Toronto SPV valve

[liam13]

New here. I am probably looking at AVR this summer, and had convinced myself I was going to get a mechanical valve. I'm 46 and fairly active. But, I work at a hospital (don't do OHS here), and I was talking with one of the cardiologist here. He's in the same group my cardiologist is in. He stated that here in Seattle, they really don't do mechanical valves much anymore since the biological technologh has improved so much. He is a big fan of the Toronto SPV. Wondering what people's experiences about this valve has been. Thanks for any info. Liam

 

[savysmommy]

Hi, and welcome. I am alson in the Seattle area. I have never heard of somebody saying that they dont do mechanical much anymore, in Seattle or anywhere. I dont think I have heard about the Toronto valve, but I am sure somebody here will be along who has. What hospital are you looking into?

 

[liam13]

Swedish Hospital. My cardio is part of the Swedish Heart group. It didn't make sense what he said, but knowing this cardiologist his comments don't surprise me. He is very leary of coumadin, because he could never see himself restricting his activity in anyway. I'd love to avoid the coumadin, but I also don't want to go through this twice - I'm only 46, so even if I got 20 years out of the valve, that would be going through this again at 66. Maybe. Liam

 

[catwoman]

liam:

How active are you?
Did you see this about someone who has a St. Jude mechanical?
http://www.startribune.com/535/story/1193368.html

 

[Cooker]

I don't feel that coumadin has restricted my life style one bit. Now mind you I don't play rugby etc. but I gof, fish, work in the yard with and without power tools

I was 49 when I had my AVR and picked mechanical to avoid (as much as possible) a second surgery. I think that someone will verify that going with a tissue valve does not mean you will never have to be on coumadin.

Cooker

 

[briansmom]

Hey, after reading that article I think I will hit up the On-X folks to sponsor my son in this year's SCORE Baja 1000 off road race. We are in the process of building a new race car and he definitely will be one of the drivers. As for the coumadin restricting his activities, it does. I will not let him race motorcycles anymore (though if he weren't 17, I probably would let him ride). I also am very nervous about snowboarding. Other than that, he is a pretty normal teenager.

 

[liam13]

The only activity I would see myself giving up is soccer. I play goalie so a certain number of collisions do happen during the game. I had already decided that this last winter was my swan song for downhill skiing. Had a great trip up to SunPeaks in BC. I still see myself backpacking, riding my motorcycle (primarily to work), lift weights and run about. My intuition is drifting back towards the mechanical. Liam

 

[tobagotwo]

The Toronto Stentless Porcine Valve is distributed by St. Jude. It does well, averaging 15-18 years, but is not protected by anticalcification treatments or nondamaging preservation techniques. It was one of the first of its type, and arguably the most successful.

The stentless Medtronic Freestyle porcine valve does have anti calcification treatments and a non-compressive preservation technique. Of the two, my own choice would be the Medtronic.

However, if you're 46, and not planning to leave the party early, there is no tissue valve made today that is likely to last your lifetime. So, if never doing it again is your biggest trigger, you're up for a carbon (mechanical) valve. My favorite in that crowd is the On-X.

Best wishes,

 

[juliek]

Thanks every one (y'all) for this helpful information.

 

[Plumber1]

Hailing from Olympia

Hailing from Olympia

I too have met with a cardiac surgeon from Swedish. Very fine fellow that helped me 9 years ago while at UW Hospital. I am slated for a AVR and a section of aortic conduit. My conversation was different -- in that St. Jude's valve was recommended. Perhaps our circumstance is different, but it is odd that even the same establishment might recommend different remedy's. Doctoring is a mix of art and science.

I have yet to decide whether to do this upcoming procedure locally or travel to Swedish.

Take heart.

 

[Magic8Ball]

liam:

How active are you?
Did you see this about someone who has a St. Jude mechanical?
http://www.startribune.com/535/story/1193368.html

Nice article but i'm glad i didnt read the phrase "made by Little Canada-based St. Jude Medical Inc" before my surgery.

I don't want little...i want big rich highly financed research dependant heart valve company....

But again, well done on getting to the top.

 

[WayneGM]

Nice article but i'm glad i didnt read the phrase "made by Little Canada-based St. Jude Medical Inc" before my surgery.

