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

Thu Jan 3 05:41:17 EST 2008

> The homograft is still the tissue of choice if available .> Prasanna> Is this still the case? Are there current data supporting this or does this still arise from the same graph from UAB that surgeons have seen in Kirklin and Barrat Boyes for decades? While homografts *may* have a lower long-term incidence of endocarditis, it does not follow they are necessarily more resistant to reinfection when placed in setting of acute sepsis, after they are like all other valves functionally dead tissue (except in rare instances of HLA match). Is there a biologically plausible explanation why these cadaveric homografts should be superior for endocarditis?

Dr Griepp in my center for thee last two decades almost exclusively used biologic (occasionally mechanical) bentalls with a stented valve mounted in a dacron prosthesis for endocarditis with root abscess. He published this in Annals few years back and did not find that the reinfection rate was any higher than seen in series with homografts (indeed it was lower at 4% and they suggested a stented conduit may be superior) Ann Thorac Surg. 2002;74(5):S1781-5. In our center a stented valve conduit is the prosthesis of choice for aortic root abscess - i know of one freestyle used in last 3 years but certainly no homograft. A valved conduit can be placed deep in the outflow tract if so desired.

I suspect the homograft data is historical and while still conventional teaching, other than surgeon preference there is little indication for its specific use, or indeed the freestyle, in the setting of endocarditis except in those cases where a conformable conduit is desired.

Ani

> Date: Thu, 3 Jan 2008 07:23:09 +0530> From: prasannasimha at gmail.com> To: OpenHeart-L at lists.hsforum.com> Subject: Re: [HSF] re: Porcine vs pericardial for Hal and others> CC: > > 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> -----------------------------------------
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