Life Expectancy with a Mechanical Valve

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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.
 
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
 
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 . . .
 
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,
 
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.
 
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:
 
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.
 
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.
 
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
 
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.
 
Aortic valve replacement

Aortic valve replacement

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
 
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.
 
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.
 
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.
 
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