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

[Edward Bender]

If the abcess is small, from a technical standpoint, it probably makes  
no difference (stentless porcine vs. homograft vs. stented valve).   
However, if this is an abcess that involves a great deal of the  
circumference of the annulus, the extra tissue available with a  
homograft comes in very handy when obliterating the abcess cavity.  I  
doubt that the type of valve makes a difference from a recurrence  
risk.  As long as you do as Tirone David and others suggest - debride  
all the infected tissue away as if it were cancer - any valve should  
do.  Closing the gap may be easier with pliable tissue like a homograft.

Ed Bender, MD


On Jan 2, 2008, at 7:53 PM, Prasanna Simha M wrote:

> I would say depends on what is available. The homograft  is still  
> the tissue
> of choice if available .
> Prasanna
>
> On Jan 3, 2008 12:19 AM, <zzhoumd at pol.net> wrote:
>
>>
>> Now I have a patient with root abscess from enteroccocus. Which  
>> valve to
>> use, homograft vs freestyle bentall?
>>
>> Z Zhou
>>
>>
>> Sent via BlackBerry by AT&T
>>
>> -----Original Message-----
>> From: Ani Anyanwu <anianyanwu at hotmail.com>
>>
>> Date: Wed, 2 Jan 2008 15:16:05
>> To:<openheart-l at lists.hsforum.com>
>> Subject: RE: [HSF] re: Porcine vs pericardial for Hal and others
>>
>>
>>>> Ani,> Not to quibble, but the CCF paper you cited had more AI  
>>>> than AS
>> as the > cause of failures in pericardial valves. > > Hal>
>>
>> Yes Hal which is why I said that the teaching pericardial fail by
>> stenosis, porcine by regurgitation does not reflect the whole truth  
>> but only
>> part of the truth.
>>
>> There is however an association. Just like with Bicuspid valves =  
>> aortic
>> stenosis hypothesis. Most bicuspid valves will never be stenotic  
>> and most
>> stenotic valves are not bicuspid but that does not mean stenosis is  
>> not a
>> more frequent occurrence in bicuspid valves than tricuspid valves  
>> (as we
>> know it is).
>>
>> I will however say that our recollections are tainted by our  
>> biases. I
>> suspect if you objectively looked at your data *on reop avrs* you  
>> would find
>> very few cases where a porcine valve was replaced for pure stenosis  
>> (i.e.
>> the integrity of the cusps was maintained). Now you have heard tom  
>> martin
>> mention this you will probably start seeing the converse and  
>> noticing most
>> porcine valves you explant *for structural degeneration* do  
>> calcify, leak
>> and have torn cusps. Indeed part of the reason you may not have  
>> observed
>> this is because your experience in rereplacing pericardial valves is
>> comparatively limited compared to porcine (i think you have said in  
>> the past
>> that you have only seen a handful of pericardial valves come back for
>> degeneration, but done loads of porcine). Another thing possibly  
>> tainting
>> your observation is your large volume mitral practice. These  
>> observations
>> apply to the aortic position - in the mitral position it is rather  
>> different
>> and porcine valves do also stenose.
>>
>> Ani
>>
>>
>>
>>
>>> From: Hgrmd at aol.com> Date: Wed, 2 Jan 2008 07:31:44 -0500>  
>>> Subject: Re:
>> [HSF] re: Porcine vs pericardial for Hal and others> To:
>> OpenHeart-L at lists.hsforum.com> CC: > > >
>> **************************************See AOL's top rated recipes > (
>> http://food.aol.com/top-rated-recipes?NCID=aoltop00030000000004)<http://food.aol.com/top-rated-recipes?NCID=aoltop00030000000004%29 
>> >>_______________________________________________>
>> 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>
>> -----------------------------------------
>> _________________________________________________________________
>> Free games, great prizes - get gaming at Gamesbox.
>>
>> http:// 
>> www.searchgamesbox.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
>> -----------------------------------------
>>
>> _______________________________________________
>> 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
>> -----------------------------------------
>>
>
>
>
> -- 
> Prasanna Simha M
> _______________________________________________
> 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
> -----------------------------------------