News worth the read trans cath valves
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Greg~
Well-known member
Awesome story!
Thanks for the post Greg
Thanks for the post Greg
normofthenorth
Well-known member
Interesting. We've had earlier discussions about (a) what happens to the old valve and (b) whether this could be done more than once to the same patient. The article seems to answer those questions.
Is this "cow valve" the Sapien valve that was the first one in North American trials?
I'm assuming that the patient's heart still has to be stopped and bypassed -- anybody know for sure?
Is this "cow valve" the Sapien valve that was the first one in North American trials?
I'm assuming that the patient's heart still has to be stopped and bypassed -- anybody know for sure?
No, the heart is not stopped and /or need the bypass machine. It is just like putting in any other stent in an artery.
They've said all along the old valve leaflets are opened behind the stent that the valve's leaflets are sewn to and that more than 1 can be used in the same person, as long as their native valve or their origonal replaced tissue are large enough in the begining. From what I know some tissue valves like the Perimount's valve opening and hemodynamics, help with being able to get 1 or more percutaneus valve placed inside it. .
Im not sure which valve it is, because I'm not aware of Webb being the first for any of the perutaneous valves, but my guess would be the Sapien since that (st pauls) is one of the centers in Sapiens Partner
trials, and I dont believe they are taking part in the corevalve trials, (for the most part the centers taking place in Corevalve are different than the ones in the sapien)
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VegasBAV
Well-known member
Does anyone know if people who get trans catheter valves need to be on Coumadin for life? I know that tissue valves don't usually require Coumadin, but these articles also reference a wire or metal casing, so I'm not sure if the wire or metal stays in the patient and whether Coumadin is required.
I'm planning on getting a tissue valve soon and would then hope to one day get it replaced by catheter when needed. That's a long way down the road, though, I hope.
I'm planning on getting a tissue valve soon and would then hope to one day get it replaced by catheter when needed. That's a long way down the road, though, I hope.
I think the metal casing is withdrawn. I suppose we could always write the surgeon and ask more questions for definitive answers. Any volunteers?
No you do not need long term Coumadin, or other anticoagulent, there might be a short 3 month or so period right after the procedure with either Coumadin or aspirin, etc, until everything is healed, like some people get after getting a tissue valve by surgery or stents now.
I'm not sure what wire or metal casing you are talking about, I believe you are referring to the stent the valve leaflets are sewn on to, and not part of the catheter device. If your talking about the stent, then that stays in place forever just like stents any where else in the body. The rest of the catheter is removed after the stent/valve is in place and expanded open. They pretty much remind me of a mix between chicken wire and thos little ""chinese finger handcuffs" we played with as kids that expand wider and lots of open spaces between the wire frame work, that make up the stent. After a while your own tissue grows thru the spaces between the wire so pretty much all the stent is embedded and there no rough spots that would cause a concern for clots to form on.
BAV, Many doctors (and others) believe the chances of getting a tissue valve that a person got recently, (past few years - or will get in the near future-) being able to have it replaced when the time comes, by cath (percutaneous) and not needing OHS are pretty good, especially if this valve last the nomal expected time frame so wouldn't need replaced for the next 15 ( or even 10) or so years.
They already started replacing older Aortic tissue valves by cath valves in high risk patients ( called valve in valve replacements, if you want to search) with good results and hemodynamics and the "PARTNER II" trials currently going on have a valve in valve arm of the trial.
They have been replacing tissue Pulmonary valves by cath the past dozen or so and they are usually used in young adults children who are healthy and active. Since Pulmonary were the first percutaneous valves, they have already replaced older percutaneous valves with newer ones, again for the most part with very good results. Of course this is still pretty new and they still are working to improve things even more, lessen risks more sizes etc. Alot of money is going into research and developement them since many people are thinking they will be common enough to make alot of money in the future, which is probably one of the reasons things are advancing much quicker then most people thought possible.
This is just MY opinion, but IF I were getting or considerring getting a tissue valve now, one of my questions for the surgeons would be if they believe which, if any, tissue valves being used now would increase your chances of being a good candidate for a percutaneous valve replacement or the largest one if /when this valve need replaced, or even fit a 2nd percutaneous valve if needed down te road. Or if they pretty much are equal.
Its been about 7 years since Justin got his pulm valve and conduit replaced and 5 since he got his conduit replaced again. Since they werent sure until his cath if they would need to replace the valve also we talked about the various valves and what was going on with the trials. So when we were getting 2nd, 3rd ...opinions one of my concerns was if any tissue valves MIGHT end up being better to be replaced by cath, since he was a teenager at the time we knew he would need several more valve replacements in his future.
Since its been a while, things have probably changed, and dont quote me since its been a while since our discussions, but at that time, his surgeons at least thought some tissue valves would be a little better to be able to to fit new valves inside when he needed one. I "believe" but could be remeberring wrong, one of the reasons was the openings for the same size valves were a little larger (don't know how much maybe not enough to make a real difference?) or usually with better hemodynamics, so placing a cath valve inside would still leave a good opening /better henodynamics than some of the others,. IF I remember correctly, some had better area for a stent to grab hold of. It kind of makes sense to me that if a company makes tissue valves and are devoloping percutaneous valves they probably would have their tissue valve in mind when designing valves that would be inserted inside older valves.
So if I was thinking i would live a nice long happy life and one day possibly need a newer valve, I would do what I could to hopefully give me the best chances of fitting a new valve (or 2) inside it, or even to make it possible to fit the largest percutaneous valve possible, to have the best hemodynamics.
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Jkm7
Well-known member
Wonderful!!!
This is not some pie in the sky, maybe for tomorrow.
It is the here and now and there are living patients who have benefited.
The next steps are surely to make it available to more patients and not only those who are too ill for conventional OHS.
Thanks for sharing the link.
This is not some pie in the sky, maybe for tomorrow.
It is the here and now and there are living patients who have benefited.
The next steps are surely to make it available to more patients and not only those who are too ill for conventional OHS.
Thanks for sharing the link.
Yes I agree. By the end of last year (11) already 40,000 percutaneous valves were implanted world wide and Im sure the number has increased quite a bit since. This summer the FDA advisory board reccomended overwhelmingly to approve the Sapien valve for high risk, people (not just the highest risk or unoperable) I believe what is considered "high" is 15 % chance of mortality, so I imagine that will be approved this year.
Jkm7
Well-known member
It's a 'game changer' IMO
So many people who opt for mechanical valve because they don't want to face a second OHS if possible, might soon have the choice for tissue without the potential need for a future OHS. Certainly all of us with tissue valves now must find this to be good news.
Heart research is advancing with exciting new procedures/treatments and choices.
So many people who opt for mechanical valve because they don't want to face a second OHS if possible, might soon have the choice for tissue without the potential need for a future OHS. Certainly all of us with tissue valves now must find this to be good news.
Heart research is advancing with exciting new procedures/treatments and choices.
ElectLive
Well-known member
As Lyn said, typically no, but precautionary measures are taken in those most likely to not tolerate the required rapid ventricular pacing for implant. In other words, bypass on standby. One of the more amazing things to me is that they're being done at experienced centers without general anesthesia (awake, no artificial airway, etc) in some cases!
