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cpt228
December 14th, 2009, 07:39 AM
Had AVR 11/05 at 50 years old doing great.
I thought life expectancy was basically unchanged.
Without other unforseen compications.
Doing some web browsing I came across a life expectancy of 16 to 22 yrs for a 35 yo with a mechanical valve
This is conta to what St Judes post @ 29.9 years for a 50 yo
With closer monitering with home testing, I am hoping that the St Judes numbers are low.

ALCapshaw2
December 14th, 2009, 08:27 AM
The numbers you quote make me wonder where they came from and what they are based on.

Mechanical Valves are designed to operate for more years than any of us can expect to live.

Sometimes they need to be replaced for other reasons such as the patient developed Endocarditis which attacks the heart or Pannus Tissue Growth blocks the free movement of the leaflet which requires replacement and 'cleaning out'.

We have members who have had mechanical valves for 30 to 42+ years and are still going strong.

(Dick...., Gina a.k.a. GeeBee?, Rxx?)

'AL Capshaw'

Woodbutcher
December 14th, 2009, 08:45 AM
I know my life expectancy was 3-6 months without one ! So, a minimum of 16 years'll do for me but atleast 60 would be prefered ?
I'm sure my surgeon said something like "with your new valve you should live nearly as long as a anybody else." I clearly remember the "nearly" !
I think I have a heightened awareness to my health in general though which I very much took for granted before I knew about my condition ?

John & Joann
December 14th, 2009, 09:16 AM
Expectation depends on who you ask. The life insurance company paid off Joann's policy years ago. She was terminated by SEARS because the company doctor said that she was a risk on the job. Both of these sources were not correct. One in our favor and one that cost us $$$. Cleveland Clinic feels that if you do not get an infection or a blood clot, your life expectancy is nearly normal. It does complicate treatment for other issues. i.e. GI, Cancer, Accidents, etc. 38 years and counting with the mechanicals and no plans to change this experience.

Philip B
December 14th, 2009, 09:17 AM
I agree with what others have responded.

We never know how much time we have. I figure something else will get me long before my St. Jude mechanical aortic valve quits on me.

Everything is on its way to some place...we just don't know what's waiting over the horizon.

I'm sure everyone is different, but I worried about my mortality a lot just before my AVR surgery and immediately after the surgery was done. At some point, I decided that living and enjoying life was too time consuming and thinking about mortality was just something I didn't have time to do.

Woodbutcher makes an excellent point that we often hear from our members. We pretty much know how short life will be without valve replacement.

Enjoy your journey and the challenges that accompany it.

-Philip

dick0236
December 14th, 2009, 09:27 AM
When mine was installed in 1967 at age 31, normal life expectancy for a 31 year old male was age 73. I passed that age about 10 months ago and am still going strong. If a mechanical valve in put in before serious heart damage occurs and if the patient takes reasonable care of himself/herself(something I have not always done:(), there is no reason not to expect a normal life expectancy.

I was told my valve would last 50 years, well past my life expectancy.....so far, so good:p:cool::D

LUVMyBirman
December 14th, 2009, 10:29 AM
Have not heard of such stats.

Looks like Dick has beat the odds. As many other members. Is that your original valve Dick? Amazing.

Just over ten years post MVR myself. At year 9 my card expected the valve to give me another 15 to 18 years. So bascially, 24-25 years from time of orig. Hopefully longer. God willin'!:)

sue943
December 14th, 2009, 10:32 AM
When I was attempting to sue the person who almost certainly caused my endocarditis a report from an expert cardiologist said that I might have a 'slightly reduced' life expectancy.

Considering I wasn't expected to survive the surgery I am quite happy with that, I would have been happier if I had been successful in my legal action. :)

dick0236
December 14th, 2009, 10:56 AM
. Is that your original valve Dick?

