What do we know (first hand) about homografts?

[Karen7]

My brother-in-law is a general surgeon in San Francisco. Recently my husband and I asked him to help us wade through the contradictory information out there about bicuspid aortic valve, aneurysm, women & heart disease, etc.

He is recommending that I go to Johns Hopkins to see a specialist in homograft valves because his reading has persuaded him it's important for me to look into. I'm still in my childbearing years and I am not likely to be compliant in a -thinning regiment -- at this point. The surgeon that I have already seen (Washington Hospital Center) said he would use a Medtronics Freestyle stentless porcine valve and that was looking pretty good to us.

Who has a homograft? Any regrets? Anybody know the surgeons at Hopkins first hand?

Thanks for your input,
Karen

 

[Paul_N]

Karen,

I'd follow your brother-in-laws suggestion. You've probably see enough here to know your choice is just that ... it's yours. The more armed you are with information, the easier it is to make a decision.

When deciding the way to go myself, I asked for my cardio(s) and surgeons suggestions. I also asked myself what I wanted and didn't want to deal with after surgery. From there, the rest was or is, up to God. I try to keep a good diet, exercise as I should, and cross my fingers I'll get a bunch of miles out of what I got. If or when I'm faced with the possibility of another surgery, I'll do the same thing ... search this site, ask for professional opinions and decide what I'm willing to do or not do. My hopes are that at time, the advances made in medicine will make choosing easier.

Today, I'm happy with my homograft and I have no regrets.

Paul

 

[Mary]

My brother-in-law is a general surgeon in San Francisco. Recently my husband and I asked him to help us wade through the contradictory information out there about bicuspid aortic valve, aneurysm, women & heart disease, etc.

He is recommending that I go to Johns Hopkins to see a specialist in homograft valves because his reading has persuaded him it's important for me to look into. I'm still in my childbearing years and I am not likely to be compliant in a -thinning regiment -- at this point. The surgeon that I have already seen (Washington Hospital Center) said he would use a Medtronics Freestyle stentless porcine valve and that was looking pretty good to us.

Who has a homograft? Any regrets? Anybody know the surgeons at Hopkins first hand?
Thanks for your input,
Karen

Karen,
Are you only wanting members with homografts to respond? No xenografts?
Mary

 

[Karen7]

Karen,
Are you only wanting members with homografts to respond? No xenografts?
Mary

No! Sorry! What's a xenograft? TELL ME ANYTHING YOU FOUND OUT, please? I just noticed that it seems that the homograft people (maybe there aren't many?) seem to keep very quiet and I want to know why...

Thanks,
Karen

 

[Mary]

No! Sorry! What's a xenograft? TELL ME ANYTHING YOU FOUND OUT, please? I just noticed that it seems that the homograft people (maybe there aren't many?) seem to keep very quiet and I want to know why...

Thanks,
Karen

Karen,
A homograft is a tissue valve from a cadaver, or oneself (if you have the Ross procedure done).
A xenograft would be a porcine or a bovine valve.

I have a bovine (cow) and it's the "latest model". I'm happy with it!
The surgeon said he would almost guarantee 12 years; my cardiologist said he thought it might go my lifetime.
I need to state that my surgeon is approaching 70 (seen alot and probably isn't into hyperbole) while my cardiologist is a young man with ROSY vision!
I guess time will tell which one comes closer!
I hope this helps.

 

[catwoman]

He is recommending that I go to Johns Hopkins to see a specialist in homograft valves ....... The surgeon that I have already seen (Washington Hospital Center) said he would use a Medtronics Freestyle stentless porcine valve and that was looking pretty good to us.

Karen:
Wonder if he means a specialist in TISSUE valves, since it appears that you'll be getting a porcine valve rather than a valve fashioned from cadaver tissue??????

 

[Karen7]

Karen:
Wonder if he means a specialist in TISSUE valves, since it appears that you'll be getting a porcine valve rather than a valve fashioned from cadaver tissue??????

Hi Marsha,

No, he knows about the porcine valve that was recommended to me and he has asked me to seek another surgeon who does human tissue valves because he's read that they have advantages over other tissue valves. So few places in the US do them...

 

[rbl1999]

Karen, I just had a bovine tissue valve on 7/21/2005 and so far I am very pleased with my decision. My husband and I made the final decision but with great input from the surgeon and the cardiologist. It is a tough decision, not so much for me as I am 59, my surgeon feels that if I take good care of myself it should last the rest of my life!!!!! And I don't have to deal with coumadin and he does not feel that I will have to be on any meds at all!!!! You will get some excellent advice here, more importantly lots of support no matter what you decide to do.... All the best Rose

 

[Karlynn]

Hi Karen,
Can I also suggest that you ask your doctors, or maybe someone knows here, what impact pregnancy has on the different types of tissue valves and their longevity, if any? (or maybe someone has that info here) Your profile says that you home school 7 children between 1 and 14. The longevity/pregnancy info might be a valuable piece of information for you as well. I had 2 small children when I went through my surgery and it was tough caring for them and it was emotionally tough on them. I couldn't lift them for weeks, doctors orders. I would imagine that with all those kids in the house, whatever valve fix you choose you're going to want it to stay fixed for quite a while , whether it be homo, xeno or mechanical.

