Mechanical or tissue aortic valve?

[Jurassic Cowboy]

Dirk:

I don't know if Delos Cosgrove had a hand in developing the new CE tissue valves, but he is a paid consultant of Edwards, or some such. In all the scientific papers listing him as a co-author there is the disclaimer, "Dr. Cosgrove discloses that he has a financial relationship with Edwards Lifesciences, L.L.C." That's why we see him on the Edwards website we have been looking at, I suppose. This is not to imply that the scientific literature has been "cooked" in Edwards direction, as these papers usually have a half dozen authors from different hospitals, so I'm sure they are honestly representing the data published in those papers. As far as the 57 slide presentation from the web goes, I couldn't say.

If you want more information about the fixation process for the newest CE valves, maybe you should just call up Edwards phone number and ask someone. I see two phone numbers on one of their Magna valve descriptions. They are (949) 250-2500 and (949) 250-3769. The second one is for "Sales" and the first is unlabled. I presume these are at their offices in Irvine, California.

J. Cowboy

 

[Phyllis]

You may try those numbers that JCowboy gave you - we did when we wanted to inquire as to the availability of the valve in Novemeber, 2003 and you may also try 800-424-3278. That is the number of the registry after you have one of their valves.

 

[Dirk]

Well,

I will contact them.

Dirk

 

[tobagotwo]

I sent a question through their website a couple of days ago, regarding whether the Magna is considered stented. I will let you know how soon (or if) I get a reply.

I'm not sure which method will get you the more knowledgeable person. I believe web questions were handled by sales reps, the last time I contacted them, six months ago.

Best wishes,

 

[tobagotwo]

Speak of the devil...I guess the website is a good method to contact them:


Hello, Robert.

I received your Magna valve-related question. PERIMOUNT Magna is a stented tissue valve, like the standard PERIMOUNT aortic valves. PERIMOUNT Magna has been compared to stentless valves in terms of performance, thus the references you have likely seen.

Please let me know if I can address any further questions, or if you require any more information.

Amy
Global Product Manager
Aortic Heart Valve Therapy

Edwards Lifesciences
One Edwards Way
Irvine, CA 92614 USA


Note: I removed the responding lady's name and number, so she doesn't get all the calls. Also, as everyone is aware that I'll be doing it, I will take this opportunity to edit the original that Phyllis reposted, so that anyone picking it up from now on will get corrected information.

Best wishes,

 

[Phyllis]

Thanks Bob, I'm glad we got that straightened out. The website is a good way to contact them. When I was searching for the number on Dick's valve to register it, I got a faster reply through the website than I did by phone. They told me by phone that I needed to get the information from the hospital. By e-mail, I gave them the patient, doctor, hospital and date of surgery and got the information I needed to register it. I've gotten to the point where I hate to pick up the phone anymore and much prefer to do everything by computer!

 

[bvdr]

About the "25%" ten year chance of stoke with a mechanical mitral valve.....

I remembered to ask my eldest son about this yesterday. He has his degree in mathematics and is a very gifted problem solver. If I understand it correctly, the way he explained it makes more sense. First of all, remember that a percentage like that does not apply to an individual but to a fixed group of people. Yes, the risk is 23-25% over a ten year period but each given year remains 2.3%. In addition to that, an individual(as a member of that group) is always at the beginning of the statistic. What I mean is that just because you have 2,5, or even 9 years without a stroke doesn't increase your odds. For the next year your chances remain at 2.5% and for the next ten years at 25%. (This is of course assuming that the 2.3- 2-5% figure is accurate).

He of course added that human being are not inanimate objects and can do many things to weigh things in their favor.

 

[Jurassic Cowboy]

mineralogy of "calcium" deposits on valves

mineralogy of "calcium" deposits on valves

For Bob H. and anyone else who might be interested:

I was wondering the other day what the medical literature means by "calcification" or "calcium" deposits on heart valves, and my aortic valve in particular. It can't be pure calcium I figured. Since I am geologically inclined I did a little poking around and found out that this "calcium" deposit is actually an organic version of the mineral APATITE, which is a calcium phosphate, with some carbonate and hydroxyl groups attached to it in this case. It's not too suprising that it's apatite, as this is what also makes up most of tooth enamel and the structural parts of bones. Apatite has a hardness of 5 (midway between talc = 1 and diamond = 10) and a conchoidal to brittle fracture. It can be just about any color in nature but in the human body I think it is usually white (like teeth and bones), due to the lack of other elements which impart color to it in the "wild." Oh yeah, and when found precipitated on heart valves, the mineralogy dorks call it a "cardiolite" deposit. Cute........

J. Cowboy

 

[tobagotwo]

Apatite deposit...