!:)

Yes, I still have the original. My cardio told me at my last exam in September that the valve is beginning to show its age, but it is still within its working parameters. I spoke with Dr. Starr, the co-inventor of my valve, a couple years ago. He told me that there were quite a few of these old Starr-Edwards valves still in use.

ShezaGirlie
December 14th, 2009, 11:39 AM
When I had my echo last week I asked the tech if he'd ever seen one of the 'ball and cage' valves. Yep, he's seen one ~ so they're still out there.

LUVMyBirman
December 14th, 2009, 12:03 PM
Good for you Dick! Just shows that the older technology can be a 'great thing':) I actually have an older model type than most. Implanted 10 years ago. Guess it depends what your surgeon is comfortable using? Medtronic tilting disk mitral. Only know one other member here with one. She is doing well and further along than I am!

aussiemember
December 14th, 2009, 12:50 PM
After my surgery both my cardio and my surgeon commented that it was unlikely my valve would cause any more problems and that it would be something else that would eventually "take me out". But I echo the thoughts of others - enjoy each day and be thankful that our condition is treatable. :D

olefin
December 14th, 2009, 03:33 PM
Not close to Dick but mine's going on 19 years and still a ticking, almost age 75. ;)

Nancy
December 14th, 2009, 03:45 PM
My husband had his aortic valve replaced with a Bjork-Shiley (mechanical) valve when he was in his forties, several years later he had a mitral valve replacement using a St. Jude mechanical.

He lived to age 75 with many, many medical problems, and as someone else mentioned, something else "took him out", with both mechanicals fully functioning until the very last moment.

They were a miracle for him. He outlived all of his highschool buddies, many of whom had heart conditions, some should have had heart surgery for blockages, maybe a valve or two and didn't.

Joe wasn't supposed to live past the age of 50, at least that's what they told him when he developed rheumatic fever as a teen.

But valve surgery and his mechanicals gave him back his lifespan.

njean
December 14th, 2009, 06:31 PM
I was 24 yrs. (1975) when Dr. Cooley implanted two mechanical valves in my ailing heart. My natural valves had been totally destroyed by a bout with rheumatic fever three years earlier.

In 2006, I had to have the 31-year old aortic valve swapped out with a brand new St. Jude valve but the 34 year old mitral valve still continues to tick even in it's compromised state.

I have the old valve in a jar --- kept it as a souvenir to remind me just how lucky I am to still be alive. :)

7324

I have posted pictures of my valve before but I found this one on the internet that I think shows up better than the one I've taken.

LUVMyBirman
December 14th, 2009, 07:32 PM
Now that is something to be proud of NJean! :) When my card said 25. I like to think closer to 30 years. As that seems to be the average of a mechanical.

duncanjo
December 14th, 2009, 09:27 PM
i think too many people read into the subject about having a mech valve i ate, drank, anything i wanted for the past two years. it yasn't slowed me down too many people worry about whats going to happen with there life in stead of trying to live there lives. thats there draw back. its not the end of ur life its a new beganning of a new life with the chances of living longer.........

Woodbutcher
December 15th, 2009, 01:52 AM
Well said duncanjo ! It's surely more about quality of life than quantity ? That's a good point. Life shouldn't be what we do between worrying about when we're going to die, we should just get on with it ! Easier said than done sometimes though...
Dick, Dayton, Jean and other long term tickers are a massive inspiration to a one year green horn like me though !

Ross
December 15th, 2009, 02:52 AM
I read somewhere that we were supposed to be in rocking chairs, sippin on some of grandpa's homemade cold remedy for the rest of our lives. :D

MarkU
December 15th, 2009, 03:54 AM
I read somewhere that we were supposed to be in rocking chairs, sippin on some of grandpa's homemade cold remedy for the rest of our lives. :D

Actually, that doesn't sound so bad, where do I sign up? ;)

Today is my ninth anniversary and my life is busier than it was before.

Too many things to do - I plan to hang around for a while longer.