You may also want to ferret out here, from people who have had valve re-surgeries, whether recovery from 2nd and 3 ops is any slower, or harder. Surgeons tend to make things sound more simple than they really are, particularly if they have a favorite way of doing it, so we've found that the best source of "what's it like" are from the people that have been there.

I know we have members who have had re-ops and I know we have members who have had pregnancies with tissue valves. I don't recall if we have any members that have had pregnancies with tissue valves and then had a re-op after. (I'm horrible at our Search function here, maybe you'd have better luck. )

While information you find here most likely will not change your choice, it will give you a better idea of what you're signing up for. Forwarned is forarmed (kind of )

And may I say that with home schooling 7 kids, you must have some helpful hints on how to keep your head about you, that would be valuable for those approaching surgery. Or just living life, for that matter!

 

[Mary]

Karen,
I could have had a tissue valve; that was offered as an option. They aren't as hard to come by as what you may think.

I know that one of the members from a southern state had one implanted last winter, if I remember correctly. (I just checked and she had a aortic cadaver valve implanted to replace her pulmonary valve.)

I haven't heard much about John Hopkins, but Cedars-Sinai is at the forefront of bicuspid aortic valve disease. You could check there to see what their recommendations are. Three or four members have recently had valve replacement at their facility.

 

[alan_delac]

Karen,

My cardiologist and cardiac surgeon advised me against homograft. They say that only three years ago they would recommend homograft but not these days for the following reasons:

· Homograft lasts approximately same time as the modern tissue (manufactured from cow, pig) valves
· Homograft is usually implanted with its root and the coronary arteries have to be reattached (not your tissue any more)
· Homograft hardens over time and turns into a ?lead pipe? and can be quite difficult to replace. This I think is the most important issue to consider ? exit strategy.

So reason my doctors changed their mind in the last few years is because these days they have to deal with replacements of homografts that were done 10-15 years ago and it is not an easy task.

I got a bovine tissue valve

 

[Karlynn]

a reply to my own reply

a reply to my own reply

Did a little net research (just because I was curious about the answer and because it may some day apply to my 19 year-old daughter) and found an article at; http://www.medscape.com/viewarticle/417123 (you have to register for free in order to read it, but it is sponsored by WebMD and they're pretty reputable.)

The upshot of that study is that with bovine pericardial prostheses, there is no increase deterioration due to pregnancy, but the shorter life-span of the valve was due to the young age of the women. (Which jives w/ our knowledge that the younger you are, the shorter longevity of the tissue valve.) There were 43 women in the study w/ a mean age of 26 (range of 16 to 37).

 

[Thom]

I had a redo at Johns Hopkins in March. The surgeon was Duke Cameron. I was told he has "great hands", and is held in high regard by surgeons across the country, and, most importantly, by his colleagues there. I found him to be very accessible and personable. During our converations he told me of his personal preference for me regarding the type of valve he would have re-implanted, but he was open to my preferences, too, and would have changed the type he recommended to one that I may have wanted, including a homograft or xenograft. Ultimately, he spared the St. Jude's mechanical valve I have, and just replaced my ascending aorta. He can be reached by e-mail, or you can contact his nurse practioner. You might want to look here:

http://www.hopkinsmedicine.org/CardiacSurgery/index.html

As far as the care provided by this hospital, I haven't had surgery at any other pre-eminent heart hospital, although I had excellent experiences with a cardiologist at Brigham and Womens. That said, compared to the hospital where I did have my first VR operation, Johns Hopkins' ranking as the best overall hospital in the country may be accurate. The nurses were extremely proficient, and the fellowes and residents were interested and caring.

I should also mention the hospital staff was very helpful with housing, and, if you choose, your significant other may sleep in your room in the step down unit while you're there.

Hope this helps.

Thom

 

[Karen7]

Thank you, Everyone

Thank you, Everyone

Thank you, Everyone. This has given me a lot of food for thought and you've made some great suggestions. Karlynn, thanks for the great WebMD article. We aren't planning on having any more kids but I want my options open. After I recover and feel a lot better, it's impossible to predict what we'll want to do. Your suggestion makes so much sense. I was only thinking the minimum (anything that doesn't require anticoagulant) but it's only logical to take the research further and find out what's best for a pregnancy scenario.

