Life Expectancy after Valve Replacement

[DachsieMom]

Well, I was 41 at the time of my AVR surgery. I have a st Jude mechanical valve conduit. My surgeon, who has done thousands of surgeries, claims I will have a normal life expectancy. I have two young children so I am going with that! Planning on at least 50 years. People live a long time in my family.

 

[ForeverThankful]

Well, I was 41 at the time of my AVR surgery. I have a st Jude mechanical valve conduit. My surgeon, who has done thousands of surgeries, claims I will have a normal life expectancy. I have two young children so I am going with that! Planning on at least 50 years. People live a long time in my family.

My Surgeon, who also has done thousands of aortic valve replacements, says the same thing as does my cardiologist and my family doctor. I trust all three with my life and if they say I will have a normal life expectancy then I will listen to them.

Here's to a long and happy life for all of us!

 

[Bigred]

Nocturne,

I had AVR surgery back in 1989 at the age of 15. This October will be 27 years for me with a St. Jude mechanical valve. I will eventually have to get this replaced since I have an ascending aortic aneurysm that I'm in the watch and wait phase of.

I would like to think that you may just be in the doom and gloom phase and are trying to adjust to information just recently received.

A couple of things that are being left out: Prosthesis plays a part in these studies. Some of the studies do not indicate what type of prosthetic was used, some are older models that are no longer used for various reasons (inefficiency, newer model, retired).

I'm not trying to get into a debate with anyone, just going to point to another study that is not so doom and gloom. Pellicle attempted to open your eyes to another way of viewing life in general but I think you may not be ready for this. We all process information differently.

http://www.stretchphotography.com/avr/documents/Emery et al-Annals-25yr StJudes.pdf

 

[cldlhd]

Pellicle, what I have done is present actual studies and articles featuring actual data on the observed longevity of AVR patients. Some of you have raised some important points, like looking at the age of the patients, or comparing their projected lifespans with those of people who have not needed AVR. And I've found other studies that do those things, and they all seem to be saying the same bleak thing.

I get that it's possible to misread the data, but if that is the case here, then actually telling me how I am misreading the data is much more useful than giving me an airy line about "look at a circle or triangle a different way and it's a cone!" You're saying that I'm misreading the data -- OK, how am I doing that? Or is that just something that people would like to believe?

I'd like to believe that I've got a normal lifespan ahead of me too! But I'd rather get the facts and make realistic assessments about my future than try to blow a rainbow up my butt. If I'm not likely to see my seventies, that sucks, but let me have that information instead of handing me a rosy illusion (which I believe my primary doc has tried to do).

I've seen articles and such online insinuating that AVR patients have normal lifespans, and all of them -- without exception -- either lack actual data or use weasel words like "comparable to a normal lifespan" or "approaches a normal lifespan". I can COMPARE myself to Michael Jordan by pointing out that we're both humans without ovarian cancer, but that doesn't mean that I'm Black, tall, or good at basketball. I can take two steps to the left and rightly claim that I have APPROACHED New York City -- doesn't mean I'm anywhere near the place.

If it's true that AVR survivors have normal lifespans, then there must be some studies revealing that information. Anyone here know of any? Anyone? Because I've found study after study and article after article indicating the opposite. If I'm wrong, there must be SOME data out there contradicting what I've found.

I can see why people might get riled up about this, because many people don't want to see the reality of their own impending deaths. And I can see -- concretely -- that at least SOME people here have made it 30, 40 years after AVR, which is great for them and great for me (because there is the possibility of a normal lifespan for me). On the other hand, if -- as you insinuate -- it's required for an AVR patient to become a health nut and engage in rigorous training in order to have a hope of living a normal lifespan -- remember that MOST people do NOT have to do that in order to make it to their eighties! Insinuating that rigorous training is needed for an AVR patient to make it to their seventies and eighties is a tacit admission that AVR patients have significantly reduced lifespans.

As I have shown:

http://www.acc.org/latest-in-cardiol...-young-patient

"Aortic stenosis, its cardiac sequalae, and its treatment all result in reduced life expectancy, regardless of therapy. The life expectancy after valve replacement varies with age, but life-table analyses of large datasets suggest the average life-expectancy of a 60 year old after aortic valve replacement is about 12 years."

Wish it were not so, but wishing won't make it so.

So that would 72 years old ? Isn't that approximately the normal life span for a male?
I know this is anecdotal but my grandmother's husband had valve replacement surgery in his 70's and died last year at the age of 88 from cancer.

 

[Agian]

Large studies from the Mayo Clinic and Children's Hospital in Toronto have found patients with BAV have a lifespan no different from control patients (without BAVs).
I haven't seen the papers. I'm sure you'd be able to find them online.