Mark

Ross
December 15th, 2009, 04:56 AM
Hey if it helps, they told me in 1991 that with my lung disease, I wouldn't be around in 10 years. Now I'm just a high school graduate and don't know that math thing real well, but I'm pretty sure that 2009-1991= more then 10 years.

Bill B
December 15th, 2009, 08:28 AM
Life expectancy numbers like that are for ALL COMERS. In all the studies of valve replacement I could find, about half of the patients had extensive co-morbidity: other conditions that affect life expectancy, such as coronary artery disease, renal disease, diabetes, hypertension, lung disease. Those end up determining life expectancy rather than the valve in these patients.

This problem in study design complicated my choice of valve when I was examining the literature in September and October prior to my AVR. The current recommendations from these studies center on AGE as the selection factor (>65 = tissue; <65 = mechanical). BUT none of the studies were done in people like me who have essentially NO co-morbidity. A multivariate analysis by Lund in 2006, wherein he compiled the data from all the earlier studies and separated out the variables affecting longevity, showed to my satisfaction that AGE itself is not the major variable but that CO-MORBIDITY is. So, since I have no major co-morbidity, my life-expectancy is quite long and I should choose a mechanical valve even if I were 75. There was a bit more to the decision I made, but that was the key factor for me.

Lund paper: http://jtcs.ctsnetjournals.org/cgi/reprint/132/1/20

netmiff
December 15th, 2009, 03:18 PM
BillB, you must be an engineer-type to have worked through all of that!

Ross : " I read somewhere that we were supposed to be in rocking chairs, sippin on some of grandpa's homemade cold remedy for the rest of our lives."

wrapped in bubblewrap so that nothing will cause us to bleed to death . . .

Cooker
December 15th, 2009, 04:12 PM
I have no doubt that my St Jude will out last me ... I plan on living long enough to be even a bigger pain in the butt ....:cool::p

tobagotwo
December 15th, 2009, 05:15 PM
Some things to consider...

- Comorbidities (when you have other things wrong with you as well as your valve issue) are definitely the biggest predictor. Particularly so if it includes arterial instabilities that lead to aneurysms, or if they have lung or kidney issues. A larger percentage of those who present with valve difficulties this early in life have other, major health issues as well. Those people, sadly, bring the life expectancy down. But not for those who are otherwise healthy.

- A cohort of 35-year-olds with valve issues would be a difficult thing to assemble. There just aren't that many and they're too scattered. Most studies of this type wind up being a very small subject group, often taken from a very narrow overall group (like from only a few or even one hospital or clinical practice). I would be very loathe to take any one study as being definitive of the age group, even if they were sorted as to comorbidities, and I've been looking at valve studies for over a decade.

- If the average lifespan after valve implantation were 16-22 years, that means the study had to run longer than 22 years to find that out. That means that even if the study just came out this year, the study could not have been started any earlier than the mid 1980s at best. More likely, it was begun in the 1970s. That means old technology. Not just the valves, but more critically the surgery itself, treatments for lung and kidney issues, and the echo technology (and MRI and CAT scanning) used to determine expanding aneurysm size. Those items alone account for a much longer life expectancy now for many with comorbidities who died underdiagnosed in earlier years.

- I would also doubt that the data would reasonably specifically demonize mechanical valves, vs. other types of valves. If the cohort were all people with mechanical valves, there is no data that could compare the mechanical valves to anything else, and thus no information as to whether the mechanical valves were part of the lower than expected lifespan.

I will, however, say that even in this unhappy study, people lived 14-22 years longer than they would have averaged had they not had the mechanical valve impanted.

I really, really wouldn't worry about what you read in that study, nor take it as applicable to your individual situation. Although we are far from there yet, things are as different medically between the 1970s and now as computers are different between then and now. From a $200,000 9'x9'x6' cube representing 1 MB of storage to a $39.95 4 GB mini-SD card the size of a standard Frito.