Paul -- thanks for being the only member with a homograft that responded. I really value the input.

Mary, Marsha & Rose, thanks for sharing your experiences with xenografts. These sound like solid, tried & true options and I very well may go that route this time.

Alan, you did the homework and thanks for letting me in on it! "Exit Strategy" will be my number one concern when I do see another surgeon. I would probably have to have at least one replacement whether I go tissue or not. Sort of hoping they'll come up with a mechanical valve that doesn't require anticoagulants in the meantime...

Thom, thanks so much for the name of your surgeon and sharing your JH experience (and a website for browsing) I really appreciate the info and plan to use it.

Karen

 

[twinmaker]

Karen, I can't speak for the surgeons at Johns Hopkins but I can speak for the cardiologists there. My cardiologist for 15 years at Hopkins was Kenneth Baughman. He was very thorough and spent a great deal of time answering any questions I would have about my condition. I feel that Hopkins is "top of the line".

 

[CCRN]

Pig envy

Pig envy

Hi,

I work in open heart surgery (just a nurse) and, as I see it, most of our surgeons like the stentless valves. I have been told since they don't have a stent (round ring that holds the bovine tissue valve or mechanical) they are more like a native valve. Some think this may make them last longer but the jury is still out on that. I wanted one of those but ended up needing my entire ascending aorta replaced as well so a mechanical valve with gortex conduit was used. There are lots of people around this site who said they went to sleep thinking they would have one thing and woke up with something entirely different. The end result seemed to be good both ways. I spoke with someone who went to the Cleveland Clinic and had minimally invasive aortic valve replacement which makes the recovery time a lot shorter. There are lots of options and it can really make your head spin. Get all the info you can and, although difficult, it will make you feel better in the end. It's great that you have a physician in the family for support. I just had a bunch of smart aleck cardiac surgeons. Best wishes in your search.

 

[CCRN]

By the way....

By the way....

Check out the Bicuspid Aortic Foundation website. You can get to it easily with a search engine. They have some interesting stuff there.

 

[PapaHappyStar]

Hi Karen,

Have you considered the Ross Procedure?, your bicuspid aortic valve is replaced with your own pulmonary valve and a donor pulmonary valve ( pulmonary homograft ) is used for the native pulmonary valve. This may be the procedure of choice for women who want to have children because your own pulmonary provides the best hemodynamics ( least resistance to blood flow ) for most people. This is important because of the increased demand for oxygenated blood ( and increased stress on the left side of the heart ) during pregnancy ( the Ross procedure is sometimes also recommended for athletes ).

I had the RP around 9.5 months ago and am doing well -- my exercise capacity has been increasing steadily since the OHS. The pulmonary homograft has mild to moderate regurgitation but this is probably due to some degree of size mis-match and remodelling in the pulmonary root. I dont think it is affecting me physically and this is what the cardiologist's opinion is as well. Problems in blood flow on the right ( pulmonary ) side of the heart are tolerated better than on the left side. The new aortic valve has no significant stenosis or regurgitation.

I will eventually need surgery to replace the pulmonary homograft and I have heard ( from a surgeon with over 300 RP's and a few RP redo's ) that the pulmonary side is much gentler to the homograft than the aortic, but the "exit stategy" issue is something I too have questions about. I've also read that percutaneous and beating heart techniques for pulmonary valve replacement are simpler to implement than for the aortic valve.

If you are young and physically active or are considering getting pregnant the RP may be your best choice.

Regards,
Burair

 

[Karen7]

Hi,

I spoke with someone who went to the Cleveland Clinic and had minimally invasive aortic valve replacement which makes the recovery time a lot shorter.

Hi CCRN, I was hoping for minimally invasive AVR -- I actually interviewed a surgeon who specializes in the DaVinci Robot -- but because I have an aneurysm on the ascending aorta, I'm not a candidate for it. This time around.

They replaced your entire ascending aorta? Ouch.

You make a good point about choosing one thing and "waking up" with another. My research may end up being theoretical only. That's why it's so important to have a surgeon you trust. Nobody needs to be second-guessing a decision like that. Thanks for the website.

Karen

 

[Karen7]

Hi Karen,

Have you considered the Ross Procedure?, your bicuspid aortic valve is replaced with your own pulmonary valve and a donor pulmonary valve ( pulmonary homograft ) is used for the native pulmonary valve. This may be the procedure of choice for women who want to have children because your own pulmonary provides the best hemodynamics ( least resistance to flow ) for most people.

If you are young and physically active or are considering getting pregnant the RP may be your best choice.

Regards,
Burair

Thank you, Burair, I'm glad to hear you're doing so well!

haven't looked into the Ross Procedure but you make some excellent points that I probably should. I understand that for the RP, you need a surgeon who specializes in that procedure because it's technically difficult.

Karen