Anyone had 3 valve replacement surgeries?

[newarrior]

t

My darling wife has had 3 OHS's for valve repair and replacement:

1) 1997: ROSS procedure with MV commissurotomy (repair).
2) 2000: MVR with pericardial bovine valve (as the MV repair in 1st surgery failed).
3) 2017: AVR and MVR with St. Jude (Master series) valves, PVR with porcine valve, and repair of TV.

Her hospital stay and recovery time got shorter and shorter with less complication(s) after each OHS. This most likely is attributable to medical and technical advances in anesthesia, pain meds, and the like to reduce complications and improve recovery.

In her 3rd OHS, even though she had all 4 valves worked on (3 replaced and 1 repair), if it wasn't for her INR not being in range yet, they would have discharged her in just 2 full days after her 8 hour surgery. Amazing!

Thank you and may god bless her and you ! She's a brave lady !

 

[MdaPA]

Thank you and may god bless her and you ! She's a brave lady !

Yes, she is!

She never complained once during her recoveries from OHS, always did what she was told and most importantly, she walked, walked and then walked! She would walk the hospital halls day and night as she knew that was the ticket to recovery and getting out of there. So after you wake up from surgery, her advice to you is to "get up and move your butt!".

 

[Springdogg]

2009 - Cadaver tissue value
2016 - Bovine tissue value

Currently getting an echo yearly as mild leaking has been identified. Current plan is to go with a mechanical valve to avoid any additional surgery. I was 26 in 2009 and am 41 now. With tissue valves, no warfarin and regular INR checks....I would forget I even had AVR. Since the last valve I have been married and have a daughter. I am physically active and fit for surgery. The only thing I wish is that the new artificial valves that have intent to last forever are were available. I could go through the rest of my life never thinking about my AVR.

 

[Chuck C]

So after you wake up from surgery, her advice to you is to "get up and move your butt!".

Amen!

 

[dick0236]

The only thing I wish is that the new artificial valves that have intent to last forever are were available. I could go through the rest of my life never thinking about my AVR.

At my current age of 88 my mechanical valve probably will last "forever"......but I doubt any of us has lived our lives without thinking about the mechanical valve we have.....I know I think about it a little most every day. Correct Warfarin management is not difficult and you should "get a handle on it" in no time. BTW, welcome to the Forum.

 

[pellicle]

I would forget I even had AVR

probably not entirely a good idea, because you still have the underlying condition (bioprosthetic heart valve disease and perhaps also connective tissue disorder) and you will still need to attend studies to check its all ok.

I got away with it (not getting checked up), thought I was "fixed" as every prior check-up indication had been good for some years. During the last ten years of this I basically wasn't even in the country (Australia) most of the time and it was only by chance that I came back (for other, unscheduled reasons). When I did get a check up they found my aneurysm and it was in a dangerous point of development. It was only found because "I thought I probably should go get checked".

My aneurysm would have killed me. Note; at that time I had had a homograft done in 1992, which (when implanted) it was suggested may perhaps be a permanent solution. It nearly was as I would no doubt have died on the trip I was planning (ski trip) and perhaps left my wife in a traumatised and life threatening situation.

So now I've got a mechanical valve and apart from the changes of taking a pill every day and self testing weekly I've only got the other changes to get used to (like aging).

My advice is don't try to pretend that you're fixed now; while the anniversary is irrelevant the ongoing check-ups aren't.

Best Wishes

 

[Rebecca]

I’ve had 3 aortic valve replacements.
At 34, surgeon wanted to give me porcine in case I wanted another child. Then after he saw my aorta fall apart in his hands during surgery, he still gave me porcine but recommended I not have another pregnancy. He said he’d seen porcine last 15 yrs, but mine lasted 11, and that was considered really good. (8 yr was average then). So, at 46 I got Carbomedic top hat mechanical. That was my roughest recovery as I was in CHF going into the surgery. Pig leaflet had torn.
Then, 8 1/2 yrs later, endocarditis from a nasty rare bacteria. After picc line for 6 weeks, needed 3rd surgery to replace aortic valve, old graft placed in 89, and mitral repair. Long surgery but I awoke feeling good. I had a partial lung collapse but it resolved. My tongue was sliced by the Dr that intubated me and I got thrush in the hospital. I had a pressure sore on my heel from the long time on my back I guess. I still left the hospital in 6 days. I walked a lot in CCU. Nurses always offered me snacks. Not many people walk at 3 am but the bed was so uncomfortable! Now I’m in my 60’s and my mitral repair has failed. I’m looking into what the future holds for my heart.

