D
davidfortune
Study results showing longevity with tissue valve under 50 years old = longevity with mech valve under 50 years old.
Tissue Valver Longevity
Tissue Valver Longevity
Help Support Valve Replacement Forums:
S
Susan BAV
That was extremely interesting and worded in such a way as anyone can understand it. I guess I had read a hint of it before, but I had forgotten or hadn't fully realized that there could be such a difference in aortic and mitral replacements, though. Thanks for posting that, David.
PathFinder
Well-known member
mechanical
mechanical
My cardiologist doesn't give a chance for discussing the choice of a valve for me. She decided, that when I must be operated. the valve will be mech for shure. I'm 23 yearo. And thid data includes only this 296 young patients, or all of the followed patients?
"Of the total group, 296 patients were younger than 50 years during their first valve operation, and those younger patients formed the basis for the primary analysis of the data.
For aortic valve replacement, the 20-year survival was 59.9 percent with mechanical valves and 72 percent with tissue valves. The 25-year survival was 47.2 percent with mechanical valves and 64.1 percent with tissue valves. After adjusting for risk factors (such as high blood pressure and coronary artery disease), survival was similar between patients who received the mechanical or biological valves."
mechanical
My cardiologist doesn't give a chance for discussing the choice of a valve for me. She decided, that when I must be operated. the valve will be mech for shure. I'm 23 yearo. And thid data includes only this 296 young patients, or all of the followed patients?
"Of the total group, 296 patients were younger than 50 years during their first valve operation, and those younger patients formed the basis for the primary analysis of the data.
For aortic valve replacement, the 20-year survival was 59.9 percent with mechanical valves and 72 percent with tissue valves. The 25-year survival was 47.2 percent with mechanical valves and 64.1 percent with tissue valves. After adjusting for risk factors (such as high blood pressure and coronary artery disease), survival was similar between patients who received the mechanical or biological valves."
M
Mary
Thanks for posting this, David.
PathFinder
Well-known member
...continue
...continue
...becouse it is only 1/4 of the observated grioup?
...continue
...becouse it is only 1/4 of the observated grioup?
D
davidfortune
The stats quoted are for the 296 patients younger than 50 years old. They found 1512 total patients who had been followed for at least 20 year (296 of these were younger than 50 when the surgery happened - the rest were over 50 when the surgery happened and so were excluded from the analysis mentioned in this study).
K
Karlynn
Thanks David, interesting article. I found it refreshing that the writer felt compelled to put this in ?The take home message of this study is meant to be hypothesis generating rather than constituting a definite recommendation.?
As with just about any report giving the edge to a particular valve choice, be it tissue, mechanical or Ross, it leaves me with questions. I don't post this question to disuade people from their own conclusions drawn by the article, just to shine a little bit of light on things not included.
296 were followed who had their surgery before the age of 50. Many of us know that "younger valve patients" can be a highly subjective label. When I see larger groups clustered together - such as "below 50", I would also like to see a further breakdown, such as 20-25, 25-35 etc. One patient could have received the valve at age 49 and another at 29 which we know is a big difference in the wear n' tear of a tissue. So the question I would have is: What is the mean age of this Below 50 group? We know that the younger you are the faster tissue valves are "chewed up" This Below 50 group would put my 21 year-old daughter and me (48) in the same group. I'm pretty certain a tissue valve would last much longer in me.
I do tend to agree with Rachel that anytime we see papers and studies such as this, they almost never discuss the "quality of life" after additional surgeries. We see it discussed with Coumadin usage, but I think it's equally as important to include the issue with redo's.
Pathfinder - I'm sorry - I don't recall if you are a man or woman. But one thing I would say is that if you are a woman and would like to bear children, you should speak with your surgeon about getting a tissue valve. If everything else with your heart would allow you to have a child, then it is safer for mother and child, to be pregnant with a tissue valve. Pregnancy can be done with mechanical, but it is pretty difficult to manage the anticoagulation issues because of birth defects possible etc.
As with just about any report giving the edge to a particular valve choice, be it tissue, mechanical or Ross, it leaves me with questions. I don't post this question to disuade people from their own conclusions drawn by the article, just to shine a little bit of light on things not included.
296 were followed who had their surgery before the age of 50. Many of us know that "younger valve patients" can be a highly subjective label. When I see larger groups clustered together - such as "below 50", I would also like to see a further breakdown, such as 20-25, 25-35 etc. One patient could have received the valve at age 49 and another at 29 which we know is a big difference in the wear n' tear of a tissue. So the question I would have is: What is the mean age of this Below 50 group? We know that the younger you are the faster tissue valves are "chewed up" This Below 50 group would put my 21 year-old daughter and me (48) in the same group. I'm pretty certain a tissue valve would last much longer in me.
I do tend to agree with Rachel that anytime we see papers and studies such as this, they almost never discuss the "quality of life" after additional surgeries. We see it discussed with Coumadin usage, but I think it's equally as important to include the issue with redo's.