Be well,

Lily
December 15th, 2009, 06:53 PM
I web-searched "mechanical valve life expectancy" and found a site which quoted similar figures as the first post: http://heart.emedtv.com/aortic-valve-replacement/life-expectancy-after-aortic-valve-replacement.html

One point this emedtv site made was that life expectancies, such as those quoted, are really unknown things, predictions really.

Regarding practical application of information pertaining to co-morbidities, sometimes they're unfortunately unknown; as yet, undiagnosed.

I was remembering a friend's experience related to her hip replacement from about 2-3 years ago. She was put on a temporary regimen of ACT. A couple of days after her successful surgery, within a very few hours, her blood count plummetted to a dangerous level. The source of blood loss was quickly found, by ruling out various things, and she was found to have a large previously undiagnosed ulcer, even though she'd had a scope, etc., done just several weeks previously. So, as it turned out for her, she had an unknown co-morbidity with a sudden onset of dire symptoms. Happily, in her situation, the doctors quickly responded and she recovered well.

BTW Tobagotwo, your post is, as usual, excellent.

dick0236
December 15th, 2009, 08:29 PM
I agree with Lilly that Tobagotwo always posts information that is well thought out. Factors other than issues with a heart valve are often the cause of a shortened life.

As he said, many of these studies are too small and too narrow to draw broad conclusions. Many, many long time "valvers" fall thru the cracks when these studies are conducted and their histories are not in the counts.

FWIW, I have never been contacted by any kind of a survey concerning my valve or anything having to do with my life after surgery. Perhaps one reason for many long time survivors not to be counted is that most medical practices do not keep records for long periods of time. In my case, all of my records prior to 1990 were purged:eek: and destroyed:mad: by my cardio. Anyone who did a cursery search might consider me to be a 19 year survivor.

A few years ago I attempted to get an ID card from the manufacturer(Edwards Lifesciences) of my valve. Edwards Lifesciences had no record of my valve (too old). We finally found a hospital record that stated "a #9 Starr-Edwards valve was surgically implanted". That one sentence on a piece of old micro-fish is the only existing record of my valve surgery.

Remember that many of the polsters often are trying to prove a point and may not be totally objective.:p;):rolleyes:

river-wear
December 15th, 2009, 09:56 PM
Dick, you should be the poster boy for Starr-Edwards. A resounding success! :)

OldManEmu
December 16th, 2009, 12:40 PM
Bill B
In all the studies of valve replacement I could find, about half of the patients had extensive co-morbidity: other conditions that affect life expectancy, such as coronary artery disease, renal disease, diabetes, hypertension, lung disease.
I totally agree this is one of the things the surgeon pointed out to me, even though I was in class 4 heart failure I should do well because I didn't have any of co-morbidity issues.
For many people it appears Valve problem is just something else to add to an already extensive list of health issues even though they may be <60 years old.

Ross
December 16th, 2009, 03:24 PM
Only problem is, surgery can impose some of those co-mordities upon you. You may come out of it with a hit to the kidneys or lungs or any other organ.

dick0236
December 16th, 2009, 04:51 PM
Only problem is, surgery can impose some of those co-mordities upon you. You may come out of it with a hit to the kidneys or lungs or any other organ.

Something to think about when choosing a valve.

twinmaker
December 16th, 2009, 05:40 PM
My valve is 28 years old. My grandmother lived to be 95 and my mom is now 88 and still going strong, and I'm planning on being around at least as long as my grandmother even with this St. Jude valve! LINDA

Lynlw
December 17th, 2009, 06:12 PM
Some things to consider...

- Comorbidities (when you have other things wrong with you as well as your valve issue) are definitely the biggest predictor. Particularly so if it includes arterial instabilities that lead to aneurysms, or if they have lung or kidney issues. A larger percentage of those who present with valve difficulties this early in life have other, major health issues as well. Those people, sadly, bring the life expectancy down. But not for those who are otherwise healthy.

