A
alan_delac
My surgeon suggested to me Freestyle Medtronic valve as my aorta is enlarged (but not to much 40mm). I just wonder how would that choice influence subsequent re-operation? Any thoughts?
Alan
Alan
Help Support Valve Replacement Forums:
Are you referring to the aortic root bioprosthesis, or "just" the valve?
The site no longer lists the Freestyle Valve as a standalone valve choice, although it may be available. The only valves listed that are "just valves" are the Moasic and the Hancock models. The site only lists Freestyles that are root-configured, stentless replacements.
If that is what your surgeon meant, then it looks like a similar replacement would have to be done next time, much as a homograft requires replacement in its entirety (homografts include from the root, all the way up through part of the aorta).
Fortunately, the current Medtronic Freestyle models have been upgraded, so make sure they give you a new model, not something from hospital stock.
Both freestyle root products now have the non-damaging Physiologic Fixation process and the AOA (alpha amino oleic acid) anticalcification treatments that were developed to extend product life for the Mosaic valve. The Freestyle: http://www.medtronics.com/cardsurgery/products/free_index.html
and the "Prestyled Freestyle": http://www.medtronics.com/cardsurgery/products/pref_index.html
Best wishes,
The site no longer lists the Freestyle Valve as a standalone valve choice, although it may be available. The only valves listed that are "just valves" are the Moasic and the Hancock models. The site only lists Freestyles that are root-configured, stentless replacements.
If that is what your surgeon meant, then it looks like a similar replacement would have to be done next time, much as a homograft requires replacement in its entirety (homografts include from the root, all the way up through part of the aorta).
Fortunately, the current Medtronic Freestyle models have been upgraded, so make sure they give you a new model, not something from hospital stock.
Both freestyle root products now have the non-damaging Physiologic Fixation process and the AOA (alpha amino oleic acid) anticalcification treatments that were developed to extend product life for the Mosaic valve. The Freestyle: http://www.medtronics.com/cardsurgery/products/free_index.html
and the "Prestyled Freestyle": http://www.medtronics.com/cardsurgery/products/pref_index.html
Best wishes,
A
alan_delac
The idea was to use the root-configured valve, but it seams to me that this choice could limit selection of suitable valves at re-operation. Another option was to use stented valve but I had feeling that they don?t last as long as stentless valves. My surgeon said that stentless valve without root replacement would not be choice for me because of my enlarged aorta. What would happen if I selected root-configured valve for the first operation and later went for a mechanical valve. Would that work?
Alan
Alan
A root-configured valve will limit your follow-up surgery choices to those valves that replace all of what was replaced the first time.
As far as the stented valves go: the mosaic is a stented valve, although it has a flexible, much thinner stent than previous models. The CE Perimount Magna is not stented, although Edwards Life Sciences does make stented tissue models, as does St. Judes.
One issue is whether what you need is a standard size or not. The products with the most advantages are made mostly in standard sizes. I guess odd sizes take too much setup to be worth the cost. The root-configured Medtronics valves seem to be the exception to that, inthat they do incorporate the latest improvements.
St. Judes does have stented tissue models, but no one is lining up to get them, and I believe they are half a generation type back. Their graphs show 76% of SJM Biocor aortic valves lasting 15 years, which is not outstanding, and the valve is manufactured from porcine tissue, rather than being a fixated natural valve.
There is one mechanical that St. Judes makes, the SJM® Masters Series Aortic Valved Graft Prosthesis, that may fill the bill, but the description is too vague to be sure if it would be an appropriate model. If it is an appropriate valve/graft type, and you heavily favor the mechanicals, you should ask why (or if) the surgeon feels it would be less desirable than the tissue setups. Link: http://www.sjm.com/devices/device.a...c+Valved+Graft+Prosthesis&location=in&type=18
Another issue is your enlarged aorta. Will that continue to enlarge? Could its tissues become weak because of the enlargement (meaning, what is the prognosis for the attachment seam tissue on the aorta with a stented valve)? Would the root-configured valve help to prevent any further enlargement or damage? Just some loose thoughts to ask about or consider. You don't want to leave a liability in your chest after the surgery is complete and the healing is done.
Good fortune in your hunt for information. It can be frustrating, but sometimes it's worth knowing you've done all you could to be sure.