 

[Nocturne]

Thanks, Bigred. I'm a data person, and I need to see the data.

The information from St. Jude's is very positive WRT the durability of their prosthetics. However, even it comes out and directly states that AVR recipients do not live as long as the general population, on average.

Agian, I'm glad to hear that BAV patients live as long as everyone else! Do they ALWAYS need AVR? I thought it was only a percentage.

In any event, I do not appear to be BAV, but rather someone who developed calcific AS at a very young age. No doubt this was partly due to lifestyle factors (mainly obesity and sedentary lifestyle), as I had been obese for -- oh, 6 or 7 years before finally losing the weight (and THEN learning about the AS). However, with the hefty percentage of obese men in their early 40s who do not exercise much but do NOT have heart disease (yet), I have to assume that there was more going on than just that -- at least in part, it appears to have been genetically shitty lipid levels, as even now at my ideal weight range and with daily exercise and healthy diet, my lipids suck.

BAV information doesn't much apply to me, and spit take inducing early onset calcific AS information doesn't much apply to most people here, it would seem. As it stands, a guy with a CAC score of 156 at age 42 is in pretty dire straits WITHOUT AS being thrown into the mix.

I can hope -- and clearly I do hope, because otherwise I wouldn't be bothering to maintain the weight loss and other lifestyle changes -- but I have few illusions about it being more than a hope to beat the odds.

 

[Nocturne]

Large studies from the Mayo Clinic and Children's Hospital in Toronto have found patients with BAV have a lifespan no different from control patients (without BAVs).
I haven't seen the papers. I'm sure you'd be able to find them online.

Think I found the study:

http://jama.jamanetwork.com/article.aspx?articleid=182573

"Conclusions In this study population of young adults with bicuspid aortic valve, age, severity of aortic stenosis, and severity of aortic regurgitation were independently associated with primary cardiac events. Over the mean follow-up duration of 9 years, survival rates were not lower than for the general population."

What is not clear is if any of the study's subjects had had AVR yet. In my first reading, I saw no mention of the procedure. But it's surely good news for the BAV folks here in the waiting room, at least!

 

[dick0236]

. I'm a data person, and I need to see the data.....but you try to find data that only supports your dire conclusions.

......The information from St. Jude's is very positive WRT the durability of their prosthetics. However, even it comes out and directly states that AVR recipients do not live as long as the general population, on average.......OK, but I guarantee that AVR patients live longer than those patients who "stick their heads in the sand" and refuse corrective surgery until it is too late.

.......Agian, I'm glad to hear that BAV patients live as long as everyone else! Do they ALWAYS need AVR?.... No, some obviously do not require surgery and others can postpone it for many years (my daughter-in-laws' father had BAV "tissue valve" at 76...and two years later he's still here and doing OK.


.......In any event, I do not appear to be BAV, but rather someone who developed calcific AS at a very young age....at the time of my surgery my docs diagnosed me with sever aortic stenosis(AS) due to scarlet/rheumatic fever at age 6 or 7......that's pretty young and I'm still here......at age 80.


....BAV information doesn't much apply to me,.....then why do you put so much "stock" in trying to fit your case into into " information doesn't much apply to me".

.

I really don't mean to be "mean spirited" with you......but you sound like me a few decades ago. I was ABSOLUTELY sure I would not live to 50 and I made myself, and those around me, as miserable as I could with my "yes, but if you only understood how sick I am" melancholy.

 

[MethodAir]

Don't believe everything you read on the internet. The risk factors for mechanical valves are very low. I haven't read anything to suggest they increase over time. A native tricuspid aortic valve is subject to wear and tear, whereas mechanical one should not be. I would be more curious to know about the mechanisms that account for the findings (in the unlikely event they even exist), rather than a bunch of blind numbers that have little or no relevance to me.

 

[pellicle]

Thanks, Bigred. I'm a data person, and I need to see the data.

what you mean is "you need to be spoon fed someone elses conclusions" ... as you ignore the data which does not support your views and fail to unertake any discussion about the actual data presented in your papers. You ignore the basic premise in how a study is contrstructed and disregard that a study is a discussion of one view of a data set, acting instead as if its the Bible not an academic work. ... you seem to wish to focus on supporting a sense of sadness for your loss ... when indeed you have not lost anything yet

 

[pellicle]

Dick

I really don't mean to be "mean spirited" with you......but you sound like me a few decades ago

I think we've all tried to be variously reasonable, discursive, even attempting to "butt kick" ... but I'm convinced that its more productive to talk to my brick wall here:

 

[Nocturne]

I really don't mean to be "mean spirited" with you......but you sound like me a few decades ago. I was ABSOLUTELY sure I would not live to 50 and I made myself, and those around me, as miserable as I could with my "yes, but if you only understood how sick I am" melancholy.

