[HSF]Bioprosthesis of choice

Tue May 1 23:50:42 EDT 2007

Since we started this topic lets get fold to really look at the data. If you assume that for each patient you will be able to put in a comparable valve, let's say Medtronic Hancock 2 or Mosaic vs Edwards Magna, with the same or almost same pressure gradient, which is the "better valve". If you look at the propaganda form both companies they would have you believe that each one has a 70 plus % freedom from need for reimplant at 15  plus yrs. If that is true then does it make a difference which one you choose? Well it might if the long term survival were different between the two. This too depends on who's propaganda you believe. Currently the data seem to favor Medtronic at 12 plus yrs as I recall but I will have to do my homework and try to post it. 
Any thoughts form the valve guru's?

Tom Martin
U of Florida
Gainesville

In a message dated 05/01/07 20:10:18 Eastern Daylight Time, hgrmd writes:
John, 
 Obviously, I agree with your choice.  BTW, since this was a recent hot topic, I have absolutely no vested interest in what valve or ring anyone uses.  I do firmly believe that the Magna is currently the best aortic bioprosthesis available for the average case.  I know of some other valves in testing that may eventually change my opinion. 

Hal 

-----Original Message----- 
From: streitman at yahoo.com 
To: OpenHeart-L at lists.hsforum.com 
Sent: Tue, 1 May 2007 4:49 PM 
Subject: Re: [HSF] Possible infected Freestyle 

Hal, 

Unfortunately at the time the only valve on the shelf 
was Medtronic.  I am new here but have finally gotten 
Edwards valves on the shelf.  I have spent the past 
several months trying to sort out the propoganda 
regarding tissue aortic valve data.  I have found 
several things interesting.  Specifically comparing 
the Mosaic Ultra to the Perimount Magna, I have found 
that the sizers for these valves are not the same.  If 
you look at the barrel end of both sets, the Magna is 
true to size (ie 25 is 25) and the Ultra barrel end is 
smaller than stated ( a 25 is really 23mm in 
diameter).  What this does in my opinion is make you 
think you are getting a bigger Medtronic valve in the 
same sized hole.  I think the EOA size for size b/t 
the two is better in the Edwards valve.  I guess what 
I am getting at is I believe that the Magna is a 
better choice from an EOA/gradient standpoint and now 
have that available. 

John 
--- Hgrmd at aol.com wrote: 

> John, 
>   Welcome to our club.  I hope one of the principles 
> you learn  from this 
> case is that less is often more.  I don't know of 
> many 80 yo  patients who would 
> truly benefit from the hassle of a 25 mm stented 
> prosthesis.  If you had 
> placed a 23 mm C-E Magna, you would have gotten the 
> same effective orifice area, 
> and presumably not had this terrible  complication. 
> I'm not sure what Tea was 
> implying about the use of pledgets  on the 
> aortotomy, but I recommend you use 
> them liberally.  Losing control  of an aortotomy is 
> a very lonely feeling. 
> Hal 
> 
> 
> 
> ************************************** See what's 
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John E Streitman, M.D. 
Cardiovascular Surgeon 
Pinehurst Surgical 
streitman at yahoo.com 

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