Questions about treatment options

[jamie14512]

Hi i'm a 28 year old male with a biscupid valve awaiting open heart surgery with severe aortic regurgitation.
I am considering a mechanical valve, though a dream of mine is to become a semi-professional boxer in which case Warafin would be off the cards:

What are the requirements for a valve repair? How would i know if im applicable?
How long do valve repairs tend to last? How about under exercise stress?

 

[Survived03]

What are the requirements for a valve repair? How would i know if im applicable?
How long do valve repairs tend to last? How about under exercise stress?

Jamie14512, I can only provide you my own experience with BAV and an ascending aortic aneurysm. They were discovered in 2003. I don't recall if I was presenting stenosis, regurgitation or otherwise. My BAV and aneurysm were discovered after showing minor symptoms of tingling in my extremities, dizziness standing after sitting for a while, and occasional skipped beats. My surgeon performed a T-David V which is aneurysm repair with valve sparing option. The surgeon told me he would look at the valve and decide if he can "clean it up" enough to allow it to stay. I'm guessing this is very subjective. He performed the valve sparing technique. They only had study data going out for seven years but it lasted me 20 years. Rather than link every article, there are quite a lot of publications from many different institutions around the world that quote various success rates for re-surgery and overall mortality. They will probably tell you that it's almost a given that you would eventually need to have you valve replaced. I hope this helps.

edit: exercise stress was minimal with the exception of keeping weight lifting to about half my weight and avoid any lifting that applies long term pushing at max capacity. I skied, mountain biked. hiked, backpacked for long hauls with 50-60 pounds all with the repaired valve.

 

[carolinemc]

Hi i'm a 28 year old male with a biscupid valve awaiting open heart surgery with severe aortic regurgitation.
I am considering a mechanical valve, though a dream of mine is to become a semi-professional boxer in which case Warafin would be off the cards:

What are the requirements for a valve repair? How would i know if im applicable?
How long do valve repairs tend to last? How about under exercise stress?

With Mechanical valve, you would have to deal with Warfarin for life. No to live without it. Many have tried and failed. Repair is a temporary fix till there is a replacement. Repairs are not guaranteed for long term. Best go with the replacement with the mechanical valve. It will last longer than a repair.

 

[jamie14512]

Thanks so much guys, is there any data on long term outcomes of repairs?

Jamie

 

[Gail in Ca]

I had my mitral valve repaired in 09 and it’s now leaking moderate to severe.
Not sure if it’s like comparing apples to oranges with the different valve.
My cardiologist only said to me that they see the repair fail.

 

[pellicle]

is there any data on long term outcomes of repairs?

would it be even transferrable given that you say:

...given that i want to get into boxing at a semi-athlete level, would it be unlikely for a homograph to last 10 years?

to me you want the most physically robust solution.

 

[tommyboy14]

According to the data of Dr. David, who invented Aortic valve repairs, freedom from reoperation is 94% at 20 years.

https://www.annalscts.com/article/v...from reoperation,94.2% and 94.2% respectively.

if that result holds more widely, then this is better than a Ross procedure and as good as a mech valve in terms of durability

Of course Dr David invented the technique, so he might be better than others...

 

[pellicle]

According to the data of Dr. David, who invented Aortic valve repairs, freedom from reoperation is 94% at 20 years.

I am a bit at a loss to explain how this appears not far above that:

it was 98.4% complete and the mean duration was 7.2±4.5 years. ​

This diagram is also interesting

I was unable to readily see what the criteria was for inclusion in a repair. A quick google revealed this:

https://www.valleyhealth.com/services/david-procedure-valve-sparing-aortic-root-replacement
(underline below mine)

You might be a candidate for this surgery if you have a healthy aortic valve, or one that can be repaired. The surgery is not for people with aortic valve damage or calcium buildup on the valve.​

​

Surgeons at Valley may recommend valve-sparing aortic root replacement if you have these conditions that affect that the aortic root:​

• Bicuspid aortic valve disease (BAV)
• Congenital heart disease
• Connective tissue problems related to Ehlers-Danlos syndrome, Marfan syndrome or Loeys-Dietz syndrome

 

[jamie14512]

I asked my surgeon about valve repair, ozaki and homograft and his response was valve repair has earlier failure than tissue valve, homografts last no longer than tissue valves (xenograft tissue valves) and are also a risky operation, an ozaki failure rate is higher than both valve repair and ozaki. He said

Nothing is guaranteed for long lasting other than a mechanical valve - any other options have a significant risk of early failure.