- A cohort of 35-year-olds with valve issues would be a difficult thing to assemble. There just aren't that many and they're too scattered. Most studies of this type wind up being a very small subject group, often taken from a very narrow overall group (like from only a few or even one hospital or clinical practice). I would be very loathe to take any one study as being definitive of the age group, even if they were sorted as to comorbidities, and I've been looking at valve studies for over a decade.

- If the average lifespan after valve implantation were 16-22 years, that means the study had to run longer than 22 years to find that out. That means that even if the study just came out this year, the study could not have been started any earlier than the mid 1980s at best. More likely, it was begun in the 1970s. That means old technology. Not just the valves, but more critically the surgery itself, treatments for lung and kidney issues, and the echo technology (and MRI and CAT scanning) used to determine expanding aneurysm size. Those items alone account for a much longer life expectancy now for many with comorbidities who died underdiagnosed in earlier years.

- I would also doubt that the data would reasonably specifically demonize mechanical valves, vs. other types of valves. If the cohort were all people with mechanical valves, there is no data that could compare the mechanical valves to anything else, and thus no information as to whether the mechanical valves were part of the lower than expected lifespan.

I will, however, say that even in this unhappy study, people lived 14-22 years longer than they would have averaged had they not had the mechanical valve impanted.

I really, really wouldn't worry about what you read in that study, nor take it as applicable to your individual situation. Although we are far from there yet, things are as different medically between the 1970s and now as computers are different between then and now. From a $200,000 9'x9'x6' cube representing 1 MB of storage to a $39.95 4 GB mini-SD card the size of a standard Frito.

Be well,


Along these lines, I keep thinking that for the most part the group with the higher comorbidity AND other conditions that affect life expectancy, going INTO surgery, would probably be the tissue valve patients, partly because of their age, since they are the older group, chances are more of the people would have the conditions that generally come along as you age, compared to the younger (sometimes decades younger) patients who usually mechanical valves.
(at least until the past few years where more younger people are choosing tissue)
The other reason is for the MOST part the only younger people (I'm talking 20-50s NOT early 60s) who got tissue valves were/ are either young women who wanted to have get pregnant/have children OR people who had other health problems (GI,bleeding disorders, Liver, ect) and were advised coumadin COULD make it more difficult.
SO I would think most of the studies that looked at ALL valve patients, the majority of the people who got mechanical valves were like Bill, (to use his example) and have essentially NO co-morbidity.
Since MOST valve problems are structural problems, many from birth and usually NOT aquired problems caused by living and/or lifestyle choices (poor eating, poor excercise, bad habits, like drugs ect) that can sometimes effect your other body systems, many of the patients are relatively healthy going into surgery so don't tend to have as many comorbidites as say a CABG would.
IF one group would be expected to have lower life expectancy based on comorbidity, it would be people that got tissue valves, so it is interesting that this study shows tissue valve patients have a higher life expectancy. I guess it must be from comorbidities that happen after the person has the surgery as they get older.


I thought it was interesting in the study Bill posted they went back and read 32 older studies, starting with valves replaced in 1975, and only ended up with about 17,000 patients, pretty much 1/2 Tissue and 1/2 mechanical and the tissue patients ended up with only slightly more reops at 5.0% than the mechanical valver patients 3.8 %. That was surprising, but I didn't see if there was a breakdown of how long after the origonal surgery did they need a redo. It could have been the valves patients got in the late 70s, who knows, it was just interesting. The death rate was higher for the tissue valve patients, BUT they were an average of 10 years older at the time of surgery.

