For reops: are you glad you started with tissue?

Valve Replacement Forums

Help Support Valve Replacement Forums:

This site may earn a commission from merchant affiliate links, including eBay, Amazon, and others.
My first OHS was not valve related but my second surgery four years later was.
I opted for bovine valve and I cannot say how grateful I am I made that choice. I had already experienced one OHS so had a very clear knowledge of what to expect and FOR ME, a tissue valve was the clear cut choice.

Only you know what is best for you but the more I learn about the status of OHS, the fact they are now doing percutaneous replacements which are so much less traumatic balanced with all I have learned re: coumadin and the risks involved in bridging for medical procedures, the attention required to testing and consistency in diet and life style..... The risk of having possibly gotten a loudly ticking valve, I know I made MY right choice. Absolutely everyone is different and it is a very hard decision.

I wish you the very best in making your decision as well as in your surgery and hope a bump free recovery for you.
Let us know what you decide and we'll wait to hear you're doing well after your surgery.

Thanks a lot. It is truly a difficult decision, but what I am learning from folks like you is that what's right for one is not necessarily right for another, and that both options can work out very well.

Appreciate the well-wishes. (BTW, I did decide on mechanical; I think I will self-manage my ACT well and that a mech valve will likely last me a normal lifetime).

Best,
pem
 
Pem, glad you've made your decision.
Not that it matters now, but I have often wondered if people who started with mechanical valves, and then needed a re-op for whatever reason, wished they had gone with a tissue the first time around.

Good point and good question! Can anyone speak to that??

Thanks!
pem
 
Hi gang

Hey Duffey, I think it is human nature to second guess a decision which flunked. We have all read of tissue folks who have had their valve fail prematurely. On the other hand we have read about MHV's bombing out. Some stay firm to the original choice of valve type while others switch the composition. At least we have a choice of technologies.

Dr Paul Fedak, [he's the guy who invented the Kryptonite glue for fusing the sternum] and I had e-mail correspondence regarding bring the On-X to my home city, as On-X was my choice and we needed to get the part on the shelves and medical staff trained prior to my surgery. He sent me a link to "ValveXchange". He said this is the future. Unfortunately we of the present older generation will not see it as the technology is in it's infancy. I have mentioned this technology on many past posts. Regardless if you have had a tissue or MHV implanted, perhaps you are in the waiting room, but are interested in the future, I encourage you to check the ValveXchange technology out. It's very cool and has some great animation.

Although I was corresponding with Dr Fedak, Dr Kidd did the deed. Could not be happier!

Is it just me, or has anyone else noticed that folks with On-X valves seem abnormally exuberant? :) Seriously, what else are they coating those valves with ;)

Anyway, the good news for all of us is that you remind us of here, is that the future is bright with promise and that technology and methods only improve with time.

Thanks!
 
All I can say about a mechanical valve is that ACT is no big deal at all. It's been the least troublesome thing of my whole post surgery experience.

I really appreciate that! Thanks for letting me know.
Best,
pem
 
I was 31 years old and decided on a bovine issue valve, I am now 42 and going in for reop 2nd surgery. I wouldn't change it. I loved my tissue valve. In fact for me, it was worth the reop. I was lucky and had no complications the first time whatsoever. It lasted 11 years, endured quite a bit. Kind of sad that I am sure I will have to have a mechanical this time. Just because everything for me was perfect with the tissue.
 
I was 31 years old and decided on a bovine issue valve, I am now 42 and going in for reop 2nd surgery. I wouldn't change it. I loved my tissue valve. In fact for me, it was worth the reop. I was lucky and had no complications the first time whatsoever. It lasted 11 years, endured quite a bit. Kind of sad that I am sure I will have to have a mechanical this time. Just because everything for me was perfect with the tissue.

Thanks for your note, Julie. Sounds like you made the perfect choice for yourself with your first valve. Can you be more specific about what you mean when you say your tissue valve "endured quite a bit"? Were you very physically active or did you have other medical things going on?

I hope your second surgery goes just as smoothly as your first and that your next valve exceeds your expectations.

Best,
pem
 
Pem -
Our lifestyle is a little different than your average elderly person. I work a full time fast paced, stressful job outside the home, also train, breed and compete nation wide German Shorthair pointing dogs, volunteer at the local animal shelter, went to school and completed an animal behavior course (2 year course) on the side, have two children active in school sports and a wonderful husband that works away from home 7 months out of the year. So those 7 months are me alone and my two kids. (with the exception of a few weekends he gets to come home) Needless to say, with no blood thinners and other issues I was able to keep up. For the last year and a half that has slowly went downhill. I cannot physically do any field work with the dogs any longer, am down to a snails pace, gaining weight, not happy about it at all. Cannot wait to get this fixed so I can resume living. I just worry how blood thinners will affect the physical contact of the training and field work I do. So now we wait and talk to the surgeon on different second options. I would love another tissue valve, but we will see what he says.... Probably not.