 

[ashadds]

I asked my surgeon about valve repair, ozaki and homograft and his response was valve repair has earlier failure than tissue valve, homografts last no longer than tissue valves (xenograft tissue valves) and are also a risky operation, an ozaki failure rate is higher than both valve repair and ozaki. He said

are you sure ? I think the resilia inspiris tissue valve last as much as a homograft

 

[pellicle]

homografts last no longer than tissue valves (xenograft tissue valves)

If the error bars on that are wide I'd agree, to get really good results from a homograft requires not only a center of excellence specialising in that, but backed up by good work in harvesting, as I posted recently this is about as good as it gets:

For all cryopreserved valves, at 15 years, the freedom was ​

⦁ 47% (0-20-year-old patients at operation), ​

⦁ 85% (21-40 years), ​

⦁ 81% (41-60 years) and ​

⦁ 94% (>60 years). Root replacement versus subcoronary implantation reduced the technical causes for reoperation and re-replacement (p = 0.0098).​

So, pick your age group in there then pick how luck you feel (same goes for the bio-prosthesis (but perhaps I've never seen such succinct presentation of that data)

For instance if you were in the middle of the 21~40 group on implant then at 15 years you could be part of the 15% who didn't make 15 years.
I was part of the group that made it to 20 years (data not presented or available on the %ages of everyone else).

Have you had Lp(a) checked?

Knowing what I know now, and knowing what technology exists now that didn't exist in 1992 when at 28 I picked a homograft I'd probably pick that now ... but of course that would not have prevented the aneurysm ... so I'd still end up having that subsequent surgery in 2011.

are you sure ? I think the resilia inspiris tissue valve last as much as a homograft

of course, a little give or take either way I'd agree with that too

 

[Gail in Ca]

In 2009 my surgeon told me to expect 10 years from a homograft. I was in my
50’s. You got a good long time from yours. I got another mechanical!

 

[jamie14512]

Knowing what I know now, and knowing what technology exists now that didn't exist in 1992 when at 28 I picked a homograft I'd probably pick that now ... but of course that would not have prevented the aneurysm ... so I'd still end up having that subsequent surgery in 2011.

Can i ask what it is that you know that would make you choose a homograft over a mechanical?

My current thinking is that it is not unlikely for a homograft to fail under 10 years so i'd rather play it safe an get a mechanical

 

[Habana58]

My choice would be to be born with a tricuspid AV , but if that did not happen and i got a suffocating bicuspid one that did not allow me to walk up a hill , then i would choose again the one that would keep me from seen again my nice Surgeon, who told me, "the one thing you dont want to do, is to see me again "

 

[dornole]

At age 28 ? I’d say get a mechanical and come up with another cool and awesome dream. There are several warfarin warriors on here that do amazing things. Repeat surgery is no joke.

 

[newarrior]

At age 28 ? I’d say get a mechanical and come up with another cool and awesome dream. There are several warfarin warriors on here that do amazing things. Repeat surgery is no joke.

Repeat surgery agreed on that-unless maybe it's a TAVI--and even then risk, stress

 

[Chuck C]

my nice Surgeon, who told me, "the one thing you dont want to do, is to see me again "

Two days after my surgery my surgeon came to visit me in ER. It was a debriefing of sorts, with him explaining to me details of what he did and how the surgery went. As always, he took as much time as needed to fully answer each and every question that I had. As he left, I gave him a heartfelt thank you then I said: "Don't take this wrong doc, but I hope that I never see you again." He laughed and agreed.