Medronics Mosaic Valve

[dbbrooks]

I received a recommendation from a consult surgeon (one that will probably not do the surgery) for a Mosaic valve from Medronics. Explained that it is was a third generation valve (porcine) with two special anti-cacification treatments that makes it preferable to Edwards bovine valve. Said it has only been approved in US for 6 years (longer elsewhere) but indications are that the longer life thesis will hold true, and that other outcomes data are as good or better than other products. Said it had greatest market share based on current implantation rates (??). Also mentioned that this valve in conjunction with his recommended partial stenotomy approach would make easier a subsequent explantation and reimplantation if one becomes necessary (an important consideration for myself, at age 55).

Any feed back on the valve or the surgeon's representations?

 

[fisher6476]

http://www.medtronic.com/newsroom/news_20000801.htmlwww.medtronic.com/newsroom/news_20000801.html

 

[tobagotwo]

OK. I'll bite. What's a partial strenotomy? I'm looking at the Mosaic valve as well. I'd like to know this.

I know that "otomy" means removal, and I think that Stren is a brand of fishing line..? Anyone...?

 

[Bryan B]

Here's an article that explains the different methods of gaining access to the heart:

http://www.womensheartfoundation.org/content/HeartSurgery/heart_surgery_options.asp

 

[ALCapshaw2]

A *sternotomy* (NOT strenotomy) is a surgical incision through the STERNUM.

 

[HFK]

I did research on the Mosaic valve ,it's a great one. Many surgeon's nation wide prefer it to CE bovine,Dr Cosgrove uses only CE. But other Dr's of same ranking use Mosaic, some use both depending on situation. The anti calcification treatment is very impressive. The biggest difference is the "Bovine is hand made from 3 pieces of cow tissue,so it is not an actual valve from a cow, they have consstructed it into a valve with cow tissue. The Mosaic is a pig valve ,3rd generation, so it's been around many years they have added the anti calcification. I guess some feel it's better to have less sutures in the valve itself. The reason why tissue v fail is the deteroration from calcium. It's so ahrd knowing what to do! But your Dr I am sure might share his reason's. I know people here on the forum are somewhat bias to CC and Dr Cosgrove but ,there are other hospitals and Dr's who are highly respected and are great surgeon's too. I have CC , and a few other's on my list for my 2nd surgery when the time comes. HFK

 

[Nancy]

Joe had his last two valve surgeries and his two lung surgeries close to home. The surgeon is superb and does some of the same high-tech stuff that's is done in other places. Three of these surgeries were done at Ellis Hospital in Schenectady, with Dr. Harry DePan. One of the lungs was done at Abany Medical Center with Dr. Riivo Ilves.

Both hospitals are high volume for thoracic surgeries.

It was so much easier to have these done close to home.

Actually there are three hospitals locally that do exceptional work. Ellis Hospital in Schenectady, NY; Albany Medical Center, Albany, NY; and St. Peter's Hospital, Albany, NY.

 

[tobagotwo]

Thank you. What a difference a consonant makes!

The original was a typo: stenotomy. I retypoed it with: strenotomy. By the time we're done, we'll have whole new surgical procedure...

I guess the type of sternotomy will depend on what the surgeon expects to find when s/he gets in there.

 

[tobagotwo]

Unbelievable. I talked to the surgeon and forgot to ask what kind of entry he'll be using. After all this...

 

[elphie]

This sounds like the valve I got, except on my id card it doesn't say the word "mosaic". My surgeon highly recommended this porcine valve over mechanical and bovine. He said he even used to recommend and perform the Ross procedure until this valve came about, but because of the expected 15-20 yrs., he now sees this valve as the one he would choose if it were him. He said he's been putting them in since 1998, and so far hasn't had to replace a single one. We can only hope that they do get the life expectancy they expect with it and then some.

 

[tobagotwo]

Actually, I am getting the Mosaic valve, as my surgeon prefers it, although he said he'd be willing to put in the CE Perimount Magna (bovine) if I want.

The thing that seems to attract the surgeons to the porcine products is that the pig valve is actually a valve. It's been chemically treated to not be rejected. In the case of the Mosaic, it has also been treated to reduce calcification. Calcification is listed as the primary cause of valve failure in every place I have seen it referred to, infections notwithstanding. Perhaps the point was that infections are a primary cause of premature tissue valve failures, rather than failures as a whole.

