[HSF] Associated Coagulation Mishaps

[Michael Firstenberg]

When you remove a valve due to excessive pannus formation - what do  
you replace it with?
the same valve?   if so, does the pannus recur?
different type valve?  if so, does that valve get a pannus?

what are the experiences that people have with the replaced valve?
most of the time (like I said before regarding St. J) is that I have  
seen a new St. J replaced or if the surgeon things that a tissue  
valve may be a better current choice (based upon the usual factors -  
age, anti-coag, patient/surgeon preference, etc) , then that is what  
they get

as this appears to be a common mode of mechanical valve failure, I  
admit to knowing/reading very little about it's longterm management  
and outcomes beyond just replacing the valve.

michael

On Oct 18, 2006, at 10:25 AM, psimha wrote:

>
> We did not have real problems as far as anticoagulation was  
> concerned (compared to other  valves) but these patients would have  
> a progressive rise in
> gradients and when it would become significant and we re operated  
> there would be extensive florid pannus extending all over and not  
> like a "ring pannus " that we see often with other valves.
> Prasanna
>
> Nasser F. Abou'Seada wrote:
>> Dear Prasanna What was your observed incidence of coagulation  
>> mishaps with this valve ????
>> .... I don't have the figures myself ready at hand .... nor have I  
>> conducted
>> an RCT .... yet ...just a "run" of costly "series" that convinced  
>> me not to
>> jeopardize more lives .... !!!!
>>
>> NFA
>>
>>
>>> From: prasannasimha
>>> Omniscience was a terrible valve wrt Pannus . It seems to be a  
>>> unique
>>> reaction to its sewing rim and I would not do Pannus excision for  
>>> these
>>> valves.
>>> Prasanna
>>>
>>> Michael Firstenberg wrote:
>>>
>>>> Common finding with Omni valves?  I was told this was more  
>>>> common with
>>>> the
>>>> St Judes.
>>>>
>>>> -michael
>>>>
>>>>
>>>> On 10/16/06, Nasser F. Abou'Seada <nfaabouseada at gmail.com> wrote:
>>>>
>>>>> Dear Prasanna
>>>>> another proof that the presence of the valve as a foreign body  
>>>>> per se
>>>>> elicits pannus formation as a reaction ..... in fact, as you have
>>>>> mentioned
>>>>> here .... I agree with you that the SUTURE TECHNIQUE and plan of
>>>>>
>> tissues
>>
>>>>> as
>>>>> opposed to the implanted prosthesis... is more deciding for pannus
>>>>> formation, than the mere presence of the prosthesis itself per se.
>>>>>
>>>>> I do concur with your observation about Omniscience /  
>>>>> Omnicarbon valves
>>>>> ....
>>>>> I used to call them Ominous-sign valves ... !! ....
>>>>> Incidentally another proof that the TYPE of the prosthesis is more
>>>>> deciding
>>>>> for/relating to pannus formation rather than the mere presence  
>>>>> of the
>>>>> prosthesis itself as a foreign body ...!!
>>>>>
>>>>> NFA
>>>>>
>>>>>
>>>>>> From: prasannasimha
>>>>>> Great James,
>>>>>> Incidentally did you use non-everting or everting sutures this  
>>>>>> time ?
>>>>>> This "underside" pannus seems to be a common mode of failure of
>>>>>> prosthetic valves. As I said using a noneverting suture technique
>>>>>>
>>>>> in the
>>>>>
>>>>>> aortic position has sharply reduced its incidence in my practice.
>>>>>> I did find a higher incidence when we were using Omniscience and
>>>>>> Omnicarbon valves
>>>>>> Prasanna
>>>>>>
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