useful facts and figures - tissue valve longevity

[Andyrdj]

Just plucked these graphs from this film of a valve debate, which you can see here http://www.edwards.com/Products/HVDebate4CosgrovePVideo.htm

First graph is for the old C/E perimount valve, you'll find these about 1:50 into the "durability" section. you'll find similar stuff for other valves.

The first is freedom of explant (re-operation) for the Perimount for various ages. The second is freedom of any degree of Structural valve deterioration for 40 y.o. individuals, with graphs for various types of valve.

Thought it might be useful to have these figures - they're so hard to find for younger patients.

Given that these are the previous generation of tissue valves, it will be interesting to see the effect of up to date anticalcification treatment. The new Magna valve with the ThermaFix treatment claims to reduce calcification by 80%.

 

[Janea]

Do you have a tissue valve?

Do you have a tissue valve?

Thanks for the graphs. They are of great interest to me since I just recieved a mosaic porcine tissue valve 3 weeks ago. I am 31 years old and it was a hard decision to make....tissue vrs. mechanical. I am curious if you have a tissue valve. If so which valve was replaced? How old are you and why did you decide to go with the tissue valve? How long have you had the valve? Are you happy with yoru decision? If you don't have a tissue valve then disregard these questions! Thanks!

 

[Ross]

Not really disputing the facts as presented, but considering it's from the manufacturer, don't you think they'd like to show it in a better light? Do other studies show the same results?

 

[Andyrdj]

Unsure!

Unsure!

That's one of the reasons I posted it here - need to subject it to close examination!

Those were all the facts I could find for younger patients. I invite you all to watch the video and extract the figures for yourselves.

The MD who came up with these figures (name of Delos M Cosgrove) also presented similar graphs for the Ross procudure and for Allograft transplants. I know that for the Ross in particular he had taken the facts and figures from several independant registries of Ross.

Note that there is a degree of altruistic honesty in the second graph, which shows that Perimount valves are more prone to some degree of SVD than allografts (which of course are more difficult to come by!).

Perhaps Dr Consgrove or Edwards Lifesciences could be contacted and asked where these results come from.

 

[Andyrdj]

Also, To Janea....

Also, To Janea....

I don't have a tissue valve, but I'm strongly leaning towards one for next op (within next 5 years). I wish to avoid anticoagulation (who doesn't) and the possible need for bridging therapy if ever I needed a non heart related operation.

 

[ALCapshaw2]

Andy,

In case you don't know of Dr. Cosgrove, here is his listing on the Cleveland Clinic directory. He is a world famous Heart Surgeon and is especially noted for his Mitral Valve Repair technique. He is also a strong advocate of the Bovine Pericardial Valve.

'AL Capshaw'

Physician Directory
Delos Cosgrove, M.D.
Phone: (216) 444-2300
Mail Code: H-18department title location
Executive Board Office Chief Executive Officer Main Campus
Thoracic and Cardiovascular Surgery Staff Main Campus
Executive Board Office Chairman, Board of Governors Main Campus (Cleveland Clinic Foundation)

appointed: 1975
medical school: University of Virginia School of Medicine Charlottesville, VA
specialty training: Internship - University of Rochester-Strong Memorial Hospital Rochester NY
Residency - Children's Hospital of Boston Boston MA
Residency - Massachusetts General Hospital Boston MA
Residency - University of Rochester-Strong Memorial Hospital Rochester NY
other education: B.A. - Williams College Williamstown MA
specialty interests: surgical treatment of thoracic and cardiovascular diseases, mitral and aortic valve repair, minimally invasive valve surgery, thoracic aneurysms, homografts, use of alternative conduits in coronary artery surgery, blood conservation


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[Christian]

Perhaps Dr Consgrove or Edwards Lifesciences could be contacted and asked where these results come from.

Your odds of getting a response from Dr. Cosgrove are likely pretty slim. He was my wife's surgeon, and she only got to speak with him for about two minutes. I'm not complaining -- just noting that he's not very accessible.

 

[Andyrdj]

Yep

Yep

On the video he did sound like the "brilliant but arrogant" type. Still, I suppose you'd rather that than an average guy with a good bedside manner.

I've actually written to Edwards lifesciences asking if they can provide the source of the information used. I mentioned that I was posting here and that a good number of valreplacement.com's users would be interested in these results - that should hopefully motivate them into some kind of action!

The graphs as they stand do explain a lot, if they're good data- i.e. the conflicting reports on how long these valves last in younger patients (some say 5 years, some say 15) is best understood on a statistical level.

 

[Guest]

I'm not sure how to interpret the graphs without knowing the quality of the data behind them.

My take on the whole issue is that tissue valves are more likely to last longer than current information says that they will. There is the possibility of developing an inferior one, but the likelihood is that in 5 years there will be much more evidence showing longer life.

My way of thinking is to put less and less weight on the shorter life of tissue valves.

