would like more info on bovine tissue valves

[Angel]

Hello, I'm a 47yr old female trying to make a decision on a replacement for my aortic valve, surgery scheduled toward the end of this month. I would like to know if anyone here knows about the bovine tissue valves. I've heard that bovine should last a little longer than porcine, but I was wondering, is there a certain kind of bovine that should last the longest or just any bovine tissue valve, or what? Any and all information you may have on the bovine valves would be greatly appreciated. If you've had a bovine tissue valve replacement, I would like to hear from you as well with your satisfaction, etc or any information you can give. Thank you so much.

 

[heartman77]

The Carpentier Edwards LifeScience Perimount Magna Ease Pericardial Valve is a highly respected valve and has shown hemodynamic stability up to 17 years. My choice came down to that valve and the St Jude Regent Mechanical valve. Here is the web site for the Bovine ( cow pericardial valve) if you would like to see more info on it..... http://www.edwards.com/products/heartvalves/magnaease.htm......... hope that helps you some...Mike

 

[fischje]

I had two bovine valves ( Carpentier Edwards) and they lasted only seven yrs.. Now I have mechanical

 

[mainframe]

I've only had 1 CE Boviine valve. It only lasted 7 years and failed pretty quickly making my second surgery more difficult. The tissue valves last longer in older folks than in younger so your age of 47 should be takein in consideration in your decision. Should you go tissue you're looking at a second surgery whether sooner or later. I was 45 when I got my CE bovine valve. My second and hopefully last valve is a mechanical.

 

[Mentu]

Dumbo's Feather

Dumbo's Feather

It is difficult to know who to answer the question you have asked. When you read studies they all refer to the past and follow valves that are different from those being used today. Surgeons each have preferences for particular valves but they, also, cannot say that without doubt one valve is better than another for every patient or even a particular patient. St Jude, Medtronic, Edwards and others produce the majority of bio-prosthetic valves used today. There is just no way to know that in 15-20 years a patient would have been better off with a St Jude Biocore instead of an Edwards Magna. Although it has not happened a lot, heart valves both mechanical and bio-prosthetic, have even been "recalled" after they have developed a history but they only develop history with use. Since no one can predict the future, we are left to rely upon the experts, our surgeons, to help us choose. Your surgeon will guide your choice based not only on performance reported by the manufacturer but also on your particular needs. No doubt there are many other issues as well; why else would some hospitals use more of one valve than another. If you have doubts about your surgeon's guidance, perhaps the real question is "do you really trust that surgeon to hold your heart in his or her hand?".

If you have doubts about your surgeon's judgment, you are certainly free to seek the opinions of other professionals. I would suggest that you might want to seek that opinion in another institution where the bias is likely to be different.

If you want my view of this issue from my vast prospective of 8 months post op, I am coming to belief that the whole issue of valve choice and the anxiety it can produce is a diversion. The real underlying problem may be that something is happening to us that we do not control. We don't control our disease, we don't control the diagnosis, we don't have much control over the surgery. Isn't it possible that the search for the perfect valve is actually part of our attempt to exert control over a situation that has caught us up just as a flood picks up a house and carries it down a river?

There are two decisions we make that govern much of what happens. We select our surgeon and the hospital where we will be treated. For many of us, these are one and the same as it was for me since my Surgeon operates routinely at only one hospital. Perhaps there are others who will disagree but it seems to me that you pretty much choose your surgeon and everything else flows from there.

The search for the perfect valve may well be like a search Dumbo's magic feather which he believed he needed in order to fly. Just as there are no magic feathers so there is no perfect valve. Most of us would live just as well and just as long with any of the excellent valves available today. Life is a compromise and the only way to know the results of our decisions is to live and make the changes that are within our power to control. We cannot control our heart valves but we can control our diets and exercise and we can control our driving habits and whether or not we use tobacco. The wonderful part is that artificial heart valves give us more time to make these choices.

