To Starkone: Choice of Bovine Pericardial
To Starkone: Choice of Bovine Pericardial
valve was relatively easy after I had pretty much filled every brain cell with all the information I could gather from all over the world and I mean All over the world, contacting researchers and teams in Glasgow, China and Australia over 8 months time. Things then weren?t as prolific as they are now thanks to the ?net and all the life experiences so well documented in this great forum . Just three years ago about the only board was CCF?s Heart Forum, a great resource at the time and still.
The valve I really wanted more than any other which is used routinely in Asian countries was the "Homovital" Aortic valve. This is a 'live' Aortic valve from a very recently deceased donor harvested and implanted within 72 hours, tissue matched, size matched and treated by a variety techniques to insure it is not rejected. (has to do with esoteric stuff like 'Leukogens'). It has a large 'installed base' in homogenous cultures like the Chinese, and Japanese where their gene pool had not been 'diversified'. In my naive days I actually considered going to Hong Kong or England to have it done because I could get nowhere here in this country, no one seemed to want to talk about it. The impracticality of that for Westerners was brought home by a Dr. Yakouv in England thru a paper he wrote about the Homovital Valve. Great for the Asians because of their similarity to each other in body structure and tissue DNA.
I didn't know at the outset that this valve is extremely rare in this country even if you have the time to wait for years for the right one to be available till I spoke with the team doing this surgery in England, and wrote to another in Australia. China was not very helpful due to language problems. It was a disppointment because the science on it was so thorough, very encouraging for longevity, superior hemodynamics, and a very little incidence of a second surgery with many lasting a minimum of 25 years.
The 'natural' solution was reduced then to the Ross.
After passing the candidacy for a Ross, I spoke with a dozen who had it, and three surgeons who performed it settling on Dr Elkins in Oklahoma, a pioneer in performing many successful ones.
He candidly told me his fail rate was 12-15% while the fail rate for the mechanical and Bovine or Porcine tissue valves was +- 1%.
No contest for me. I wanted the lowest fail rate on the planet. I don't consider myself real real lucky re: heart issues having had them since near birth.
I explored the Dr. Tirone David Aortic valve which was really intriguing, very high tech, but when I e-mailed my material to him in Toronto, he responded that his valve was for other applications, not purely and only Aortic Valve implantation and he considered the Mechanical, porcine or Bovine as my best choice.
All in all after gathering and sifting the information, ruling out the Ross and the David valve, I learned that Surgeons have their preferred favorites and there is little one can do about it, nor should they since expertise by a team with a certain valve and procedure is as important as the valve chosen. I looked for a surgeon who specialized the majority of the time ONLY on valves--no transplant guys, no by-pass gurus, only valves as a specialty, preferably mechanical and animal tissue. That led me to Cosgrove at CCF thru the Forum.
I never actully met him till on the table. He came in shook my hand, his chief OR nurse said he was going fix me up and he had three choices he would use based on what he saw when the aorta was finally opened and he saw the field: C-E Bovine Pericardial Valve, Mechanical Valve or Ross operation. He said there was a 5% chance he would do a Ross based on available data; I asked him if his brother was on the table what valve he would recommend. He said that two weeks earlier he had a fellow my age, same leakage, regurg, and stenosis, a Professor in Cardiology or Heart Surgery from Harvard University, on the table and presented him with the same three choices. The professor chose the Bovine Valve without hesitation, and, "does that tell you anything?" I guess if a guy who teaches this stuff selected it and is that distinguished I might want to follow his lead.
Age matters greatly in the choice of prosthesis as does Personal tolerance for an assured second surgery for another valve when the Bovine wears out, which it will slowly, over 5-18 years, depending on pretty much on many uncontrollable factors. I have read in these forums of people who, even under an early death sentence write that they will not go thru it again. I didn't consider the surgery that gruesome to rule out a number 2.
As everyone here will attest, the choice, within Surgical Team and institutional limits is yours, and a tough one it can be, unless you have absolute obsessions about some things, like I did. It can be bewildering. What I was sure of helped me greatly in narrowing it down:
1) I did not want Coumadin, not because of the inconvenience and chemicals but the constant monitoring, for another reason (see below)
2) I did not think I'd be averse to a second, possibly far superior valve being installed in my 70s, (should some other of life's caprices not get me in the meantime).
3) in relation to the noise of a mechanical valve I wanted freedom from ANY consciousness of my heart for at least part of my time on this earth, after living with the reminders of this disease for 56 years; I wanted, if possible, no reminders, day to day. (see above),
4) I wanted the LEAST amount of time on the pump,
5) minimal cutting and sewing - a mini sternotomy.
Those were my criteria. They were all met by the C-E Bovine Pericardial valve. I hope it did not bore you and that it helps a bit
and that you may NEVER need surgery.