Apatite deposit...

"Cardiolite" had me rolling. There was a roomfull of grown men giggling when they came up with that, I'm sure.

My father was the minerologist in the family, and was well-known in the Franklin-Ogdensburg area of NJ, home to the largest selection of fluorescent minerals in the (country? world? I forget.). He had specimens of apatite in his mineral collection, but they weren't his most prized minerals.

I don't blame him for that. My own, internal apatite collection was not a favorite asset of mine, either. Some pieces from his collection wound up in the Museum of Natural History, a few in the Smithsonian, and most with other collectors. I have a few specimens of his remaining.

My own collection most likely wound up in the "infectious waste" trash bin behind the hospital.

Thanks for that story. I enjoyed it.

Best wishes,

 

[d-mac]

Aortic valve replacement and aortic graft patient - soon to be

Aortic valve replacement and aortic graft patient - soon to be

Hello all

Have followed the string so far with interest and will probably read it and others under this topic again over the next few days. Excellent information from you all and a lot to digest. Amazing how one can become versed in what were once foreign matters, once it concerns you directly. JC and Buzz + many others, read all of your stories with interest.

I have a uniformly dilated ascending aortic anuerysm (55mm) and bicuspid aortic valve with moderate regurgitation. Diagnosed in the last 4 weeks - what a whirlwind! I am a 36 yo Australian police officer, extremely fit (until I was told to stop everything 4 weeks ago), and very surprised at this development. I still wake up in the morning and go "was that a dream?"

Surgeons have indicated surgery in the next 3-4 weeks due to the size of the anuerysm. I have started to contemplate the valve choice. I am certainly not au fait with names and brands as many of you are but I am sure that will come. In Australia we may not even have access to some of the products you talk about due to regulatory approvals, although that is only a theory at this point. I have to admit I favour a biological valve (over here either human or porcine were offered by my surgeon) due to probably having a meds-free life for some time to come. However while I favour this, I know it is my relatively young age that tends to dictate I should take the mechanical choice. Also, apparently they can get the replacement artificail valve/aorta assembles as one piece and do the job a bit neater that way (don't you hate being in this position?).

Despite this my surgeon proudly tells of a 55yo patient (today) who has a biological valve (human) inserted 20 years ago and still going strong - how's them apples? Now, I have seen some comments about "homografts" in the posts. Neither my cardiologist nor surgeon have mentioned these. I saw in another string that these were being indicated for 'younger' people. Any comments?

Is there anybody out there who has had their employer reassess their operational capacities following taking a mechanical valve with its attendant medication issues - ie. especially police or military? I have travelled overseas a bit with my job to remote missions and wonder what others' experience has been in a similar situation. Long shot I know but if any of you have a similar experience, please tell....

Thanks for reading. I have been sleeping while you did.

Darren

PS Surgeon also said he believed a drug to manage anti-coagulation without regular blood tests was only about 3 years away???

 

[tobagotwo]

Darren,

The surgeon was probably thinking of a current anticoagulant drug under FDA scrutiny called Exanta. It will probably not meet the criteria in the US, from what anticoagulation expert Al Lodwick has related to us: www.warfarinfo.com/ximelagatran.htm

Homografts are a fine approach for many people, and are the human valves that you mention in your post. Porcine models are called heterografts or xenografts. Both homografts and xenografts can be available as "one piece" units.

I would check with your officers to see if you would be limited in your duty assignments if you were taking Coumadin. I greatly suspect that you would be.

Your age does make something of a case for a mechanical valve unit, if possible permanency is your major objective. However, you must make that determination yourself, as all options are available to you, and you are the person who must live with the result.

It's a lot to take in all at once, and I hope you're holding up as well as you sound. Going from feeling very fit, to finding that your heart is failing you can be an emotional roller coaster This is a good place to vent, with people who have gone through (or will go through) what you are about to. If you're feeling something, someone here has felt it, too. There's no shame in being jolted by this kind of news.

You are young and very fit, and those are excellent harbingers for good results and rapid recovery. I hope your surgery brings you the result you most want, and that you'll keep us up with your progress, issues, and questions.

Best wishes,

 

[Jurassic Cowboy]

Darren in oz:

Welcome to the club mate. You'll catch onto the valve lingo quickly, I'm sure. I really recommend the Google search engine as a resource for finding out about different kinds of valves, companies and even models. I don't have too much additional advice to offer beyond what Bob H. wrote above. He knows a lot about this stuff, even though he's from New Jersey! Seriously though, a homograft might be a good way to go for your situation. Arnold Schwarzenegger had a homograft replacement of his aortic valve at age 49, which was about 7 years ago, for example.