 

[Peachy]

Hi Andy

If you are having your op on the NHS you will probably find that you do not get a choice of particular models. I wanted to have a tissue valve as I did not want to have to take Warfarin. My surgeon however said I would be getting a mechanical valve as this is what they use. When I said I wanted a tissue valve he eventually discussed it and agreed to do tissue but right up to the operation he was still trying to get me to have a mechanical valve. What they forget to tell you however is that you will be on Warfarin for the rest of your life. You have to do your homework and go prepared with your arguments for and against otherwise they will not listen to anything you have to say. I got a Carpentier-Edwards porcine valve which is the tissue valves they use and hopefully should last between 8 to 10 years maybe longer but haven't seen any statistics for my particular model. Good luck with your research.

 

[Der Biermeister]

what was this the guy said about drinking and a mechanical valve? It was just a quick blurb

 

[tobagotwo]

It's not a problem, as long as you drink steadily...

Best wishes,

 

[Andyrdj]

reply to peachy

reply to peachy

These stats I have published are, as far as I know, the stats for your particular model.

Interesting about your story. Last time I thought I might be in for an imminent operation, the junior registrar seemed certain that after all disussions I'd be persuaded to go mechanical. So I did my homework, wrote to my consultant pointing out that I knew of all sorts of alternatives - newer tissue valves, Ross Procedure, experimental tissue engineering etc.

To my surprise, he replied "you have adequately listed the drawbacks of warfarinisation and it is perfectly acceptable to decline these". He suggested my best non mech option was a tissue valve.

He mentioned that he himself used the C/E or St Jude Biocor Valves - he works at the Northern General Hospital, sheffield. Last time I wnet for an ultrasound (a month ago) I asked the technician if she had scanned certain valve types, and the Mosaic Valve was included.

I personally intend to push for the C/E perimount Magna, my arguments being that it is based on the proven technology of the perimount, not too radical a departure from the old design, but has a larger effective orifice area and a more advanced anticalfication process.

I know they can be reluctant to try the newer ones without 10 years or more feedback, but I'm going to push for it. They can be very conservative, our surgeons, and it looks like yours was more concerned with the simple longevity statistic rather than what the option would mean to you.

 

[Ion Manea]

Valve Choice

Valve Choice

Andy and all

I am 48 and I have a congenital bicuspid aotic valve with severe stenosis (72cm2) and no significant symptoms.

I was supposed to go to surgery by now (actually my first cardiolog was pushing me for it way back in 2000).

I am still ?dragging my feet? in making the final decision mainly because I don?t have clear symptoms.

Well actually "Symptoms" is another subject open for interpretation and discussion but ?

My question to you all is:

- What was the reasoning for your cardiolog or surgeon for recommending the Ross procedure versus the straight aortic tissue valve replacement?

There are obvious additional risks and complications related to the change from a single valve patient to a 2 valve patient. So what are the benefits of RP to outweight the single tissue valve?

In my discussion with Dr Tirone David at Toronto General Hospital I selected RP as my choice but now I am starting to have second thoughts about my decision, so any feedback would be welcome.


Thank you all and good luck and good health to everyone

Ion Manea

 

[Andyrdj]

Pros and cons

Pros and cons

Benefits are that it is the only proceudre at present known to offer the possibility of a lifelong solution free from anticoagulation.

Cons are:
- 2 valves need to be watched instead of 1
- quote from my surgeon "The usual mode of failure of the Ross procedure is the calcification of the pulmonary conduit and this makes re-operation considerably more difficult (I have performed a number of these now and can testify to that!). "

Given that the donor pulmonary is not your own tissue, it is apt to calcify (more slowly than in aortic position? I'm not sure)

The original post has some re-operation stats for the Ross - worth watching

 

[Ion Manea]

Ross- The Only Chance for Free Anticoagulation

Ross- The Only Chance for Free Anticoagulation

Hello Andy,
Thank you for the reply.
Can you please elaborate a bit of the "Ross offers the only change of life free of Anticoagulation"?
I am not quite sure if that means "a chance for life free of re-operation required" or it means more literally "no anticoagulants required".
If it means the second choice than I am confuzed since my understanding was that mechanical valves require regular anti-coaglant medication and "tissue" does not.
What am I missing?

As for calcification due to foreign tissue than RP should be on the plus side since pulmonary side has lower pressure so lower work required by the foreign valve (relativ to the aortic position).

Thank you

 

[Sir Reel]

The Ross procedure may give you valves that last the rest of your life (like the mechanical) without the need for blood thinners.

My cardiologist told me last month that they are seeing problems with the implanted pulmonary valve requiring re-operation, so you can end up with a perfect Ross and the need for another operation in 10 years. I don't know more, but you may want to explore that further if you are considering the Ross.

 

[Andyrdj]

Also

Also

There has been an experimental study with tissue valves grown on a scaffold from cells taken from the patient's own leg vein.

http://news.bbc.co.uk/2/hi/health/3267615.stm
and
http://www.americanheart.org/presenter.jhtml?identifier=3016892

The artificial valve was used as the pulmonary replacement in a Ross, since they don't think it's strong enough at present to last in the Aortic position. This valve will not calcify because it is the patient's own cells


The follow up as far as I can see has been good, it must be approaching 6 years now. It's still regarded as experimental, but it has the potential anyway.

 

[Lynlw]

they have been doing alot of work on this at Boston's children's hospital too. Justin got his pulmonary valve and conduit replaced last may and his docs at both CHOP (one of the leading centers for chd) and st chris, believe when he needs it replaced in about 10 years he will be able to use this technology, Lyn