[HSF] Associated Coagulation Mishaps

[psimha]

We do have to replace that valve - unfortunately every valve which is 
stented has a sewing rim and so would be prone to Pannus formation. That 
will remain risk even after re replacement.
I have one case were we did a primary AVR 12 years back. He had 
increased gradients within 3 years and was redone with another valve. 
This too started getting increased gradients (incidentally this was 
another type of valve) after 2 years,. This was also a florid extensive 
pannus. We finally put a cryolife O'brien valve in him . So far he is OK !!
May be certain patients react to foreign materials(sewing rim) 
differently.Also different sewing rims have different compositions that 
may all have different responses.
Prasanna
Michael Firstenberg wrote:
> 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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