I don't want little...i want big rich highly financed research dependant heart valve company....

But again, well done on getting to the top.

I was confused by "Little Canada-based St. Jude Medical" as I understood they were an American company, not Canadian. Then I noticed the "L" in Little Canada was capitalized so thought it might be a name vs. an adjective. However, looked them up and they are headquartered in St. Paul Minnesota so I'm still confused what "Little Canada-based..." means. In any event, I wouldn't consider them "little" as their corporate profile shows they are a $3.3 billion company that employs 11,000 people.

 

[WayneGM]

Mystery solved....apparently "Little Canada" is the name of a suburb of St. Paul Minnesota.

 

[frankd]

The Toronto Stentless Porcine Valve is distributed by St. Jude. It does well, averaging 15-18 years, but is not protected by anticalcification treatments or nondamaging preservation techniques. It was one of the first of it's type, and arguably the most successful.

Hi, great forum you guys have here, but I feel the need to jump in here to comment on this important topic in this post of a few months ago.
Some background info first on me.
I had my first AVR (for Congenital AS) done at age 39, in 1992.... that was the Toronto SPV, implanted by the hands of Dr. Tirone David (who of course designed this valve, and is considered one of the best heart surgeons on the planet). The hope was that the stentless design of this new valve would make it more durable and longer lasting than stented valves. I guess I was a good test case to see how this valve would perform in a young patient.

Now Bob, I'm not sure where you got the impression that the Toronto SPV lasts 15-18 years. For one thing, It has only been in use since 1991! In my case I got just under 13 good years from this valve...I did well, given the latest data released by Dr. David himself that shows that in patients younger than 65, 12 years is typical longevity of this valve (http://www.westernthoracic.org/Abstracts/2007/7.html.)
So, while this valve typically performs admirably for about 10 years, after that things go downhill and in fact it turns out to be no more durable than other current tissue valves. Of course this is only coming to light in the last few years.
Anyway, so I needed a redo in 2005 when the SPV started failing, and of course I went straight back to Dr. David (more correctly, his office called me based on what they saw on my last echo, at about the same time I started having symptoms and knew my number was up again). He steered me towards a mechanical this time (even though I was 13 years older) but I decided on a tissue valve again (quality of life and all that). He ultimately put in a CE Perimount, and I was good to go again (this time for 15 years or more hopefully).
So I suspect that the Toronto SPV has fallen out of favor somewhat lately, and is probably used mainly in older patients , 70+ or so, where it is a great fit.
Anyway, I just wanted to share all that...
I have left out a lot of details like why I was in the hospital for 17 days after I had the redo, but that is a story for another day!
Cheers,
FrankD

 

[tobagotwo]

Mean valve life for tissue valves is given in terms of the mean age of the recipients, which is over 65. Here is a different view, based on a more average recipient group: http://www.icr-heart.com/biennial2003/files/17159.doc

Based on that, the estimate likely does hold at 15 years or better for the actual average recipient, vs. a special age group.

However, you're correct about the actuality of the SPV data I have. It was taken from a St. Jude site (the link no longer works) a number of years ago, shortly after I started looking into valves. I had never questioned it, and haven't found anything so far that corroborates it. For that, I apologize.

Thank you,

 

[frankd]

No worries Bob, I had seen that data you pointed to before, but it only goes out to 10 years... the point is that until a few months ago, no published data was available on the SPV that went out past 10 years. Have a close look at the 10 and 12 year columns in the chart I referenced, and you will see that freedom from reoperation or structural valve failure at 12 years including ALL ages of patients (mean age in fact 65) is only 69%, a very sharp drop from 10 years. I have seen nothing published that goes to 15 years (the very early SPV valves, if still implanted , would just be at 15-16 years now).

 

[tobagotwo]

Good thing I've been pushing the Medtronics Freestyle over the TSPV...

Best wishes,

 

[frankd]

Good thing I've been pushing the Medtronics Freestyle over the TSPV...

Best wishes,

Well of course there are many choices, and no clearcut 'right' answer even after over 40 years of work on valve design. And stentless valves as a group have over the years not been shown to make much of a difference in terms of quality of life or longevity. My 2nd implanted valve, a CE Perimount, does the job just fine, even for an active person like like me (hiking, biking, skiing).
Cheers,
FrankD