Best wishes with your decisions. Do what's right for you. :)
 
luana as i said am really sorry for what mainframe went through, and i hope nobody else goes through it, but thankfully it is not common to go through all those problems, thats all i was trying to say, and to say act is no big deal,well for most it isnt, but for some it is, there can be problems on both tissue and mech and to say otherwise is very misleading,THANKFULLY these are a rare happening,
 
Very interesting! Thanks. I'll be talking with the ACT rep on Monday and pose the question about protection from pannus growth.

How do you find the clicking of the On-X? Do you notice it?

Thanks again!
pem

PEM,
I'm guessing you meant you will be talking to the ATS rep, not ACT, unless you are lining up who would manage your Coumadin already,

.. Anyway from what I know about pannus or excessive scar tissue, for either tissue OR mechanical valves, first it is relatively rare, but often the problem is pannus that forms at the actual seam where they sew the valves or grafts to your own tissue, that causes stenosis and altho it can be fatal if it grew on or by the leaflets,(by blocking them from opening or closing) my guess is the majority of REDOs are because of pannus at the seams and not blocking leaflets. I THINK as far as I know the ON-X design just guards the leaflets from pannus or scarring, not the seam.

Anything I've read on ATS valves needing REDO for pannus, was it was very rare -actually even the link ON-X gives showing ATS needing replaced for pannus was the article on the FIRST case (1st reported anyway) and I haven't seen anything showing it happened to many people. Granted the oldest ATS valves have only been in patients a year or so longer than when ON-X was first used, I BELIEVE with out looking everything up right now, some where around the early -mid 90s, so who knows if it is a gradual thing- if more cases will be showing up in the near future. BUT IF I personally were leaning toward a ATS valve, I don't think I would worry too much about if another valve has a barrier to the leaflets and ATS doesn't, since odds are pretty high against pannus forming to start with and even better in ATS as far as I can tell without spending days reading studies. At least i probably wouldn't let my mind be changed because of fear of pannus, if there are other reasons you think the ATS is better for you.

Altho I thought something about the concave of the design helped also, but that probably was more of a help in keeping clots from forming on the leaflets...Which is the other main reason mech valves need replaced, beside BE. Altho IF clots are forming on a mech valvs leaflets, they often form relatively quickly without notice (unlike pannus formation, that you can keep an eye on with yearly check ups) so many patients don't make it to surgery so wouldn't be counted as REDOs.

Justin has been thru many surgeries and intervention and like Norma said "Luckily what happened to me, doesn't happen to many, so don't spend time fretting about "what might happen". I really believe you can make the best choices for yourself ( Altho IMO the MOST important decision is the surgeon and center where you will have the surgery) and hope for the best, but really don't worry about or drive yourself nuts with all the different "what if's" that might happen.
Odd are VERY good anyone will have a very succesful surgery and recovery for the most part, especially if you go into it relatively healthy, with no other serious medical problems like lung issues etc. With experienced surgeons and centers, first time REDOs have the same odds. Several studies have shown in the larger CHD center where the surgeons do REDOs and multiple REDOs weekly if no daily, even the 3rd and 4th have great results, altho I doubt someone in their 40s getting their first OHS NOW would need a 3rd or 4th OHS.
Just like odds are you could live decades w/ a mech valve and anticoagulants and not have any Major clots or bleeds.

Even IF you have a terrible time of it, most likely, you will end up better than you would with out the surgery, it may take longer than anyone wants but the vast majority even with terrible complications, or other major health problems going INTO surgery go on to live very good active lives. The same with any problems you could have from having a mech valve and coumadin or other anticoagulant, chances are good after recovery you'd have a long happy life.

Justin had some terrible complications from surgeries AND even from Caths. -He was in and out (mostly in) of the hospital for 6 months after his surgery at 18 months (over 20 years ago when they didn't know as much about treating some things), it was a very complex surgery (they pretty much rebuilt his heart & rerouted his blood) on and off the vent etc, with pericardial fluid, then caught RSV. then after his 5th OHS he had a massive infection that anything i googled started with high mortality rate, after anothr big surgery and muscle flap to hold his sternum together, he had a longer recovery, but is doing great. He also had minor bumps,but for the most part he was home earlier (less than a week) for his 3rd, 4th and 5th OHS than his first 2 so it just as many say each person experience is different and even each surgery for 1 person can be different -the more OHS doesn't necessarily mean each one will be worse. I know hundreds of kids/adults that have had 3 or more -very complex surgeries and are doing great. Sadly we all know people who didn't survive their first.
My Mom also had terrible complication's from both caths and OHS, being trached and months in rehab so I know first hand how bad surgery or even caths can be.