Best wishes,
As far as the stented valves go: the mosaic is a stented valve, although it has a flexible, much thinner stent than previous models. The CE Perimount Magna is not stented, although Edwards Life Sciences does make stented tissue models, as does St. Judes.
One issue is whether what you need is a standard size or not. The products with the most advantages are made mostly in standard sizes. I guess odd sizes take too much setup to be worth the cost. The root-configured Medtronics valves seem to be the exception to that, inthat they do incorporate the latest improvements.
St. Judes does have stented tissue models, but no one is lining up to get them, and I believe they are half a generation type back. Their graphs show 76% of SJM Biocor aortic valves lasting 15 years, which is not outstanding, and the valve is manufactured from porcine tissue, rather than being a fixated natural valve.
There is one mechanical that St. Judes makes, the SJM® Masters Series Aortic Valved Graft Prosthesis, that may fill the bill, but the description is too vague to be sure if it would be an appropriate model. If it is an appropriate valve/graft type, and you heavily favor the mechanicals, you should ask why (or if) the surgeon feels it would be less desirable than the tissue setups. Link: http://www.sjm.com/devices/device.a...c+Valved+Graft+Prosthesis&location=in&type=18
Another issue is your enlarged aorta. Will that continue to enlarge? Could its tissues become weak because of the enlargement (meaning, what is the prognosis for the attachment seam tissue on the aorta with a stented valve)? Would the root-configured valve help to prevent any further enlargement or damage? Just some loose thoughts to ask about or consider. You don't want to leave a liability in your chest after the surgery is complete and the healing is done.
Good fortune in your hunt for information. It can be frustrating, but sometimes it's worth knowing you've done all you could to be sure.
Best wishes,
Alan,
Are you a candidate for the Ross Procedure? If so they can take your pulmonary valve with root and replace your pulmonary valve with a cadaver valve with root. Just a thought, but don't know your medical history, access to a surgeon that does the ross, and whether or not you would want to consider this type procedure.
Are you a candidate for the Ross Procedure? If so they can take your pulmonary valve with root and replace your pulmonary valve with a cadaver valve with root. Just a thought, but don't know your medical history, access to a surgeon that does the ross, and whether or not you would want to consider this type procedure.
A
alan_delac
Thanks for all that info.
Bob, you are sharing wealth of your knowledge with the rest of us. I?m very thankful for that.
My operation is still some time away, but I would like to have my preferences sorted out in case things start deteriorating fast.
Bryan, I have given up on Ross as it?s not readily available in Australia.
Size of my aorta has been stable for the last 14 years so I don?t think I?m in some great danger from that side.
Bob, do you think that Mosaic valve has comparable life expectancy to a modern stentless valve? Why did you choose Mosaic valve?
Regards
Alan
Bob, you are sharing wealth of your knowledge with the rest of us. I?m very thankful for that.
My operation is still some time away, but I would like to have my preferences sorted out in case things start deteriorating fast.
Bryan, I have given up on Ross as it?s not readily available in Australia.
Size of my aorta has been stable for the last 14 years so I don?t think I?m in some great danger from that side.
Bob, do you think that Mosaic valve has comparable life expectancy to a modern stentless valve? Why did you choose Mosaic valve?
Regards
Alan
CEPM and Mosaic Valves
CEPM and Mosaic Valves
Of the tissue valves, the two which consistently float to the top are the Medtronic Mosiac porcine valve and the Carpentier-Edwards Perimount bovine valve (by Edwards Lifesciences, Inc.).
The new, premium CE Perimount Magna has a modified mount so that the stent doesn't narrow the bloodflow. The regular CE Perimount model is also stented, and is now made with the same anticalcification processes. It has, as far as documentation can be trusted, the longest life cycle of all the tissue valves, with 90% lasting at least 18 years, even before the new anticalcification treatments were begun. It is a manufactured valve, sewn together from natural cow pericardium which has been run through fixation and preservation processes. Its main advantages have been that it takes longer to calcify and the leaflets do not deteriorate as fast as others. The latest model also has a chemical anticalcification process applied to it, and the website is now showing a low-pressure fixation process (possibly similar to Medtronics' process) that was not displayed a month ago.
However, some surgeons treat the CEPM/CEP valve as their second choice, as it is not completely naturally configured. I suspect that there is also that underlying concern that some manufacturing flaw will be discovered, and their patients might be involved (note: it has been out for over 20 years, and that has never happened). There is similar reluctance with certain of the mechanical valves.
