Which valve and wear and tear

[Phil]

This is my first post.
I had surgery to repair my aortic valve in 1965 and had AVR in 2002 (human tissue).
I had a check up last week where my surgeon mentioned I was experiencing 'wear and tear' and that he felt the valve would need to be replaced once again. (Perhaps 12 months time - although, he felt it may longer).
I was a little shocked as I thought I would get more years from the valve which was replaced in 2002.
My surgeon is open to replacing the value with human or animal tissue. However, my cardiologist is pretty against it (favoring a mechanical valve).
It's all a little confusing.
My questions are:
Which valve is best? (I'm 53).
When the valve starts its wear and tear process does it ever plateau, or is it a continual donward spiral?
Any responses would be greatly appreciated.
Cheers.
Phil.

 

[ottagal]

Hi Phil,
I am sorry to read of your circumstances, but glad you found us. I wish I had answers for you, but unfortunately don't at this point. Hopefully, other members who have had a second surgery will chime in to give you some advice.
Hang in there...you will get through it. This is a great place for support.

 

[Phil]

I'm glad I have found the site, too.
It's an informative and empowering.
Thanks for your good wishes.

Phil.

 

[OldManEmu]

Welcome Phil
A tissue valve that is implanted in a 43 year old and has given 10+ years of service has done OK.
Once the valve starts to deteriorate it will continue to do so until it requires replacement.
Valve choice is a difficult decision; I think the best way to look at it is which has the downside that you find most acceptable.

 

[Phil]

Thanks for your response.
I guess I want to know how long the deterioration takes before surgery, but realize it must be an individual thing.
I need to relax and wait the 12 months and see. I'm having an Eco in May next year. Hopefully, this will make things clearer.
Your response is much appreciated.
Cheers.


Phil.

 

[chaconne]

Phil,

If you're going to go mechanical, I think all the options out there are good, particularly the bi-leaflet: St. Jude, ATS and On-X. I just had an On-X put in a week ago. These are supposed to last a lifetime, but issues other than the valve wearing out can occur and limit the useful life.

You will find that there are a lot of people on this forum that chose mechanical and are very happy. This includes athletes, and those who do manual labor.

Best wishes with your situation and valve choice.
-Steve

 

[Randy Fecteau]

Phil.
Hello and welcome. Don't know about deterioration but I know that I am 54 and they didn't even consider using a tissue valve at my age. ( but that will be your decision). My surgeon said he only wanted to hopefully do one surgery and that a tissue valve would definately result in another surgery in my lifetime. I have only had a mechanical valve for seven weeks. besides getting my warfarin level stable I don't find any other restrictions so far and I am glad that I will have a good chance of never having another surgery. Whatever choice you make I'm sure it will be the right one for you good luck with all your journeys.

 

[Greg a]

Phil, WELCOME TO THE FAMILY the choice you face is VERY personal and once you make it be comfortable with it. Proponents of mechanical valve (I think member Dick has had a mechanical for almost 44 years) are comfortable testing their blood and adjusting meds. My dad was not so comfortable and so picked a tissue (bovine) that lasted him 23years.

 

[Lynlw]

Welcome Phil
A tissue valve that is implanted in a 43 year old and has given 10+ years of service has done OK.
Once the valve starts to deteriorate it will continue to do so until it requires replacement.
Valve choice is a difficult decision; I think the best way to look at it is which has the downside that you find most acceptable.

I agree with EMU. Hopefully it will be a little while before your valve needs replaced and the ways things are happening , by then maybe your choices are clearer Since you were in your 40s this valve and will be in 50s next, accordig to most stats the tissue valve SHOULD last longer in 50 year olds.

As for which tissue valves last the longest both the Edwards perimount and Hanncock II both have great stats at 20-25 years in "older' people, I'm not sure which valves are commonly used in Austrailia, but it seems the hancock isn't used much in the US.

FWIW CCF is now using the Edwards perimount in most of their patients 40 and up.. mainly because of how the "newer" tissue valves are lasting as well has how good the stats are for REDOS, but the fact the odds that IF you choose a tissue valve now, it has a good chances of being able to have it replaced by cath has alot to do with it. that could be the best of both worlds, no REDo and no coumadin.

Since you've already had surgery and know what recovery was like etc. it might be easier to decide what you rather try to avoid by this choice.

Good luck even tho I hope it is a long time before you need surgery, i hope you stick around.

 

[Luana]

I was almost your age when I had my AVR. I was leaning towards a tissue valve. My surgeon told me it would mean at least 2 or 3 additional surgeries . That was enough to convince me to get a mechanical valve.

Not sure what's so personal about the decision. If you don't mind having more surgeries, get a tissue valve. If you don't want more surgeries (which, of course, there is no guaranty), then get a mechanical valve.

I don't think trying to avoid ACT is the best reason for choosing a tissue valve as you may end up needing it for a-fib or another reason. A blood test once a month is no big deal and my dose only changes slightly every once in a while. The ACT has been the easiest part of my recovery.

 

[Phil]

Thanks. I'm leaning more towards a medhanical one. I think .....

 

[Phil]

7 weeks - wow. Glad it 's working out for you.

Take it easy.

Phil.

 

[normofthenorth]

Either choice can turn out to be easy or hard. Let me "third" Emu & Lyn's suggestion to compare the downsides, too. If things go smoothly, either way, you'll never be tempted to second-guess your decision. But if you (e.g.) choose mech and need a re-op anyway, or choose tissue and have to be on lifelong ACT anyway, you'll have lots of time to second-guess, and maybe regret or beat yourself up. It's worth a few minutes to review those possible reactions first.

At 53, I think you're still younger than the crossover age for most of the official guidelines -- i.e., I think most national Heart Associations would still suggest that your overall expectations would be better with mech. There are excellent reasons to hope that you could have a non-invasive tissue "re-do" via TAVI -- or that ACT protocols will become much easier for mech valves. I think those upsides should go into the "stew" along with the downsides and the most likely or "expected" outcomes.

Good luck! Any of your valve choices will be a big improvement on a valve that's starting to fail.

 

[Phil]

Thanks for taking the time to respond.

I agree with all of what you said and know ultimately, the decision I make will be the right one for me.

I've enjoyed all of the responses and in a strange way feel connected to a community who knows what it's like dealing with a heart that's not working so well at the moment. It feels empowering.

You have a good day.

Cheers.


Phil.