I don't think you are being mean spirited at all. In fact, I'm glad to hear that you were in the same place I was when you were younger and less experienced with your condition. It's to be hoped that someday I'll be 80 and telling some terrified initiate something similar. I'll raise a glass to you if that ever happens!

 

[Nocturne]

Don't believe everything you read on the internet. The risk factors for mechanical valves are very low. I haven't read anything to suggest they increase over time. A native tricuspid aortic valve is subject to wear and tear, whereas mechanical one should not be. I would be more curious to know about the mechanisms that account for the findings (in the unlikely event they even exist), rather than a bunch of blind numbers that have little or no relevance to me.

Actually, what I'm seeing in the studies I have read is that the lower lifespan typical of AVR recipients generally isn't about valve failure per se. Again, the more recent study I posted found a survival rate of 90% normal for AVR recipients who didn't have any comorbidities.

OTOH, looking at the average survival rate as compared to the overall population, it's pretty clear that AVR and comorbidities must go hand in hand. That's certainly going to be the case for me, given my abominable CAC score. I technically have heart disease (subclinical) at the age of 42. Not good.

I spoke at length with coworker yesterday, though. This woman has a rare lung disease that creates cysts in her lungs, and will likely need a lung transplant in the future. She learned of it while she was pregnant with her first child, at the age of 23. The doctors came out and told her that she had about 10 years to live. Then she got breast cancer.

She's still alive now, at the age of 52. She goes out and parties 3-4 nights a week because that's what she did at 23 when she first learned she had a decade to live. Interesting perspective.

 

[cldlhd]

Comorbitities also go hand in hand with brown eyes....point is comorbitities with any health issue is going to make earlier mortality more likely. I'm 47 and my CT scan I had 2 years ago showed some plaque in my one artery. My doom and gloom cardiologist had me ready to pick out a grave sight but my cardiac cath showed my arteries were large and clear, the plaque is apparently within the wall, not good but my surgeon who reviewed my scans concluded my heart attack risk is low and besides my bav and aneurysm my heart looked healthy. So I had the aneurysm replaced with a graft, the valve repaired and although I'm not fanatical about it I am physically active and try to eat healthy ( I do like a beer or 3 and occasionally when watching tv or a good movie I have a bowl of ice cream-all in moderation) . Point is you do what you can you can't go back and change the fact that you were overweight so just try to do the right things from here out.

 

[MethodAir]

Actually, what I'm seeing in the studies I have read is that the lower lifespan typical of AVR recipients generally isn't about valve failure per se. Again, the more recent study I posted found a survival rate of 90% normal for AVR recipients who didn't have any comorbidities.

The bottom line is that AVR is not a significant risk factor for developing any kind of medical condition (and therefore, a valve recipient can reasonably expect a normal life expectancy, barring other unrelated medical conditions). It's more relevant to focus on how a valve replacement can radically improve heart function (and quality of life).

 

[tommyboy14]

Hello,

I have not visited this site recently, but before I had my AVR, I did some research on this issue. I am an economist, so I deal with statistics and data all of the time.

I have read a lot of articles before I made my choice. So Let me summarise my view on this matter, especially since I needed a root replacement as well, all at the age of 34. In statistics there is something called sample selection bias. In plain language this means that a result is driven by the underlying population you are studying. That is, if your sample includes very sick people, then you cannot use the results to make conclusions for the life expectancy of people, who asides from AVR are healthy. Unfortunately this is something that even experienced statisticians can get wrong and therefore any data that you look at in terms of life expectancy has be interpreted with great caution.

Indeed, the whole debate about the Ross procudure is precisely about this. Lots of studies show that the Ross results in near normal life expectancy. But this could be because the patients chosen for this procedure have very strong underlying baseline health. It is only offered to people who have no other medical problems and whose hearts are in relatively good shape because of the strains that a double valve replacement puts on the patient. On the other hand, mechanical and tissue valves are offered to everyone. So the underlying populations of treated patients are different.
This issue has been explored by the following article:

http://circ.ahajournals.org/content/123/1/31.full.pdf

Note that once you compare Ross procedure patients to mechanical valve recipients, who baseline health is identical to the Ross group and whose INR is optimaly regulated, individuals in both groups have normal life expectancy. Indeed, individuals in the mechanical valve group are slightly less likely to die. Now Look at the authors of the article: Hans Sievers is one of the Worlds foremost Ross procedure surgeons. You can google him and see that over a 20 year period, his sub coronary approach yields excellent results in terms of re-operation and survival. Heinrich Koertke, on the other hand, is the Man who introduced INR home monitoring in Germany and also the world. When I interviewed surgeons around the world for my operation, I spoke to Dr. Sievers and he fully agreed with the conclusion of the article. He told me that he thought that the prothesis does not make a difference in terms of survival. So I suppose that this pretty good proof that, so long you are healthy otherwise, you can expect a normal life expectancy even after AVR.

