[HSF] re: Porcine vs pericardial for Hal and others

[Ani Anyanwu]

Hal
 
There is literature to support this. It is well accepted that porcine valves and homografts generally fail by cusp tears - this one will find in the literature from the 1980s. With the increasing use of pericardial valves in the late 1980s, it became increasingly observed that some pericardial valves restenosedwithout calcific degeneration and stenosis was the indication for surgery. Stenosis of bioprosthetic valves was previously a rare cause of structural failure. The observation of stenosis as a not infrequent cause of failure was made in all pericardial valves in use at the time notably the CE and Mitroflow,  and to a lesser extent the Ionescu-Shiley and Hancock pericardial (high short term failures with the latter two meant cusp tear was still overwhelming cause of failure as valves often did not survive long enough to fibrose and stenose).
 
I think the most detailed analysis of pericardial failure was published recently by Cleveland Clinic (but there are other similar reports) - see Roselli, Smedira and Blackstone JHVD 2006 15:421-8. They analyzed 70 explants of CE pericardial valves for structural degeneration and noted the hemodynamic consequence of SVD was stenosis in 18, mixed in 20 and regurgitation 23 (9 not ascribable). Only 27 had calcification  as mechanism (which is almost invariable with failures of porcine grafts of homografts) others with non-calcific degeneration, fibrosis etc. The authors noted that these different much from porcine valves which generally calcified and then tore cusps, whereas for the pericardial valves, a substantial proportion would fail without either process.
 
Of course pericardial valves also do fail by regurgitation, though to a lesser degree than porcine valves, but for some reason the data is often misinterpreted as an 'absolute' and we would often hear it said that porcine valves fail by regurgitation and pericardial by stenosis - this reflects part of the truth but not the whole truth (as substantial numbers of pericardial valves also fail by regurgitation). It is also true that failure of pericardial valves is often less acute than that of porcine valves as the infiltrative process causing stenosis is often a gradual one (as seen by data from failures of the Mitroflow valve).
 
Ani



> To: OpenHeart-L at lists.hsforum.com> Subject: Re: [HSF] re: Porcine vs pericardial for Hal and others> Date: Tue, 1 Jan 2008 21:13:31 -0500> From: tdmartin2000 at aol.com> CC: > > Hal> I don't know of any reference except both the Edwards and Medtronic companies tout this. It only makes sense. Pericardium is thicker and stronger from the very begining. That is why they say that the regurgitant volume is greater as it takes a little more force to close them. > When bioprosthetics fail they almost always begin their failure by calcification. The stronger pericardium doesn't tear, it just becomes stiff and ultimately stenotic. The? porcine leaflets begin very thin and when they get calcium build up they tend to eventually tear at the "hinge" pt. When they tear they lead to AI. Not that they can't have AS also but it is almost always AI.> The Edwards guys like to use that as a negative for porcine valves, saying that when they tear they can lead to acute severe AI leading to acute CHF.> > Tom> > > -----Original Message-----> From: Hgrmd at aol.com> To: OpenHeart-L at lists.hsforum.com> Sent: Sun, 30 Dec 2007 9:13 pm> Subject: Re: [HSF] re: Porcine vs pericardial for Hal and others> > > > Tom,> Frankly, I was unaware that there are significant differences in the mode > of failure of the pericardial and porcine valves. Do you know where I can > read that pericardial get stenotic and porcine get insufficient? I'm not > doubting you, I just haven't heard that one. Now that you mention it, the one > pericardial valve that I replaced was stenotic.> > Hal> > > > **************************************See AOL's top rated recipes > (http://food.aol.com/top-rated-recipes?NCID=aoltop00030000000004)> _______________________________________________> OpenHeart-L mailing list> > Send postings to:> OpenHeart-L at lists.hsforum.com> > To UNSUBSCRIBE, to CHANGE email address, or to view archives:> http://mmp.cjp.com/mailman/listinfo/openheart-l> > All messages transmitted by the OpenHeart-L are subject to the policies and > disclaimers posted at:> http://www.hsforum.com/listdisclaim> -----------------------------------------> > > ________________________________________________________________________> More new features than ever. Check out the new AOL Mail ! - http://webmail.aol.com> _______________________________________________> OpenHeart-L mailing list> > Send postings to:> OpenHeart-L at lists.hsforum.com> > To UNSUBSCRIBE, to CHANGE email address, or to view archives:> http://mmp.cjp.com/mailman/listinfo/openheart-l> > All messages transmitted by the OpenHeart-L are subject to the policies and > disclaimers posted at:> http://www.hsforum.com/listdisclaim> -----------------------------------------
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