Larry

 

[Lily]

Not advocating one valve over another; but I was cleaning out some of my old emails and found this article link and thought this might be as good a place as any to drop it in:

"Which biologic valve should we select for the 45- to 65-year-old age group requiring aortic valve replacement?"

http://jtcs.ctsnetjournals.org/cgi/content/full/129/5/1041

Hope it is helpful

 

[Luckyguy17]

I have to totally agree with Larry/Mentu's assessment that there is some compromise in valve selection and the choice will be made in discussion with your surgeon (your preferences and the surgeon's) and once this is done, you will live with the decision, with the hope of success in surgery, little complications and some longevity and proper operation of the prosthetic and for quite some time.

You may notice that there are members on this forum that have had OHS and then been reoperated...some having OHS once again within a year for a similar issue or for addressing another issue or another valve...this happens and can't be much fun, but it is reality and likely could not be pedicted at the intial OHS.

Unfortunately OHS, AVR, MVR are highly complex procedures and we as patients can only control our lifestyle and rehab in attempting to ensure as rapid and complete a recovery as possible, we must rely on the professionals to do as professional job as possible in diagnosis and applying the best correction to each individual problem...this is somewhat frustrating for individuals that have a tendancy to be control feaks as the patient's control is very minimal in the stages of surgery.

In the US there seems to be more lattitude in selection of hospital facility, surgeon, cardiologist...we in Canada do not really have much control on who and where as the system is driven by referrals from GP to cardiologist to surgeon and therefore hospital....so with our process a lack of confidence in any of the professionals and a wish for change may be a pipe dream, but with that said I am happy with my process and the professionals that have worked on me.

Another difference in regions and the post op process, if i am understanding, some in the US are having echogram post op, meetings with cardiologist and surgeon...in our system, once released from hospital, we are encouraged to call in or go to emergency if in need or having abnormal symptoms, but meeting with cardiologist and surgeon is 30 days or more post op....the only follow up is to remove staples/sutures and the anti coag clinics...there is no measurment or discussion on surgical results on the short term...which i do find weird.

Gil

 

[ottagal]

Another difference in regions and the post op process, if i am understanding, some in the US are having echogram post op, meetings with cardiologist and surgeon...in our system, once released from hospital, we are encouraged to call in or go to emergency if in need or having abnormal symptoms, but meeting with cardiologist and surgeon is 30 days or more post op....the only follow up is to remove staples/sutures and the anti coag clinics...there is no measurment or discussion on surgical results on the short term...which i do find weird.

Gil

I, too agree with Mentu and Lucky Guys' insightful comments and philosophical approach regarding valve choice. As many members have stated, the new valve (whether mechanical or tissue) is going to be better than the native diseased valve.

Gil,
In my case I had a 24 hour hotline to call when released from the Heart Institute if any problems came up (which was reassuring for me and family) . When I had to be re-admiited after after being released from the hospital , I did not have to go to our hospital emergency. Instead, I was directly admitted to the Heart Institute with a bed waiting for me and the surgeon came to see me shortly after. Perhaps, different protocols for different hospitals.

 

[Luckyguy17]

Ottawagal,

agree, different hospitals, different protocols...am sure i would get the attention if needed....unfortunately for me the cardiology institute is 1 to 1.5 hours away driving

I did equip myself with new oral thermometer and new Omron BP measuring device and find myself regularly checking both...thought it might be my early warning system if something untoward....but so far so good for me

Gil

 

[Luana]

Angel, I don't think it matters if the bovine valve comes from St. Jude Medical, Carpentier-Edwards, or whoever else is making bovine valves; how long the valve will last in you will be about the same, and someone here can correct me if I'm wrong. Also keep in mind that the younger you are, the shorter the valve will last. I'm not much older than you are and was considering a tissue valve when surgeon said I'd be lucky to get seven years out of it and could face 2 or 3 additional surgeries.

