Question Title: Collapsed Pig Valve

Dear Scott, thank you for your question. Porcine cardiac valves have a limited durability of 10-15 years because the leaflets calcify and degenerate. Replacement of a degenerated porcine valve is commonly done and the choice of the valve prosthesis to use is made by the patient's cardiologist and cardiac surgeon. From my experience, porcine valves are typically replaced with another porcine valve because there had to be a reason why a mechanical valve wasn't used the first time (i.e. - the patient is unable to tolerate anticoagulation). Redo valve replacement is associated with higher risks than a first-time valve replacement but risk prognosis is individualized for each patient. If the aorta is also enlarged, a composite aortic graft would need to be used to replace the diseased portion of the aorta and the new valve prosthesis may need to be sewn into the composite graft. Dr. Bruce Lytle is the cardiac surgeon at Cleveland Clinic with the most experience in this area and you can contact his office at 1-216-444-6962. I've listed a few references from Medline below for your information.

I hope you find this information useful. Information provided in the heart forum is for general purposes only. Specific diagnoses and therapies can only be provided by your physician. Please feel free to write back with additional questions.

Unique Identifier
98309271
Authors
Akins CW. Buckley MJ. Daggett WM. Hilgenberg AD. Vlahakes GJ. Torchiana DF. Madsen JC.
Institution
Cardiac Surgical Unit, Massachusetts General Hospital, Boston 02114, USA.
Title
Risk of reoperative valve replacement for failed mitral and aortic bioprostheses.
Source
Annals of Thoracic Surgery. 65(6):1545-51; discussion 1551-2, 1998 Jun.

Abstract
BACKGROUND: One factor influencing the choice of mechanical versus bioprosthetic valves is reoperation for bioprosthetic valve failure. To define its operative risk, we reviewed our results with valve reoperation for bioprosthetic valve failure. METHODS: Records of 400 consecutive patients having reoperative mitral, aortic, or mitral and aortic bioprosthetic valve replacement from January 1985 to March 1997 were reviewed. RESULTS: Reoperations were for failed bioprosthetic mitral valves in 219 patients, failed aortic valves in 153 patients, and failed aortic and mitral valves in 28 patients. Including 26 operations (6%) for acute endocarditis, 153 operations (38%) were nonelective. One hundred nine patients (27%) had other valves repaired or replaced, and 72 (18%) had coronary bypass grafting. The incidence of death in the mitral, aortic, and double-valve groups was respectively, 15 (6.8%), 12 (7.8%), and 4 (14.3%); and the incidence of prolonged postoperative hospital stay (>14 days) was, respectively, 57 (26.0%), 41 (26.8%), and 8 (28.6%). Only 7 of 147 patients (4.8%) having elective, isolated, first-time valve reoperation died. Multivariable predictors (p < 0.05) of hospital death were age greater than 65 years, male sex, renal insufficiency, and nonelective operation; and predictors of prolonged stay were acute endocarditis, renal insufficiency, any concurrent cardiac operation, and elevated pulmonary artery systolic pressure. CONCLUSIONS: Reoperative bioprosthetic valve replacement can be performed with acceptable mortality and hospital stay. The best results are achieved with elective valve replacement, without concurrent cardiac procedures.

Unique Identifier
95251449
Authors
Safi HJ. Iliopoulos DC. Duff DS.
Institution
Baylor College of Medicine, Methodist Hospital, Houston, Texas, USA.
Title
Repeat replacement of aortic valve bioprosthesis.
Source
Annals of Thoracic Surgery. 59(5):1217-9, 1995 May.

Abstract
We describe a safe and simple technique for replacing an aortic valve bioprosthesis in a patient who also had a previously implanted ascending aortic graft and multiple coronary artery bypass grafts. This method allows for isolated valve replacement without removal of the ascending aortic graft or alteration of the coronary artery bypass graft attachments.