Also why we don't count on anything, was he also is "unlucky" or "lucky" depending how you look at it, He got BE when he was 11 from losing a baby molar but had a complete recovery with just antibiotics, he had to have a mulfunctioning pacemaker removed, luckily he wasn't using it at the time so didn't have to get a new one (the first was in his abdomin under his ribs, if he got another it would have been another incision since they would have put it in the shoulder area.
He is a "scar building machine" according to his surgeon who is one of the worlds top CHD surgeons so his last 2 OHS we knew going in his heart was fused to his sternum, making it risky to open him, but he also tends to build tissue. He got a tissu valve w/ 2 dacron conduits in 05 less than a year later he had severe pulmonary stenosis, we were sad since we hoped the tissue valve would last at leest 10 years (on right side) we actually talked about having it replaced by cath as part of the Melody trials, but they couldn't get a good look during the echo or MRI, but when he had the cath it turned out the tissue valve was perfect, the dacron conduit that 'should" have lasted a lifetime needed replaced. They ended up replacing that section of dacron, but the valve looked perfect so they left that and the other section of dacron..
We couldn't believe the part that didn't last 2 years was the part that should have lasted decades or the rest of his life, but things happen.



I'm not trying to change your mind I think you will be very happy with your mechanical valve since you've put alot of thought into it.
so i didn't ask earlier, but since there is alot of discussion on various valves in your thread, I was wonderring when you said

"One surgeon believes that the newer "3rd generation" tissue valves will last 20-25 years or even longer(!) However he is extrapolating and the data doesn't yet exist to support or refute that. The other surgeon (both are world class) is more cautious about projecting with regard to the newer tissue valves.

I would suspect that the 3rd gen valve will perform better than the 2nd gen, but who knows if they will truly approach the longevity of mech valves. Based on my reading, it looks like tissue valves simply don't last as long in people under 60. I'm 41, so I put myself in the category of a shorter tissue valve lifespan - even with the newer valves, I think I'd be lucky to get 15 years. Which isn't bad. But I'm 41, so 41+15+15+15 get's me to 70"

Which tissue valves were you talking about? Sometimes, time goes so fast, people, even docotrs might not think valves have been around as long as they have, for example the valves most used today, Perimount , Biocore and Hanncock II were first used in the earlier 80s so I a NOT sayng any people have had one that long just that they have about 30 years worth of data on them. There was a long thread in the last year or so where we were figuring out when different tissue and mech valves were first implanted in people. So we could see what valve had REAL tract records of being around 20-25 years and which valves HOPED to last long or lifetime but haven't been in use long enough to have 20 year records.

Another thing I found interesting talking to various doctors, (not from studies just thoughts and opinions) usually in the middle of the night when Justin was in the hospital almost a month in 07 and I couldn't sleep, is that last time I had alot of discussion about it), is many believe the tissue valve 'longevity" in someone, is probably related to how active the bone growth/healing is.
For example in really young kids who are still growing and their body chemistry for growing bones is very strong they calcify tissue valves /grafts quickly. As you get older it takes people longer to heal broken bones, chances are if someone in the late 20s broke their bones it would heal much faster than someone in their 60s 0r 70s. The same chemsitry is probably related to how long or short a tissue valve would PROBABLY last in that age group. Also when people start getting to the age were their bone density becomes less, like women after menopause etc..tissue valves last longer.

Of course that could be completely wrong, but it made sense to me.
 
Last edited:
Pem -
Our lifestyle is a little different than your average elderly person. I work a full time fast paced, stressful job outside the home, also train, breed and compete nation wide German Shorthair pointing dogs, volunteer at the local animal shelter, went to school and completed an animal behavior course (2 year course) on the side, have two children active in school sports and a wonderful husband that works away from home 7 months out of the year. So those 7 months are me alone and my two kids. (with the exception of a few weekends he gets to come home) Needless to say, with no blood thinners and other issues I was able to keep up. For the last year and a half that has slowly went downhill. I cannot physically do any field work with the dogs any longer, am down to a snails pace, gaining weight, not happy about it at all. Cannot wait to get this fixed so I can resume living. I just worry how blood thinners will affect the physical contact of the training and field work I do. So now we wait and talk to the surgeon on different second options. I would love another tissue valve, but we will see what he says.... Probably not.

