I want options please

[filomena]

I am a 47 year old young women who has mitro stenosis. I an now told that I am narrow enough to receive a valve replacement. I have only been given one surgeon (I found two more on my own). And I feel that the only option being pushed on me is the mechanical valve. right now I am on coumadine(7.25) and the fatique is very harrd on me. Am I alone in wanting minimally invasive surgery and a valve that does not require coumadine.
How can I find out a surgeons track record on the types of procedures they use.  I s the human valve a good option for me ? If one is not available for me what is my second option? I am having my surgery done in Salt Lake City  are there any good surgeons that do valve repair in my area? PLease help.I board and rescue horses and dogs.

[Cleveland Clinic, MD]

Ted - Yes that is true, the Ross procedure is not being done as much any more.

[Ted]

I AM AWARE OF THE ROSS PROCEDURE AND IT MAKES A LOT OF SENSE TO ME BUT I AM NOT AWARE OF ITS BEING DONE SUCCESSFULLY VERY OFTEN.
IS THIS TRUE.. I AM 54 YRS OLD AND NEED A NEW AORTIC VALVE..

I WAS CONSIDERING A HOMOGRAFT THINKING THAT THE ROSS PROCEDURE WAS NOT REALLY AN OPTION..
PLEASE ADVISE ME OF THE LATEST INFO ON THIS SUBJECT

THANKS

TED

[Cleveland Clinic, MD]

Thanks for the encouraging words and comments.

[Gregory Gomez]

Gretings:

Your post moved me to write.

You are facing a difficult decision. Let
me suggest that you find a good cardiologist
and heart surgeon that will help you make
your decision. You might also involve your
closest friends and family. You need all
the support your can get. Let me also
suggest that you read the information
contained in the following web site
on valve replacement:

http://www.heartlab.rri.on.ca/qa/

Best of luck,

Greg

[shannon]

I had minimally invasive mitral valve and PFO repair here in Utah, done by Don Doty's partner, Dr. Kent Jones.  He's the top (well, at least according to my research) doc in Utah doing minimally invasive valve surgery.  I've heard, though, that aortic repair is technically harder and may require the open-chest approach.

Homograft should certainly be on your list of options for research; again, it all depends on your physical situation.  Not everyone is a candidate for homograft.

I chose to have a mechanical valve in the event my valve was unrepairable simply because I hated the idea of more surgery later in life.  I felt if it was possible to avoid that, I would do so.  The mechanical was the only possibility for that.  So it's very much a personal choice and you have to take into consideration such things as planning a family, sports involvement, etc.

You can e-mail me directly at ***@**** if I can answer any questions from a patient's point of view.

Take care --

Shannon

[Cleveland Clinic, MD]

Thanks for your comments.

[Gary]

I saw his article on minimally invasive surgery in a medical journal. Perhaps you've heard of him?

Donald Doty, M.D.
University of Utah School of Medicine,
Salt Lake City, UT

[Cleveland Clinic, MD]

Thank you for your question.  Your question is a classic debate and one that we hear often in this forum. "Which is better - a tissue valve or a mechanical valve?"  There are pros and cons of each which I outline below.  The Ross procedure is a third option for patients with aortic stenosis that transplants the patients own pulmonic valve to the position of the aortic valve and places a new valve in the pulmonic position. Ultimately the decision is between you and your doctors.  Good Luck.

Tissue Valve.
Examples: CE Valve, Homograft, Porcine

Pros: Do not require anticoagulation. (unless there is another indication such as atrial fibrillation)

Cons: Have a limited life span often requiring repeat surgery.

Mechanical Valves
Examples: St. Judes, Medtronic-Hall

Pros: Long life span

Cons: Require anticoagulation to prevent blood clot complications
***********************
Here are some articles of interest that your local medical library should be able to help you find.

Authors

Starr A. Grunkemeier GL. Fessler CL.

Title

Tissue and mechanical valves: mutually advantageous
interplay. [Review] [78 refs]


Source

Journal of Cardiac Surgery. 3(3 Suppl):437-47, 1988 Sep.



Authors

Wernly JA. Crawford MH.

Title

Choosing a prosthetic heart valve. [Review]
[59 refs]


Source

Cardiology Clinics. 16(3):491-504, 1998 Aug.


Authors

Antunes MJ. Franco CG.