 

[neil]

hi ,well ive got the porky pig valve honk honk, but as stated above by mento who buts it better than i could,it really is a personnel choice in the end,as the question was about which bovine valve it seems a shame that again some people are questioning valve choice and kinda putting down tissue? ,kinda annoying

 

[Ross]

hi ,well ive got the porky pig valve honk honk, but as stated above by mento who buts it better than i could,it really is a personnel choice in the end,as the question was about which bovine valve it seems a shame that again some people are questioning valve choice and kinda putting down tissue? ,kinda annoying

Neil I don't see anyone putting down the tissue choice. You've only had one surgery my friend. God forbid should you experience what we did when it comes time for replacement. Chris didn't put tissue down in his post, he stated that it made a second surgery more difficult because he nearly lost his life. That's 2 surgeries for him. I've had 2 and both times, were near disasters. Certainly not everyone is going to have the hard times that we did, but by golly, people do need to be aware that you don't want to do this more then you have too. Telling people the truth about what happened to you is not annoying. It's being honest.

 

[Lynlw]

Hi, welcome, just something I've noticed is most people come to VR when they are starting to need surgery or for a tissue valve a REDO, So most people either need or got their valves after VR was stated about 10 years ago, there arent many members that have had their valves a long time. A few people hang around after surgery but the majority sadly leave, when they are recoverred and don't have questions, life happens and they often slowly dissapear.
Right now in the US the bovine valve with the longest proven track record (mainly because it was one of the earlier valves with the anticalcification treatment) is the Edwards, it has been been over 20 years in patients over 60 and (last I remember about 80% were still doing fine in the ver 60 group) FWIW this is the valve CCF and a few of the other larger centers use in their patients 40 and up. For tissue valves The St Jude biocor has a similar record in Europe and was recently started being used in the US. MOST Porcine valves are actual pig valves, but for the most part Bovine valves are man made using the pericardial sac from cows for the leaflets and a man made ring/sewing cuff. The Biocor is a mixed valve mainly pig I believe with part bovine, but I'm not exactly sure.

 

[neil]

ross i see where your coming from and yes you cert have been through the mill,but the bottom line is most re ops do well,and most do fine after,in a small number yes there are problems,but it is a very small number,its like somebody coming on here who had a bad result using anti coags and every time somebody was thinking of getting a mech coming out and saying what a bad deal there had,there will always be a small amount of problems whichever you pick, but most do well in both,

 

[Luana]

The fact of additional surgeries needs to be considered when thinking about a tissue valve. It is not an "if"; it's a "when." Re-ops tend to be more difficult and higher risk. You know what your health is like now, but you don't know what it will be like when you need a re-op. If you're an early 20s or 30s person, it's probably reasonable to assume you may still have good overall general health. As we get older the likelihood of other things going on with health increase. Additional surgeries was the deal-breaker for me.

My surgery was about 10 days after Chris had his second surgery. For those not around then, Chris had a really rough time and people were praying for him non-stop. (Go back in the archives and read the posts from around mid-Nov that Bill sent) Bill B was the one who kept us informed of what was going on. I thought of Chris when I was in the hospital and hoped by the time I got home, he'd be home and better, too. I don't remember how many weeks he was in ICU, but he had one heck of a long haul. Did that have an influence on my decision? Yes. Yes, most will not have such a difficult re-op, but no one knows what it will be like.

 

[Lynlw]

The fact of additional surgeries needs to be considered when thinking about a tissue valve. It is not an "if"; it's a "when." Re-ops tend to be more difficult and higher risk. You know what your health is like now, but you don't know what it will be like when you need a re-op. If you're an early 20s or 30s person, it's probably reasonable to assume you may still have good overall general health. As we get older the likelihood of other things going on with health increase. Additional surgeries was the deal-breaker for me.

My surgery was about 10 days after Chris had his second surgery. For those not around then, Chris had a really rough time and people were praying for him non-stop. (Go back in the archives and read the posts from around mid-Nov that Bill sent) Bill B was the one who kept us informed of what was going on. I thought of Chris when I was in the hospital and hoped by the time I got home, he'd be home and better, too. I don't remember how many weeks he was in ICU, but he had one heck of a long haul. Did that have an influence on my decision? Yes. Yes, most will not have such a difficult re-op, but no one knows what it will be like.