Just had my 2nd surgery at 67 and have had some good days but some bad days. Last night my hear rhythm was off and still have fluid on a lung. When this new valve wares out my 3rd valve replacement will be tavet.

 

[tommyboy14]

I’ve had 3 aortic valve replacements.
At 34, surgeon wanted to give me porcine in case I wanted another child. Then after he saw my aorta fall apart in his hands during surgery, he still gave me porcine but recommended I not have another pregnancy. He said he’d seen porcine last 15 yrs, but mine lasted 11, and that was considered really good. (8 yr was average then). So, at 46 I got Carbomedic top hat mechanical. That was my roughest recovery as I was in CHF going into the surgery. Pig leaflet had torn.
Then, 8 1/2 yrs later, endocarditis from a nasty rare bacteria. After picc line for 6 weeks, needed 3rd surgery to replace aortic valve, old graft placed in 89, and mitral repair. Long surgery but I awoke feeling good. I had a partial lung collapse but it resolved. My tongue was sliced by the Dr that intubated me and I got thrush in the hospital. I had a pressure sore on my heel from the long time on my back I guess. I still left the hospital in 6 days. I walked a lot in CCU. Nurses always offered me snacks. Not many people walk at 3 am but the bed was so uncomfortable! Now I’m in my 60’s and my mitral repair has failed. I’m looking into what the future holds for my heart.

i hope that they figure out how to fix your mitral via the clips.
otherwise the best solution may be a mechanical in the hands of a surgeon who is a reop specialist (those do exist).

my reop surgeon had done 6th avr before without a problem and had outstanding mortality and morbidity rates on very complex reops.

perhaps best solution

 

[Chuck C]

Hi Rebecca.

Congratulations on coming through your second surgery!

When this new valve wares out my 3rd valve replacement will be tavet.

Out of curiousity, who is promising you that your next procedure WILL be a TAVR? We see a lot of these promises and in reality there is a lot of disappointment when patients learn that they are not eligible for TAVR. I'm not clear about what % are eligible, or if there has actually been a study to determine this, but anecdotally it seems that most are not eligible when it comes time for their evaluation. I know that when my stenotic native valve was evaluated that it was determined that I was not eligible. In reality, I would say that the best one can say is that they "hope" to be eligible for TAVR on the next round.

 

[Springdogg]

probably not entirely a good idea, because you still have the underlying condition (bioprosthetic heart valve disease and perhaps also connective tissue disorder) and you will still need to attend studies to check its all ok.

I got away with it (not getting checked up), thought I was "fixed" as every prior check-up indication had been good for some years. During the last ten years of this I basically wasn't even in the country (Australia) most of the time and it was only by chance that I came back (for other, unscheduled reasons). When I did get a check up they found my aneurysm and it was in a dangerous point of development. It was only found because "I thought I probably should go get checked".

My aneurysm would have killed me. Note; at that time I had had a homograft done in 1992, which (when implanted) it was suggested may perhaps be a permanent solution. It nearly was as I would no doubt have died on the trip I was planning (ski trip) and perhaps left my wife in a traumatised and life threatening situation.

So now I've got a mechanical valve and apart from the changes of taking a pill every day and self testing weekly I've only got the other changes to get used to (like aging).

My advice is don't try to pretend that you're fixed now; while the anniversary is irrelevant the ongoing check-ups aren't.

Best Wishes

I see my cardiologist twice a year and now also have a yearly echo. I am just saying that I don't think about my AVR on a day to day basis.

 

[tom in MO]

Hi Rebecca.

Congratulations on coming through your second surgery!


Out of curiousity, who is promising you that your next procedure WILL be a TAVR? We see a lot of these promises and in reality there is a lot of disappointment when patients learn that they are not eligible for TAVR. I'm not clear about what % are eligible, or if there has actually been a study to determine this, but anecdotally it seems that most are not eligible when it comes time for their evaluation. I know that when my stenotic native valve was evaluated that it was determined that I was not eligible. In reality, I would say that the best one can say is that they "hope" to be eligible for TAVR on the next round.

Rebecca got 12 years out of her first valve. At 67 now, she may never need a third replacement.