The Medtronics Mosaic is the premier porcine tissue valve. It is a natural pig aortic valve, run through a fixation and preservation process. Its previous numbers put it at three to five years less service life than the CEPM. However, a new process is being used that does not damage the valve leaflets with physical pressure during the fixation. That is expected to extend its life greatly. Also, an anticalcification process (AOA) has been added to decrease degradation of flexibility.
Surgeons tend to like that this is a "real" valve, and operates in an entirely natural manner. The general feeling seems to be that it should work best with the rest of the heart functions, although I doubt that there is literature that would actually validate those intuitions.
The stent that is in the Mosaic is a very flexible stent, and is half the width of the stents of previous models from Medtronics and other companies, which allows more bloodflow diameter for its size.
The stent helps to hold the shape of the root and provides a more stable seam area for the surgeon to sew in. A description I've heard of heart surgeons is that once they're in the chest, they're human sewing machines.
Regarding natural action of the valve, my echo tech showed me a video of my heart beating, and declared that she could not tell any difference between it and a normally functioning original valve, and would not know that it was a replacement if she hadn't known about the surgery. That is the Gold Standard for me.
As far as what I originally wanted: I was torn between the CEPM and the MM, and my surgeon was agreeable to implanting either one. It turns out that he was one of the top surgeons in the world for the most Mosaics implanted. I decided to take that as a gentle hint.
It would be good to understand what underlying value the surgeon feels there would be to the root-configured valve before ruling it out. Any of the valves discussed here should be an excellent choice, depending on what you eventually learn about your exact condition.
Best wishes,
CEPM and Mosaic Valves
Of the tissue valves, the two which consistently float to the top are the Medtronic Mosiac porcine valve and the Carpentier-Edwards Perimount bovine valve (by Edwards Lifesciences, Inc.).
The new, premium CE Perimount Magna has a modified mount so that the stent doesn't narrow the bloodflow. The regular CE Perimount model is also stented, and is now made with the same anticalcification processes. It has, as far as documentation can be trusted, the longest life cycle of all the tissue valves, with 90% lasting at least 18 years, even before the new anticalcification treatments were begun. It is a manufactured valve, sewn together from natural cow pericardium which has been run through fixation and preservation processes. Its main advantages have been that it takes longer to calcify and the leaflets do not deteriorate as fast as others. The latest model also has a chemical anticalcification process applied to it, and the website is now showing a low-pressure fixation process (possibly similar to Medtronics' process) that was not displayed a month ago.
However, some surgeons treat the CEPM/CEP valve as their second choice, as it is not completely naturally configured. I suspect that there is also that underlying concern that some manufacturing flaw will be discovered, and their patients might be involved (note: it has been out for over 20 years, and that has never happened). There is similar reluctance with certain of the mechanical valves.
The Medtronics Mosaic is the premier porcine tissue valve. It is a natural pig aortic valve, run through a fixation and preservation process. Its previous numbers put it at three to five years less service life than the CEPM. However, a new process is being used that does not damage the valve leaflets with physical pressure during the fixation. That is expected to extend its life greatly. Also, an anticalcification process (AOA) has been added to decrease degradation of flexibility.
Surgeons tend to like that this is a "real" valve, and operates in an entirely natural manner. The general feeling seems to be that it should work best with the rest of the heart functions, although I doubt that there is literature that would actually validate those intuitions.
The stent that is in the Mosaic is a very flexible stent, and is half the width of the stents of previous models from Medtronics and other companies, which allows more bloodflow diameter for its size.
The stent helps to hold the shape of the root and provides a more stable seam area for the surgeon to sew in. A description I've heard of heart surgeons is that once they're in the chest, they're human sewing machines.
Regarding natural action of the valve, my echo tech showed me a video of my heart beating, and declared that she could not tell any difference between it and a normally functioning original valve, and would not know that it was a replacement if she hadn't known about the surgery. That is the Gold Standard for me.
As far as what I originally wanted: I was torn between the CEPM and the MM, and my surgeon was agreeable to implanting either one. It turns out that he was one of the top surgeons in the world for the most Mosaics implanted. I decided to take that as a gentle hint.
It would be good to understand what underlying value the surgeon feels there would be to the root-configured valve before ruling it out. Any of the valves discussed here should be an excellent choice, depending on what you eventually learn about your exact condition.
Best wishes,