That's one of the studies used in http://circ.ahajournals.org/cgi/content/full/117/2/253?etoc Choice of Prosthetic Heart Valve in Today’s Practice
about the trend going going toward tissue valves for younger patients, and
"A meta-analysis of 32 articles evaluated mortality from 15 mechanical and 23 biological valve series including 17 439 patients and 101 819 patient-years of follow-up. This meta-analysis found no difference in risk-corrected mortality between mechanical and bioprosthetic aortic valves regardless of patient age9 and suggested that the choice between a tissue and mechanical valve should not be based on age alone"

Its good that patients, for the most part, get to talk about valve choice with their surgeons and choose which ever valve they feel best fits their personalities.
It will be interesting to see what the studies show in another decade.

sandpoet
February 21st, 2013, 02:06 PM
I had an AVR in March 2008 at 53 yoa due to bacterial endocarditis. Immediately after that surgery, they discovered a brain aneurysm(subdural hematoma) as a simultaneous complication of the sepsis. Three months later, in cognitive rehab, symptoms identical to the Aortic valve failure(tiredness, difficulty breathing) arose and a group of cardiologistists in Santa Barbara performed an echo-cardiogram and diagnosed Mitro-valve failure. No hospital locally would reop, because of the short time period after the brain surgery, so I transferred to a hospital 300 miles away to get a 2nd opinion. The cardiologists did a TEE and discovered that the first valve had dehisted from the annuplasty ring and I had a hole in my heart, so they determined it safe to reop and scheduled a redo. After being anethesized for surgery, they could not intubate me because of a tracheal constriction. This was brought on by the lengthy brain surgery which left lesions on my trachea. Unable to dilate the trachea at that hospital, I was transferred to Stanford and they dilated my Trachea and did the AVR. Fortunately, I have lived my life with complete dedication to health(eating & exersize). This likely saved my life.
I agree with many other posters on this blog that mortality should not preoccupy you. I was not in fear before the surgery(s), but somewhat hyperchrondiac for months after the 2nd surgery. I learned throughout this process to live your life to the fullest because we all had a brush with death and apparently, it wasn't our time to go. I do think that the doctors are more afraid of malpractice and will air to the side of caution when recommending physical activity post rehab. I returned to athletic activities, including strength training after my trusted and highly credentialed GP told me I had no limitations. I am keenly aware of my body after those recommendations. I developed a-fib after the heart surgeries, but Warfarin protects me. I was on a few different heart arrhythmia drugs for about a year, but my GP allowed me to stop using them, after I told him they were limiting my aerobic intensity. I look favorably on the future and I have a 6 & 8 year old who give me two good reasons to live.


I agree with what others have responded.

We never know how much time we have. I figure something else will get me long before my St. Jude mechanical aortic valve quits on me.

Everything is on its way to some place...we just don't know what's waiting over the horizon.

I'm sure everyone is different, but I worried about my mortality a lot just before my AVR surgery and immediately after the surgery was done. At some point, I decided that living and enjoying life was too time consuming and thinking about mortality was just something I didn't have time to do.

Woodbutcher makes an excellent point that we often hear from our members. We pretty much know how short life will be without valve replacement.

Enjoy your journey and the challenges that accompany it.


-Philip

virginian777
February 21st, 2013, 06:48 PM
just got discharged from hospital today 1st avr 4-26-12 edwards mechanical starged leaking to the point that 2nd surgery was nessary best to do now,this time went with bovine dr told as he did the first time they all have a life time warranty so go live a good clean a life as you can.

dtread
February 22nd, 2013, 02:45 AM
Edwards made mechanical heart valves many years ago. Edwards did not make mechanical heart valves for use in the U.S.A. in April 2012. Unless you got one of their old ones that had been sitting on the shelf for ten years or longer? You would have had to have had it installed somewhere other than the U.S.A. If you had your first AVR in April 2012 that means the valve only lasted about 9 months. Whatever your story, it sounds like a defective valve, which does happen in a very small percentage of instances. But mechanical heart valves are tested nine ways from Sunday before they are released from production for actual usage.

mknuppel
February 26th, 2013, 08:23 AM
Referring back to dick0236's earlier post.

I always enjoy your positive outlook in your postings! Always lifts me up when I want to bring myself down. I just wanted to say thanks!

I agree with your statements - My doctor indicated that my life expectancy would not be affected. The valve will outlast me with some provided TLC.