Best wishes with your decisions. Do what's right for you. :)

Julie, IF you REALLY are happy with your tissue valve and want another one, thats what you should get. I know CCF probably does more valve surgeries thaan just about anyoe in the world and uses about 90% tissue valves. Since 1/3 of their valve surgeries are REDOS (My guess many are just 2nd surgeries, not just replacing a tissue valve) then obviously many of their patients get a 2nd tissue valve.

Good luck, IMO unless you have something medically that would make either choice a problem for you, 40s are probably the toughest age to decide which valve would be the best to avoid big problems, like a bad REDO for tissue or a major clot or bleed with mechanical. Right now the fact there are so many exciting things happening to make life with either tissue valves or mechanical valves bettter or at least safer, probably makes the choices even harder not easier.
Since you're going to the Mayo, and have a chance to talk to some of the brightes doctors, i'm sure whatever choice you make you'll do well and live a long happy life.
 
Pem -
Our lifestyle is a little different than your average elderly person. I work a full time fast paced, stressful job outside the home, also train, breed and compete nation wide German Shorthair pointing dogs, volunteer at the local animal shelter, went to school and completed an animal behavior course (2 year course) on the side, have two children active in school sports and a wonderful husband that works away from home 7 months out of the year. So those 7 months are me alone and my two kids. (with the exception of a few weekends he gets to come home) Needless to say, with no blood thinners and other issues I was able to keep up. For the last year and a half that has slowly went downhill. I cannot physically do any field work with the dogs any longer, am down to a snails pace, gaining weight, not happy about it at all. Cannot wait to get this fixed so I can resume living. I just worry how blood thinners will affect the physical contact of the training and field work I do. So now we wait and talk to the surgeon on different second options. I would love another tissue valve, but we will see what he says.... Probably not.

Best wishes with your decisions. Do what's right for you. :)

Wow - I see what you mean. That's quite impressive.

From what I have read on the forum, one is not quite so "fragile" as you might think on ACT. I guess it varies from person to person, but maybe if you stay on the lower end of the INR range you can reduce "nuisance" effects, like bruising and longer bleeding when you get cut. I was on Coumadin for just 3 months and the only thing I noticed was that when I cut my finger it took 3-4 hours to completely stop bleeding. Not a big deal - just had to replace the band-aid several times. I think it was a deeper-than-usual cut. Otherwise, it was life as usual. Every time I got pummeled by the kids (sometimes pretty hard) I was afraid some organ was going to bleed out - but of course it didn't. I think there's a lot on the forum about this kind of thing.

Anyway, hope the discussion with your surgeon goes well and you arrive at an outcome you are comfortable with!

Best,
pem
 
Hmmm, no one mentions the additional 3-4 hours in surgery to get thru the scar tissue from the previous surgeries...
It is hard to 2nd guess one's (or one's surgeon's) choice on the 1st valve. My 1st surgeon told me to expect 15 yrs from my porcine valve at age 34, and he was off by 4 yrs. I was horrified when my cardio told me it was failing at 11 yrs. My surgeon tells me like it is, to expect 10 yrs from a tissue valve. Most people here are not being told that, I don't know why? Of course, I enjoyed the yrs without meds or act. But, they are over much too quickly, and then on to a mechanical. I think when some of us start in our 30's we just can't keep going with tissue, at least with the sternal surgery.
 
Wow - I see what you mean. That's quite impressive.

From what I have read on the forum, one is not quite so "fragile" as you might think on ACT. I guess it varies from person to person, but maybe if you stay on the lower end of the INR range you can reduce "nuisance" effects, like bruising and longer bleeding when you get cut. I was on Coumadin for just 3 months and the only thing I noticed was that when I cut my finger it took 3-4 hours to completely stop bleeding. Not a big deal - just had to replace the band-aid several times. I think it was a deeper-than-usual cut. Otherwise, it was life as usual. Every time I got pummeled by the kids (sometimes pretty hard) I was afraid some organ was going to bleed out - but of course it didn't. I think there's a lot on the forum about this kind of thing.

Anyway, hope the discussion with your surgeon goes well and you arrive at an outcome you are comfortable with!

Best,
pem

Pem,
The only bruising I've had since I've been taking warfarin was from the IVs I had in the hospital. In the past year-and-a-half, I've had no additional bruising.

As for the cut you had, it sounds like stitches or some kind of medical intervention would have been in order. 3-4 hours for something to bleed is too long, and it sounds like the ACT had nothing to do with that length of time, as typically, those on ACT take minutes longer to clot, not hours.
 
