cgi/content/abstract/90/3/775? . The many studies discussed in the last few pages of that study -- many of them dealing with bovine (moo moo, not oink oink!) valves -- were done similarly, including good news AND bad.

 

[Julian]

On a side note, porcine valves are not kosher right? I mean seriously, if I was Jewish I would have to get a bovine valve transplant? I mean its one thing to screw up and eat a ham sandwich and have to go cleanse yourself at the temple but if this thing is inside you engrafted; you would be screwed.

 

[Lynlw]

Its always good to hear from the different surgeons/centers and their experiences. That is good to hear Dr. Rassi's experience with those 335 patients who were still alive AND even better 330 of them still had their origonal valve 22 years later. Most studies, Even large ones not that many people make it to the 20-25 year post op point, so to hear about these 300 + and their valves doing well is encouraging. I do agree with you chances are they were probably in their mid 50s -70s when they got there valves, I would guess many were in their 50-60s since its still not all that common for people (even those who didn't have any health issues), make it into their 90s.
Another thought I had, was chances are they had perimount valves, so since they usually have nice big openings, IF/WHEN they do live long enough to need this valve replaced there's a good chance they can be candidates to have it replaced by cath, something they probably never dreamed of when they chose their tissue valve in the early 90s.

 

[Rebecca]

On Oct. 13th 2011 I received a pig valve and was told 20 years and that it was a fourth generation valve.

 

[neil]

yep agree with above posts , brill news , a happy oink oink from me,

 

[tobagotwo]

My understanding from a post some time ago is that if it's a lifesaving measure, the porcine valve is not an issue for most Jewish people. However, since there's a bovine (and even an equine) valve available, that would seem much easier to explain to your rabbi.

Similarly, heparin is harvested form pig intestines, so would fall into the same category, and could potentially affect the decisions of some very strict worshippers to avoid mechanical valves as well.

Best wishes,

 

[Julian]

My understanding from a post some time ago is that if it's a lifesaving measure, the porcine valve is not an issue for most Jewish people. However, since there's a bovine (and even an equine) valve available, that would seem much easier to explain to your rabbi.

Similarly, heparin is harvested form pig intestines, so would fall into the same category, and could potentially affect the decisions of some very strict worshippers to avoid mechanical valves as well.

Best wishes,

Concerning heparin I think this maybe injected in surgery I know they injected me with it. We may not have a choice when it comes to OHS.

 

[Greg a]

Concerning heparin I think this maybe injected in surgery I know they injected me with it. We may not have a choice when it comes to OHS.

It is my understanding that it is also injected at each dialysis treatment so probably done on bypass as well

 

[normofthenorth]

I happened to mention (by e-mail) to a Rabbi I know that I was likely to get a replacement valve from a pig. She e-mailed me a clipping about (or maybe by?) an Orthodox Rabbi who got a pig valve and explained why it was not an issue at all. Basically, health/illness trumps all the other rules in Judaism, including for those much more Orthodox and observant than I.

 

[Lynlw]

I happened to mention (by e-mail) to a Rabbi I know that I was likely to get a replacement valve from a pig. She e-mailed me a clipping about (or maybe by?) an Orthodox Rabbi who got a pig valve and explained why it was not an issue at all. Basically, health/illness trumps all the other rules in Judaism, including for those much more Orthodox and observant than I.

I googled this when I was bored yesterday (Just and don were working), because that is kind of what i remeberred hearing, I'm not jewish and so dont know if this is a reliable site but http://www.myjewishlearning.com/ask_the_expert/at/Ask_the_Expertxenotransplant.shtml

here is part of it
So there is no halakhic problem with pigskin and pig heart valves—on the way to Jerusalem or at any other time. Beyond that, there's a very important tenet of Judaism called pikuah nefesh, or, saving a life. According to Jewish law, any of the mitzvot in the Torah (except idolatry, murder, and forbidden sexual relationships) can and in fact should be violated in order to save a person's life; the pikuah nefesh principle is that strong. This means that even if the use of pig parts wasn't generally allowed by halakhah, when people's lives are at stake, we are commanded to do whatever is necessary to save them.

I thought this article was interesting because it ended with
Incidentally, this exact issue was brought up on an episode of Grey's Anatomy a few years ago. In the episode ("Save Me" Episode 8, Season 1) an Orthodox Jewish girl refuses to have a life-saving xenotransplant from a pig because it's not kosher. The surgeons eventually do the procedure with a xenotransplant from a cow, instead. When the episode first aired, the Orthodox Jewish community responded by condemning the depiction of Jews and Jewish law. Rabbi Avi Shafran, Director of Public Affairs for Agudath Israel of America, called the character's refusal of the pig part "silliness."

 

[joanie]

I'm Jewish (not Orthodox) and before my surgery I had several fun-spirited discussions with friends about whether a pig valve would be permissible to someone far more observant to me. Among my favorite scenerios that was raised was the possibility of a airport metal detector type device at the synagogue door to scan for pig parts in congregants. Buzz . . . you can't come in!

But as others have noted, the real answer is that porcine valves are not a problem. Oink!

 

[epstns]

I'm Jewish, and ended up with MOO as my valve chant, but like Joanie, we had a lot of fun with all the fabricated implications.

We also walk a wide arc around all the burger joints now, but at least my valve doesn't squeal when we go past bar-b-que joints!

 

[LJM]

I have a Bovine Valve and its been there since 2006 & i hope is lasts for a long long time.

My Dr has told me after 4 open hearts he doesnt know how much more my heart can take.

 

[neil]

steve be careful what you say about us piggies, remember when you go to sleep tonight and you hear a oink oink coming from your wardrobe, be very very frightened lol

 

[Rebecca]

Today I had my six week visit with the surgeon and he told me my pig valve should last 20 years. I am almost 55. After surgery in the hospital I was hearing a oinking noise. I ask my sister if she could hear the noise and she could. The noise was from my water heating pad that I had folded in half and it was attach to a moter to keep the water moving in the heat pad.

 

[Duffey]

steve be careful what you say about us piggies, remember when you go to sleep tonight and you hear a oink oink coming from your wardrobe, be very very frightened lol

We moo-ers ain't afraid of any little piggies Neil!