Title

Advances in surgical treatment of acquired valve disease
[published erratum appears in Curr Opin Cardiol 1996 Jul;11(4):454]. [Review]
[111 refs]


Source

Current Opinion in Cardiology. 11(2):139-54, 1996 Mar.




Support groups:

http:///www.inficad.com/~hanky/heart.htm

[Cleveland Clinic, MD]

Thank you for your question.  Your question is a classic debate and one that we hear often in this forum. "Which is better - a tissue valve or a mechanical valve?"  There are pros and cons of each which I outline below.  The Ross procedure is a third option for patients with aortic stenosis that transplants the patients own pulmonic valve to the position of the aortic valve and places a new valve in the pulmonic position. Ultimately the decision is between you and your doctors.  Good Luck.

Tissue Valve.
Examples: CE Valve, Homograft, Porcine

Pros: Do not require anticoagulation. (unless there is another indication such as atrial fibrillation)

Cons: Have a limited life span often requiring repeat surgery.

Mechanical Valves
Examples: St. Judes, Medtronic-Hall

Pros: Long life span

Cons: Require anticoagulation to prevent blood clot complications
***********************
Here are some articles of interest that your local medical library should be able to help you find.

Authors

Starr A. Grunkemeier GL. Fessler CL.

Title

Tissue and mechanical valves: mutually advantageous
interplay. [Review] [78 refs]


Source

Journal of Cardiac Surgery. 3(3 Suppl):437-47, 1988 Sep.



Authors

Wernly JA. Crawford MH.

Title

Choosing a prosthetic heart valve. [Review]
[59 refs]


Source

Cardiology Clinics. 16(3):491-504, 1998 Aug.

Abstract

Although most of the available prosthetic heart valves function remarkably well, the variety of available choices attests to the inability of any single one to fulfill the requirements of the ideal valve substitute. The mechanical prostheses include the caged-ball, tilting-disc, and bileaflet valves. Tissue valves available in the United States are the Carpentier-Edwards and Hancock porcine heterograft valves and the Carpentier-Edwards pericardial valve. Review of several large comparative studies on valve performance reveals that the overall results with tissue and mechanical valves are about equal at the end of 10 years. The characteristics of each type of valve substitute dictate the selection of one prosthesis in preference to others for a particular patient. Mechanical prostheses are recommended for patients without contraindications for anticoagulants. Tissue valves are reserved for patients over 65 years of age or for patients in whom anticoagulation is contraindicated. Multiple other patient-related factors need to be considered in selecting the appropriate valve, including the psychosocial situation and patient preference. [References: 59]


Authors

Antunes MJ. Franco CG.

Title

Advances in surgical treatment of acquired valve disease
[published erratum appears in Curr Opin Cardiol 1996 Jul;11(4):454]. [Review]
[111 refs]


Source

Current Opinion in Cardiology. 11(2):139-54, 1996 Mar.


Abstract

After the first two decades of constant improvements in valve prostheses, no major advance has occurred since the mid 1980s. Hence, valve replacement remained the exchange of one disease for another. With minor and, for the most part, statistically nonsignificant variations, the spectrum of late valve-related complications remained unaltered and the few series published in the year under review brought no additional information of relevance. By contrast, in the past few years there has been a growing enthusiasm for the use of allografts, stentless porcine bioprostheses, and pulmonary autografts. Not only was there a surge of interest in the allografts as aortic valve substitutes, but in the past year there have also been several reports of use for whole or partial mitral or tricuspid valve replacement. On the other hand, stentless bioprostheses are also gaining increasing acceptance, and all major manufacturers of heart valve prostheses have models for use in different situations and with different techniques. Finally, the Ross operation is now being performed around the world. Despite these advances, valve repair still merits the preference of many surgeons. Mitral valvuloplasty preserves left ventricular function much better than valve replacement. By contrast, the results of aortic valve repair look much less impressive. Lastly, this work focuses on recent reports on special aspects of surgery for native or prosthetic valve endocarditis, especially with the use of allografts or autografts; on the results of valve surgery in elderly patients, a fast growing group; and on the controversial issues of anticoagulation in patients with artificial valves. [References: 111]

Support groups:

http:///www.inficad.com/~hanky/heart.htm

[Cleveland Clinic, MD]

Thank you for your question.  Your question is a classic debate and one that we hear often in this forum. "Which is better - a tissue valve or a mechanical valve?"  There are pros and cons of each which I outline below.  The Ross procedure is a third option for patients with aortic stenosis that transplants the patients own pulmonic valve to the position of the aortic valve and places a new valve in the pulmonic position. Ultimately the decision is between you and your doctors.  Good Luck.