The bovine (CE) valve is not actually a natural valve, but is a valve manufactured from natural materials (bovine pericardium). It has also been chemically treated not to be rejected. However, it can fail due to a manufacturing fault (quite rare). That bit of manufacturing is what sems to send the surgeons off of it. This latest version, just put out in February, has a new, anti-calcification treatment also.

The statistics published on a limited number of the CE valves are quite strong, indicating that over 90% reached 18 years with the valve, 80% reached 20 years. However, Winston Churchill aptly stated that there are three kinds of lies: "lies, damned lies, and statistics." I don't mean that some valves didn't last that long, or that they lied, but do watch out how you interpret what the study says. It is implied, "of those who remained alive through the study..."

This longevity does couple well with the "normal life" ranges usually given for tissue valves, though. Standard expectations have generally been for porcine valves to go 13-15 years, and bovines 15-18 years. With the new models, both are claiming that 25 years may be within reach. I certainly hope we're all around to see that happen. I'm hoping my next valve will go the distance.

Personally, I'm not as concerned with the fact that the porcine valve might not go as long as the bovine right now. But that's a matter of personal timing. If I get 15 years from it, I will be 66. That's a somewhat more operable age than 71. In 15 years, a tissue valve should have been developed that can take me the rest of the way.

On the other hand, if it does last 20 years, I get to see my granddaughter graduate high school before I have to be reoperated. It's not unlike playing the market: bull or bear.

I'll take the time I get, either way, thank you.

 

[tobagotwo]

As far as the teeth/gums infection question: there seems to be a correlation there. If you or a member of your family has gum issues, they should be treated immediately and permanently.

Gums cycle tremendous amounts of blood, as the chewing process frequently damages them, and they need to be able to repair themselves rapidly. Infections, even at low levels, are carried out to the rest of the system by this expanded blood flow. Infectious material, even if apparently handled well by the body, seems to be implicated in a large number of mischiefs, including arterial wall damage, arterial blockage, valve damage, and valvular infections (particularly on aftermarket valves).

Gums generally should not be red all the way to the tooth line. They should turn a lighter, pinker color before they get there. They should not bleed from pressure, brushing, or flossing, unless you happen to be too rough on one particular morning.

I'm not speaking from a holier-than-thou position: I've had nasty gum surgery (because I had nasty gums). They even chose to remove some teeth to enhance the repair process and keep the gums infection-free. Not a high point of my existance. However, it really turned out much better than I had expected.

Initially, I had warned the periodontist that I would not be willing to spend an hour a day with Mr. Toothbrush and Ms. Floss. I said that if it was going to require an overly significant part of my life to take care of my mouth, just yank 'em all, and let that be an end of it.

The periodontist said it wouldn't take anything like that much time, and it doesn't. Less than ten minutes now, once a day, keeps my teeth and gums in excellent shape. Cleanings at the dentist last about fifteen minutes, are not bloody ordeals, and involve compliments instead of the former admonitions. And I don't have to slink out of the dentist's office anymore, thinking evil thoughts about the technician.

As you can guess, I'm not a particularly docile or "trainable" individual, so if I can handle it, I guess most others could, too.

 

[elphie]

Susan,
Don't know the answer to your question, but I do know that I have a hard time eating pork since my surgery.

 

[tobagotwo]

Pigs are omnivores, just like humans, but a bit less picky. As pigs are often fed leftovers, including from restaurants and grocery stores, I guess they can eat just about anything we can dish out.

The real question is, how can you stay Kosher?

 

[tobagotwo]

Just a follow-up:

I had the Mosaic valve implanted Tuesday, was home Friday, and spent some time walking through the daffs. Today, I feel pretty good, and am being careful not to get my heart rate up too much. However, stairs are not the issue I thought they'd be, and I don't speed up the rythm if I go fairly slowly. Still, I want to be as cautious as is reasonable. My take on this is that I have been very fortunate indeed, and I don't want to screw that up now.

No coumadin. I had some a-fib Wednesday night, so there will be Plavix for a while, but that's not much.

Nobody answered if you could stay Kosher with a pig valve?

 

[RCB]

You make it seem easy!

You make it seem easy!

Some guys have all the luck. I would tell you to take
it easy on yourself, but I'm reluctant to give anybody advice
who seem to be a role model for a quick recovery.
YOU DA MAN

 

[bvdr]

Kosher with a pig valve? I say yes....but my husband says no. I think you better ask someone who knows.