However, even a homograft probably won't last forever and most doctors will probably recommend a mechanical valve for you, given your young age.

I do have the sense that the ease/difficulty of the surgery is not too dependent on the kind of valve; mechanical vs tissue. In fact, my cardiologist referred to aortic valve replacement as "routine heart surgery" these days. My immediate reaction was, "Doc, in my spare time I collect oxymorons, and I'd put 'routine heart surgery' right in there with jumbo shrimp and civil war as a first class example!" Despite all of that you certainly want to have this done by the best surgeon and in the best hospital within a reasonable distance of your home base.

In the end the choice of valve is up to you, but remember, whichever you choose is going to be a winner, because it's going to save your life!

Best of luck,
J. Cowboy

 

[Granbonny]

Darren

Darren

Go to the top of our forum..click on members. Click on J's and scroll down for James W...He is also a policeman in Oregon and had a tissue valve put in 1 1/2 years ago. Send him an e-mail or PM..whichever, he is taking. I'm sure he will reply to you. sometimes, he still comes on our Sunday chats.I was interested in helping James way back before his VR replacement..because my son is also a policeman..Age 35...I know, James is still on the force. Bonnie

 

[tobagotwo]

Darren,

If you want more information about tissue valves, I just did a post that has a lot of links toward that end as well: http://www.valvereplacement.com/forums/showthread.php?p=95982#post95982post95982

Best wishes,

 

[Gail in Ca]

I have had both types, porcine lasting 11 yrs placed at age 34 ,and then mechanical placed at 46. I would still take that 11 yrs with porcine and no coumadin. Life goes back to normal, like you never had surgery and you can forget it for 11 yrs anyway. Then mechanical, poking the finger weekly, taking medication for INR, the clicking, and life is never back to 'normal'.
Of course I am so thankful to just be here with my clicker, but..
Recently I cut my heel and it was quite deep, but I figured I didn't need to see the Dr for it. The next day when my bandage was still soaking thru I called the nurse and she told me what to do, but wanted me to come in if it didn't stop. So , I now know what it's like to have more than just a scratch while on coumadin. Not too pleasant.
Gail

 

[Jurassic Cowboy]

98-year-old (!) man undergoes AVR

98-year-old (!) man undergoes AVR

Here's a flash from our local newpaper this morning. Two days ago a 98-year-old man successfully underwent aortic valve replacement surgery at Rhode Island Hospital in Providence, RI. There's a picture of him in the paper this morning sitting up in bed drinking ginger ale and reporting that he felt fine, given the experience. Unfortunately, the story did not say what kind of valve he received.

He is the oldest patient in the history of that hospital (and I'll bet most other hospitals) to successfully undergo open heart surgery. The patient is a retired MD, having had a family practice for 46 years in the local area. He started his practice in the 1930's when an office visit cost $1 and a house call cost $2.

I suppose that the message for all the rest of us "spring chickens" with valve problems is that if he can do it, then we can too.

Best, J. Cowboy

 

[Granbonny]

Thanks Cowboy

Thanks Cowboy

That is the best story I have heard...Surely, he got a tissue..so he would not have to worry about taking coumadin I would love to hear a follow-up..if your newspaper has one. My age 90 year old daddy has a stomach aneurysm..We were told 3 years ago..to leave it alone..He would have a harder time recouping than the chances of it bursting at his age. Family chose not even to have it measured, ect. yearly. Let him enjoy life. He still mows his grass with a hand mower, cooks a huge breakfast every morning..and never misses an Atlanta Braves game. Even staying up late for the West Coast games. Only takes a b/p med once a day.Bonnie

 

[tobagotwo]

Part of the reason that there is a hub for the CEPM in Cleveland is that Dr. Cosgrove, an excellent and respected leading surgeon at CCF, works with the Edwards Lifesciences research and development teams, as well as some others from CCF, although I don't think it was directly related to valves. This is not a bad thing, and the relationship is freely disclosed by Dr. Cosgrove.

The Mosaic is not identical to the Hancock II, starting with the mosaic's half-thickness stent, which improves its flow characteristics. The AOA treatment and physiologic fixation process also differed from the Hancock II until very recently. Medtronics has now extended its treatments to the rest of its valves, to improve all of its lines.

Following is a link to a study of anticalcification treatments, including glutaraldehyde, ethanol (used by the St. Jude Epic valves), and AOA (in use by the Mosaic valve). In it, very different physical response characteristics are noted in the previous Hancock II valve versus the Mosaic, in ways not associated with calcification.

http://ats.ctsnetjournals.org/cgi/c...g/cgi/search&resourcetype=1&journalcode=annts

Best wishes,