Tissue Valve.
Examples: CE Valve, Homograft, Porcine

Pros: Do not require anticoagulation. (unless there is another indication such as atrial fibrillation)

Cons: Have a limited life span often requiring repeat surgery.

Mechanical Valves
Examples: St. Judes, Medtronic-Hall

Pros: Long life span

Cons: Require anticoagulation to prevent blood clot complications
***********************
Here are some articles of interest that your local medical library should be able to help you find.

Authors

Starr A. Grunkemeier GL. Fessler CL.

Title

Tissue and mechanical valves: mutually advantageous
interplay. [Review] [78 refs]


Source

Journal of Cardiac Surgery. 3(3 Suppl):437-47, 1988 Sep.


Abstract

This report is concerned with the dynamic interplay between glutaraldehyde preserved tissue valves (bioprostheses) and mechanical valves. These two classes of valve replacement devices are not competitive, but provide some nonoverlapping characteristic advantages and disadvantages. By proper selection, it may be possible to tailor the kind of device used for a particular patient, thus improving the overall results of bioprosthetic and mechanical valve replacement. Careful selection of patients according to age and the safety of anticoagulation should achieve a series of patients with mechanical and bioprosthetic valves that would be superior to a series in which all patients received a single device. Thus, these devices should be viewed as complimentary rather than competitive since the value of properly matching a prosthesis to the patient will be reflected in improved overall results with each class of prosthesis. [References: 78]
\

Authors

Wernly JA. Crawford MH.

Title

Choosing a prosthetic heart valve. [Review]
[59 refs]


Source

Cardiology Clinics. 16(3):491-504, 1998 Aug.

Abstract

Although most of the available prosthetic heart valves function remarkably well, the variety of available choices attests to the inability of any single one to fulfill the requirements of the ideal valve substitute. The mechanical prostheses include the caged-ball, tilting-disc, and bileaflet valves. Tissue valves available in the United States are the Carpentier-Edwards and Hancock porcine heterograft valves and the Carpentier-Edwards pericardial valve. Review of several large comparative studies on valve performance reveals that the overall results with tissue and mechanical valves are about equal at the end of 10 years. The characteristics of each type of valve substitute dictate the selection of one prosthesis in preference to others for a particular patient. Mechanical prostheses are recommended for patients without contraindications for anticoagulants. Tissue valves are reserved for patients over 65 years of age or for patients in whom anticoagulation is contraindicated. Multiple other patient-related factors need to be considered in selecting the appropriate valve, including the psychosocial situation and patient preference. [References: 59]


Authors

Antunes MJ. Franco CG.

Title

Advances in surgical treatment of acquired valve disease
[published erratum appears in Curr Opin Cardiol 1996 Jul;11(4):454]. [Review]
[111 refs]


Source

Current Opinion in Cardiology. 11(2):139-54, 1996 Mar.


Abstract

After the first two decades of constant improvements in valve prostheses, no major advance has occurred since the mid 1980s. Hence, valve replacement remained the exchange of one disease for another. With minor and, for the most part, statistically nonsignificant variations, the spectrum of late valve-related complications remained unaltered and the few series published in the year under review brought no additional information of relevance. By contrast, in the past few years there has been a growing enthusiasm for the use of allografts, stentless porcine bioprostheses, and pulmonary autografts. Not only was there a surge of interest in the allografts as aortic valve substitutes, but in the past year there have also been several reports of use for whole or partial mitral or tricuspid valve replacement. On the other hand, stentless bioprostheses are also gaining increasing acceptance, and all major manufacturers of heart valve prostheses have models for use in different situations and with different techniques. Finally, the Ross operation is now being performed around the world. Despite these advances, valve repair still merits the preference of many surgeons. Mitral valvuloplasty preserves left ventricular function much better than valve replacement. By contrast, the results of aortic valve repair look much less impressive. Lastly, this work focuses on recent reports on special aspects of surgery for native or prosthetic valve endocarditis, especially with the use of allografts or autografts; on the results of valve surgery in elderly patients, a fast growing group; and on the controversial issues of anticoagulation in patients with artificial valves. [References: 111]

Support groups:

http:///www.inficad.com/~hanky/heart.htm