Indeed, if you look at this paper
http://www.ncbi.nlm.nih.gov/pubmed/17888968

you can see normal life expectancy following the Bental procedure which is what I had. and the most senior co-author on that paper, Randal Griepp help developed the first heart transplant programs in the US.

So studies from some of the most reputable experts in the field suggest that AVR does not affect your life expectancy, so long your baseline health is fine.
Indeed, when I was discharged from the hospital, I could see that I was probably the only person in my discharge class that did not have significant other health problems.
And the data support this hypothesis. This is precisely why it is important to interpret all of these life expectancy numbers with respect to the sample population. After all, if you there 60 elephants and 20 mice in a study, you would not be able predict what happens to the mouse just based on the average, would you?

I hope that this helps clarify things.

 

[Agian]

After all, if you there 60 elephants and 20 mice in a study, you would not be able predict what happens to the mouse just based on the average, would you?
I hope that this helps clarify things.

Elephants have little in common with mice. They're substantially bigger and have a different diet.

 

[Agian]

After all, if you there 60 elephants and 20 mice in a study, you would not be able predict what happens to the mouse just based on the average, would you?
I hope that this helps clarify things.

Elephants have little in common with mice. They're substantially bigger and have a different diet.

 

[MethodAir]

Hello,

I have not visited this site recently, but before I had my AVR, I did some research on this issue. I am an economist, so I deal with statistics and data all of the time.

I have read a lot of articles before I made my choice. So Let me summarise my view on this matter, especially since I needed a root replacement as well, all at the age of 34. In statistics there is something called sample selection bias. In plain language this means that a result is driven by the underlying population you are studying. That is, if your sample includes very sick people, then you cannot use the results to make conclusions for the life expectancy of people, who asides from AVR are healthy. Unfortunately this is something that even experienced statisticians can get wrong and therefore any data that you look at in terms of life expectancy has be interpreted with great caution.

Indeed, the whole debate about the Ross procudure is precisely about this. Lots of studies show that the Ross results in near normal life expectancy. But this could be because the patients chosen for this procedure have very strong underlying baseline health. It is only offered to people who have no other medical problems and whose hearts are in relatively good shape because of the strains that a double valve replacement puts on the patient. On the other hand, mechanical and tissue valves are offered to everyone. So the underlying populations of treated patients are different.
This issue has been explored by the following article:

http://circ.ahajournals.org/content/123/1/31.full.pdf

Note that once you compare Ross procedure patients to mechanical valve recipients, who baseline health is identical to the Ross group and whose INR is optimaly regulated, individuals in both groups have normal life expectancy. Indeed, individuals in the mechanical valve group are slightly less likely to die. Now Look at the authors of the article: Hans Sievers is one of the Worlds foremost Ross procedure surgeons. You can google him and see that over a 20 year period, his sub coronary approach yields excellent results in terms of re-operation and survival. Heinrich Koertke, on the other hand, is the Man who introduced INR home monitoring in Germany and also the world. When I interviewed surgeons around the world for my operation, I spoke to Dr. Sievers and he fully agreed with the conclusion of the article. He told me that he thought that the prothesis does not make a difference in terms of survival. So I suppose that this pretty good proof that, so long you are healthy otherwise, you can expect a normal life expectancy even after AVR.

Indeed, if you look at this paper
http://www.ncbi.nlm.nih.gov/pubmed/17888968

you can see normal life expectancy following the Bental procedure which is what I had. and the most senior co-author on that paper, Randal Griepp help developed the first heart transplant programs in the US.

So studies from some of the most reputable experts in the field suggest that AVR does not affect your life expectancy, so long your baseline health is fine.
Indeed, when I was discharged from the hospital, I could see that I was probably the only person in my discharge class that did not have significant other health problems.
And the data support this hypothesis. This is precisely why it is important to interpret all of these life expectancy numbers with respect to the sample population. After all, if you there 60 elephants and 20 mice in a study, you would not be able predict what happens to the mouse just based on the average, would you?

I hope that this helps clarify things.

Clarity comes from reducing verbose language. One can bypass a lot of extraneous, superfluous data by merely focusing on substantiated risk factors. It's like the cardiac surgeon who outlined the mechanisms of heart disease. He isn't trying to fulfill the foregone conclusions of lobbyists in the food and medical industries with their 'peer reviewed' studies.

There is always someone ready to twist information to suit their own needs.

 

[pellicle]

I thought this was relevant, for while we may focus on our heart issues the rest of the factors influencing humanity still influence us.

http://www.abc.net.au/health/feature...14/4235445.htm