Just to clarify, 1st time REDOs have about the same morbidity/mortality rate as first surgeries and while some people have a terrible first OR 2nd surgery, many people, including members here say their REDOs , 2nd or more were easier on them than their 1st surgery. Also many people, including my son, that have major serious life threatening complications after surgery, have a longer recovery but do well after they recover.
Of course you won't know until you are having surgery which way yours will go, but the vast majority do well. Just like you never know IF you will be one of the people that have problems because of a mechanical valve and the need for coumadin. Either bleeds or clots and strokes. MOST people do perfectly fine , but your chances of having problems because of a mechanical valve are about the same as risk of REDOs. It really is something that is up to each person which are the risks they rather live with.

 

[Lily]

Just to clarify, 1st time REDOs have about the same morbidity/mortality rate as first surgeries . . .

There was a similar point made in the earlier link I posted, which also footnoted this 2004 article, entitled,
The risks and benefits of reoperative aortic valve replacement: http://www.ncbi.nlm.nih.gov/pubmed/15138098?dopt=Abstract

And here is a quote from that second link: "CONCLUSIONS: In this series, the risk of reoperation AVR is comparable with the published risks of long-term warfarin sodium (Coumadin) administration after mechanical AVR. Any adult who requires AVR may be well advised to consider tissue prostheses."

 

[mainframe]

If you've had a bovine tissue valve replacement, I would like to hear from you as well with your satisfaction, etc or any information you can give.

Neil,

I'm not trying to be negative about the bovine value. I certainly had the hopes of getting the 12 to 15 years my first surgeon suggested I would get and that surgical and valve choices would be greatly improved by the time I had to have a re-do. Unfortunately neither happened.

Angel requested to hear from folks that had a bovine valve. I shared my experience which I do alot less than everytime someone is thinking of getting a tissue valve. Would you be less annoyed if I had a great experience? Or should I just not participate because I didn't have a great experience?

I hope you get many years of your porcine value and if not I hope you don't have to go through what I did.

 

[Mentu]

Perhaps, we might all agree that there are clear instances when one particular valve type is suggested by our own circumstance. More often this issue leaves us feeling ambivalent. Chris' experience is not unique and must be considered when making this choice. Two weeks ago, I developed an infection which I was fortunate in recognizing and calling to my Doctor's attention. She at once started me on 2 grams of antibiotic per day and sent off a sample for culture. Two days later, the lab identified the bacteria as one known to damage tissue valves both natural and artificial so my Doctor told me that I will need to continue the antibiotic for 4 weeks to insure the infection is eliminated. No matter which way we go with respect to valve construction we cannot avoid the baggage each brings to the table. It is a fact that tissue valves are less robust than mechanicals.

I've suggested to several people that they should try not to focus on only one aspect of any particular valve unless that is truly their only major concern. If long term stability is what matters to you, then your decision is clear but often we have several factors to consider which muddies the water and makes selection more difficult. This is why one can only make a rational decision by sitting down with ones surgeon and talking about it. We hire architects when we build, we hire mechanics to fix our cars and we hire surgeons to fix our hearts. Hopefully, they help illuminate the bigger picture beyond just the more narrow focus on anticoagulant or the potential for re-operation that can become our fixation.

Larry

 

[mauiboy]

Mine is Edwards Bovine Pericardium

Mine is Edwards Bovine Pericardium

Angel, mine is Edwards Perimount Magna Ease 23mm. Have no complaints after one month of use. No Toyota recall yet. Don't know how long it will last especially since I'm 55 yrs old and below the 60 yr old cutoff where bioprosthetic valve longevity begins. Basically I'm pretty happy that I don't have to mess with blood thinners or adjusting INR levels for life. While patients say that coumadin is not a problem they always hope that someday it will be replaced by another low maintenance drug like aspirin. I know I may have to face reoperation someday (10-20 yrs depending on luck) but hopefully like a replacement drug for coumadin there will be simpler less invasive procedure to replace the valves in the future. My comments are only my opinion not to be confused with the experts in the forum. Best of luck to you in your surgery and valve decision.

Much Aloha...Eric