 

[Earthsciencerocks]

Hello,
So met with cardiologist, following CT scan, and TAVR surgeon and we agreed that TAVR will be very LOW on my list of choices. I have bovine 23mm valve and patient mismatch would be the result of a TAVR.
I'm planning on a mechanical SAVR. Most likely a Medtronic Open Pivot Standard (ATS) as big as they can stuff in there. Thank-You pellicle for the always amazing logical data driven articles helping my choice!!!
We meet with surgeon June 25th, followed by scheduling surgery date.
Something that keeps replaying itself in my head is how my last surgeon (2nd AVR surgery) told us third surgery probably won't be an option due to so much scar tissue, adhesions, etc.
But, I'm meeting with an amazing surgeon that I pray will review last surgery notes and come up with a workable plan.
Positives are I've lost 40lbs and am no longer obese (BMI), not diabetic, no renal failure, no endorcaditis, it will be a planned surgery (hopefully) not emergency like last one, calcified bovine valve still working but poorly, I'm asymptomatic for now, am much healthier than last AVR, work out 5 days a week with the blessing of my cardiologist.
So, we'll see what the angiogram shows next week. And, followed in 2 weeks with appointment with surgeon.
My history is: 2007 27mm Medtronic Freestyle porcine AVR, 2016 23mm Edwards Magna bovine AVR.
God bless all those out there! We can do this! Godspeed your recoveries!

 

[Chuck C]

I'm planning on a mechanical SAVR. Most likely a Medtronic Open Pivot Standard (ATS)

As this will be OHS #3, I believe you are making a wise decision. Hoping that this will be your last one and with a mechanical valve, it will likely be your last.

We meet with surgeon June 25th, followed by scheduling surgery date.

Wishing you the very best of luck with your procedure. Please keep us posted.

 

[3mm]

You're doing all the right things to prepare! I'm sure it will go well.

 

[pellicle]

Good morning

... I have bovine 23mm valve and patient mismatch would be the result of a TAVR.

yep

I'm planning on a mechanical SAVR.

wise choice at this stage ...

Most likely a Medtronic Open Pivot Standard (ATS) as big as they can stuff in there. Thank-You pellicle for the always amazing logical data driven articles helping my choice!!!

you're welcome, but I want to say that while I have an ATS (and it came with benefits that I did not know about at the time and may not apply to you) you should also consider the St Jude, not least because it has such a good and long history, but because its one of the best for appearing to deliver on its specifications. In this post (link) I have presented a table (and the citation from where) in support of a discussion about valves and expectations. I would encourage you to read that. A note worth making is that; in that I coloured two valves, one red and the other green because they were the valves under discussion, I did not add that colour for any other reason.

If your sugeon prefers the ATS then I would go with what he likes because there is more to a successful surgery than the valve, there is the technique of fitting it.

We meet with surgeon June 25th, followed by scheduling surgery date.
Something that keeps replaying itself in my head is how my last surgeon (2nd AVR surgery) told us third surgery probably won't be an option due to so much scar tissue, adhesions, etc.

that's not strictly correct, I'd phrase it as "due to scar tissue, adhesions (which are a form of scar tissue) that a 3rd surgery will be more difficult".

My own surgeon on my 3rd (consult my bio) would be important because "you really don't want a 4th" ...

Positives are I've lost 40lbs and am no longer obese (BMI), not diabetic, no renal failure, no endorcaditis,

excellent!!

So, we'll see what the angiogram shows next week. And, followed in 2 weeks with appointment with surgeon.

I'll be keeping a close watch on your progress ...

My history is: 2007 27mm Medtronic Freestyle porcine AVR, 2016 23mm Edwards Magna bovine AVR.

Yep ... you don't want a #4 ...

Best Wishes

 

[Gail in Ca]

You are approaching your 3rd surgery with a great attitude! It puts the positive vibes out into the universe.
I awoke from #3 feeling so good. I did spend an extra day in ICU, so I guess the partial collapsed lung caused that. I know I was mostly ignored in that section of ICU, so I think it was just precautionary.
After that, my recovery went very well.
I’m thinking positive thoughts for your 3rd to go that well!

 

[tommyboy14]

@Earthsciencerocks

I think that the ATS is a great choice. All of these valves are very similar, but they have specific benefits. There is some research to suggest that you dont hear the ATS as much as other valve due to the open pivot design. It is also the only valve with one study (yes only one, but pretty good quality) to suggest that the valve can handle INR 1.5-2.5 without any aspirin. I am not suggesting that your keep your INR there, but this means that if your INR does fall below 2, there is no reason to stress all that much.

I have an ON-X. I am happy with my choice, since the valve has pretty good hemodynamics. My mean and peak gradient is 5 and 10, which apparently is very low. But the On-X is superloud. At least in my body. I am pretty skinny (BMI 22, H 190cm, W 81kg) and I have an aortic graft, so perhaps there are some echo chamber effects. Nevertheless, my 8 year old can hear the valve from 5 meters away - yes you read that right.

Best of luck with your surgery. I am sure you are in great hands.

Finally, it is just the matter of finding the right surgeon. On #2, I found a surgeon who specialised in reops. He told me replaced someone's AVR for the sixth time before successfully.

I will keep my fingers crossed for you.