Pathfinder - I'm sorry - I don't recall if you are a man or woman. But one thing I would say is that if you are a woman and would like to bear children, you should speak with your surgeon about getting a tissue valve. If everything else with your heart would allow you to have a child, then it is safer for mother and child, to be pregnant with a tissue valve. Pregnancy can be done with mechanical, but it is pretty difficult to manage the anticoagulation issues because of birth defects possible etc.
D
davidfortune
Karlynn said:
Agreed on the age breakdown. The difference between 20 and 40 in terms of tissue valve longevity is probably significant. I would hypothesize that the number of valve recipients dimishes drastically as age diminishes (i.e. many fewer 20 year olds receive valve replacement than 40 year olds and many fewer 40 year olds receive valve replacment than 60 year olds). So the age related breakdown and analysis becomes progressively less relevant (since the statistical pool is much smaller) as the patient age decreases.
Other studies have addressed both longevity and quality of life (in large populations of valve recipients) and the general result of those studies is that:
1. Valve type has no affect on quality of life
2. Valve type has no affect on patient longevity.
There are several factors that may affect the results of a study of this type in both directions. These are just considerations, and are not intended to bolster or detract from the study. Just more grist for the thought mill.
- To speak to Pathfinder's earlier thread, people just didn't have as good an overall chance with OHS 30 or more years ago to begin with. To all our happiness, the longevity numbers actually probably improve every year for both types of valves.
- People may have been given mechanical valves because they had more serious or specialized issues (such as irradiated hearts or myxomatous tissue). It would be difficult to incorporate risk factors for that.
- Anticoagulation was not very accurate for many years, and there were a lot more ignorant medical professionals around then. There were many ACT bleeding and clotting tragedies that needn't have happened.
- Early mechanical valves were more primtive functionally, and weren't proof against bodily corrosion like the pyrolytic carbon models made today. While some of these earlier models did survived quite a while in use, many did not.
- Tissue valves were primitive 30 years ago. Because of this, there were more frequent reops, as tissue valves had a much shorter average lifetime than they do now - generally less than a decade.
- OHS operating techniques and particularly reoperations were unrefined, and generally much more risky than they are now. (Not to minimize that they remain a risk.)
- The under-50 study group is not very large.
Again, just some thoughts you may or may not want to apply to qualify the results somewhat, to whatever degree you feel they may affect the outcome.
I'm delighted that you found this, Mr. Fortune. This is great reading for me. RCB knows how gratifying it is for me to see this type of result. However, I would be remiss if I said I felt it supplied the definitve answer. I look forward to more of this type of long-term study.
Best wishes,
- To speak to Pathfinder's earlier thread, people just didn't have as good an overall chance with OHS 30 or more years ago to begin with. To all our happiness, the longevity numbers actually probably improve every year for both types of valves.
- People may have been given mechanical valves because they had more serious or specialized issues (such as irradiated hearts or myxomatous tissue). It would be difficult to incorporate risk factors for that.
- Anticoagulation was not very accurate for many years, and there were a lot more ignorant medical professionals around then. There were many ACT bleeding and clotting tragedies that needn't have happened.
- Early mechanical valves were more primtive functionally, and weren't proof against bodily corrosion like the pyrolytic carbon models made today. While some of these earlier models did survived quite a while in use, many did not.
- Tissue valves were primitive 30 years ago. Because of this, there were more frequent reops, as tissue valves had a much shorter average lifetime than they do now - generally less than a decade.
- OHS operating techniques and particularly reoperations were unrefined, and generally much more risky than they are now. (Not to minimize that they remain a risk.)
- The under-50 study group is not very large.
Again, just some thoughts you may or may not want to apply to qualify the results somewhat, to whatever degree you feel they may affect the outcome.
I'm delighted that you found this, Mr. Fortune. This is great reading for me. RCB knows how gratifying it is for me to see this type of result. However, I would be remiss if I said I felt it supplied the definitve answer. I look forward to more of this type of long-term study.
Best wishes,
davidfortune said:
David,
I am 45 years old and about to have MV surgery, hopefully a repair, but I have to be prepared to have a replacement option in place for the surgery. I was about to comment that I was very happy my surgeon was open about discussing tissue valves with me - then I realized my soon-to-be surgeon is your surgeon! My 48 yr old brother recently had a mitral bovine valve replacement along with a sister-in-law who had both AV and MV bovine valve replacements last year. They are both doing great and don't seem to be having the same issues as my sister who had a mitral mechanical valve replacement several years ago. As many have said on this web site, it really is a personal choice - it is nice to have a surgeon open to making it my choice.
MaryC
Mitral Valve Surgery 02/08/07, Dr Ryan in Plano, TX
D
davidfortune
Karlynn said:
tobagotwo said:
Absolutely agree. Sorry I didn't add any preamble to my link as I found the article pretty self-explanatory. I was in no way intending to imply that one single study is by itself definitive. It was interesting in particular because it echoed comments by several surgeons recently to VR.COM members (myself included). However, I do think it is "just the tip of the iceberg" so to speak and really only additional time and additional long term studies will bear out the longevity of today's tissue valves (as obviously this study was primarily addressing the prior generation [or maybe 2 generations back] of valves just due to its length of followup - 20 years).
