valve durability,how many times it could be replaced?

[ZAHRA]

Hello. My son Is 15 sears old. He was born with TOF @ abscence of Pulminary valve.He was sick most of the time .
He had his 1st surgury when he was 2 years old .They closed the whole with a patch and used a human homograph(aged 22).He was just a little bit better.But still getting sick very often.
He had his 2nd surgury when he was 7 years old.The vaLve was Calcified and was leaking. They used A Carpentier Tissue Valve, Aortic ,size 23.(calf). It worked very nice on him.He could have a normal activity.looking very healty. and still does.
3 Weeks ego he had his yearly checkup. The TEE. showed high pressure on his heart.Apparently he needs another valve replacement. This time they are suggesting a hancock II from Medtronic, which is also a Bioprosthesis.size 25.
He is only 15 and my concern is that how many times this valve can be replaced? What is the best ,available for him? Is there any statistics available about the durability of different valves,brands,for his age?I am hoping to find one that lasts longer.

 

[Karlynn]

Welcome Zahara! I'm a mechanical valve person so don't know much about the specifics of the different types of tissue valves. We have other members, who I'm sure will be along shortly, that do know a lot and will help you explore the information.

But I just wanted to say "Welcome!"

Best wishes.

 

[tobagotwo]

There just happens to be a comparison study available through the Medtronics site, here: http://www.medtronic.com/cardsurgery/products/han2_compresu.html

I would read them to be very similar results, very slightly favoring the Hancock II. They are small studies, and may have been carefully chosen for the presentation, but are probably close to an overall reality for valves made at that time.

The thing to remember is that these studies are about valves that were manufactured almost twenty years ago. However, the newer versions of these two valves have differences that have potential to produce a very different chart fifteen years from now. The Carpentier (Edwards Scientific) valve now has a thinner stent (allows a bigger valve), noncompressing tissue preparation processes and anticalcification treatments. The Hancock series is not listed by Medtronics as having these features.

It is not unusual for surgeons to lean toward one brand or another, and as the top offerings from different companies are quite close in capability, the bias usually has a benign result. The possibility is there that this is a "mostly Medtronics" shop.

But...

If so, what interests me more is why they aren't leaning more towards the Medtronics Mosaic or Freestyle valves. They have advanced treatments on a par with the Carpentier-Edwards offerings. Why would they not choose one of those products (or the CE), which would appear to have a technological advantage for longevity?

If the answer is the comparison chart in the link above, they should consider they're looking at results from 20-year-old technology, rather than current offerings.

Just my thoughts...

Best wishes,

 

[tobagotwo]

The point is that the Hancock IIs don't show a track record of 20-year reliability. I believe the comparison charts displayed on the site are at fifteen years for a reason.

As the other valves, which do have anticalcification features, have at least the same durability from similar studies (actually, their non-treated, but otherwise equivalent forebears), I would still have to ask why they are not in strong consideration.

Best wishes,