Last edited:
Hmmm, no one mentions the additional 3-4 hours in surgery to get thru the scar tissue from the previous surgeries...
It is hard to 2nd guess one's (or one's surgeon's) choice on the 1st valve. My 1st surgeon told me to expect 15 yrs from my porcine valve at age 34, and he was off by 4 yrs. I was horrified when my cardio told me it was failing at 11 yrs. My surgeon tells me like it is, to expect 10 yrs from a tissue valve. Most people here are not being told that, I don't know why? Of course, I enjoyed the yrs without meds or act. But, they are over much too quickly, and then on to a mechanical. I think when some of us start in our 30's we just can't keep going with tissue, at least with the sternal surgery.



I think it would be helpful to mention the tissue valve about which you comment lasted 11 years, was implanted in 1989. Tissue valves have vastly improved since that time. It doesn't seem quite right to omit that bit of pertinent information.

My Mass General surgeon implanted my tissue valve as my second OHS. My first did not involve any valve issues. When I asked both before and after the surgery about scar tissue from the first and difficulty it added to the surgery, my surgeon said it was no problem at all for him. He went through whatever scar tissue safely and 'handily'.
 
Gail, Not all of us are on the table for an additional 3-4 hours for scar removal for subsequent surgeries. My experience was much like Jkm's, no real problems or prolonged surgery time due to any scaring issues. I, too, have a tissue valve that was implanted as my second surgery (first surgery also not valve related).


Kim
 
Pem,
The only bruising I've had since I've been taking warfarin was from the IVs I had in the hospital. In the past year-and-a-half, I've had no additional bruising.

As for the cut you had, it sounds like stitches or some kind of medical intervention would have been in order. 3-4 hours for something to bleed is too long, and it sounds like the ACT had nothing to do with that length of time, as typically, those on ACT take minutes longer to clot, not hours.

Honestly - it was deeper than a surface scratch, but not stitch-worthy in my experience (I've had my share of cuts from woodworking, etc). Maybe I'm a "strong responder" to coumadin. My INR was stable at 2.6 - perhaps that's plenty for me.

Also, between study data and anecdotal data, I'm starting to form a strong impression that the actual amount of coumadin may be a relevant factor in coagulation rate. In other words, it may not be just INR, but rather the amount of coumadin you are taking that affects coagulation. One reason I think this is that a Swedish study (cited by On-X in its compendium of papers in support of clinical trials with reduced INR) concluded that when INR levels increase naturally, they see no increase in hemorrhaging, but when INR levels increase due to coumadin, then there is some occurrence of bleeding. Here's the paper link: http://www.bmj.com/content/325/7372/1073.full.pdf

In general, I conclude from this paper that someone on coumadin would do well to gradually decrease the INR levels over time so that they reach a target narrow range of 2.3-2.5 in their 70s (starting of course from a higher level when they are younger). Of course, that's just my own take-away from the study, but I encourage you to read it if you are on lifelong coumadin because I think there is some evidence that lower INR levels may be better than what today's standards indicate. Of course, one has to factor in individual differences and track record, etc. (I am not a doctor, just play one on TV, etc.)

pem
 
I think it would be helpful to mention the tissue valve about which you comment lasted 11 years, was implanted in 1989. Tissue valves have vastly improved since that time. It doesn't seem quite right to omit that bit of pertinent information.

My Mass General surgeon implanted my tissue valve as my second OHS. My first did not involve any valve issues. When I asked both before and after the surgery about scar tissue from the first and difficulty it added to the surgery, my surgeon said it was no problem at all for him. He went through whatever scar tissue safely and 'handily'.

I recently spoke with someone who got a bovine valve put in about 7 years ago in his early 40s. His surgeon told him that it would likely last 30-35 years, and possibly longer. Is there truly evidence to support this? I understand that there have been improvements on tissue valves, and that the "3rd generation" valves are expected to last significantly longer, but 30-35 years? That would be great!

pem
 
I have not heard 30-35 years but have had doctors say 20-25 is not unrealisitic to hope for.
I think it hugely pertinent to bring into the conversation the high likelihood that many (most ?) tissue valves implanted today will have a great chance of being replaced, if replacement becomes necessary, by cath and not by traumatic surgery. We are into a whole new world of valve replacements. It isn't tomorrow; they are today replacing valves by cath in patients too ill to have traditional surgery. It will become common for the majority of valve patients to have percutaneous replacement. The studies will show us how long cath replaced valves will remain viable.

So many of the world's top cardiothoracic surgeons are saying the same thing.... they cannot all be wrong. Percutaneous valve replacement is not a 'far off dream'.
 
Back
Top