K
Karlynn
One thing that does seem to be remiss in most studies is the issue of quality of life after repeat surgeries. I think one of the reasons for this may be because of the subjectivity of the topic. What is one person's good quality (their ability or resignation to live with some limitations) may be poor quality of another (possibly someone who is an avid athlete having to step back on their activity.) I think it would be hard to quantify this to a point valid enough to include in any paper. Therefore it gets overlooked or remains unaddressed.
I think this is also the reason that debates over valve choice and whether Coumadin is a live saver or an evil drug continues to be contentious. None of us operate on the exact same definition of "quality". For me, taking a pill daily and testing my blood a few times a month does nothing to diminish the quality of my life. For someone else it may be a constant reminder of their "affliction". I was glad to have a valve that didn't put me on a definite time line for my next surgery and gave me hope that it may not even come to pass. For someone else, they'd rather live with the knowledge that the next surgery is inevitable. Neither my thoughts, nor the opposing thought is wrong. What is one person's quality is another person's bad dream. Makes it very hard to put on paper and assign a number to it.
I think this is also the reason that debates over valve choice and whether Coumadin is a live saver or an evil drug continues to be contentious. None of us operate on the exact same definition of "quality". For me, taking a pill daily and testing my blood a few times a month does nothing to diminish the quality of my life. For someone else it may be a constant reminder of their "affliction". I was glad to have a valve that didn't put me on a definite time line for my next surgery and gave me hope that it may not even come to pass. For someone else, they'd rather live with the knowledge that the next surgery is inevitable. Neither my thoughts, nor the opposing thought is wrong. What is one person's quality is another person's bad dream. Makes it very hard to put on paper and assign a number to it.
PathFinder
Well-known member
for bAV
for bAV
It is good to read, that the BAV-people are not prone to coronary artery decease
(The general reason for troubles according to this study). Finaly something not bad for us.
for bAV
It is good to read, that the BAV-people are not prone to coronary artery decease
(The general reason for troubles according to this study). Finaly something not bad for us.ALCapshaw2
Well-known member
I have graphs of "Freedom from Explant" for Pericardial Valves based on age at surgery from the Journal of Thoracoc Cardopvascular Surgery 2006.
The Under 50 group shows a STEEP DECLINE between 10 and 11 years out, from 85% to 50%, followed by a slow decline to 20% at 18 years.
The data for 50 to 60 year olds falls off more gradually beginning at 10 years (90%), to 60% at 15 years, to 30% at 18 years.
I *assume* that this data is for Pericardial Valves WITHOUT coatings to slow calcificaiton.
'AL Capshaw'
The Under 50 group shows a STEEP DECLINE between 10 and 11 years out, from 85% to 50%, followed by a slow decline to 20% at 18 years.
The data for 50 to 60 year olds falls off more gradually beginning at 10 years (90%), to 60% at 15 years, to 30% at 18 years.
I *assume* that this data is for Pericardial Valves WITHOUT coatings to slow calcificaiton.
'AL Capshaw'
C
CathyK.
I am with you David. I think this is only the tip of the iceberg. Thank you for posting this.
This sounds like what Bob has been saying for some time.
This sounds like what Bob has been saying for some time.
Those of us who read threads on this subject should not have been surprised by these results. To me, the big unknown is your own surgical experience. Some people have the surgery and are on their way home after three days. I knew I was going to be OK, but I was still fighting a grim battle after 7 days, followed by a long recovery period.
What would the next battle be like 20 years later, when you may be in your mid seventies? Of course you can increasse you odds by perssonal health decisions, and such things as your choice of surgeon. Then you can read all the studies you want, BUT: there is only one way you are going to find out what the answer is for you.
This sounds like what Bob has been saying for some time.
Those of us who read threads on this subject should not have been surprised by these results. To me, the big unknown is your own surgical experience. Some people have the surgery and are on their way home after three days. I knew I was going to be OK, but I was still fighting a grim battle after 7 days, followed by a long recovery period.
What would the next battle be like 20 years later, when you may be in your mid seventies? Of course you can increasse you odds by perssonal health decisions, and such things as your choice of surgeon. Then you can read all the studies you want, BUT: there is only one way you are going to find out what the answer is for you.
Karlynn said:
G
geebee
A few things come to mind in reading the article and these posts. First, I am really glad I am still alive, having beaten the odds. Second, regarding quality of life - I am in constant a-fib directly as a result of multiple surgeries. Granted, I would continue to have surgeries if needed but my quality of life is diminished because I have had 3 OHS. Third, I was never as sick before my second and third OHS as I was before my first. Given how sick I was, I would never put myself in a position where I had a replacement valve that would deteriorate as my original valve did. The one thing that never seems to get much coverage is that a tissue valve will be subject to failure similar to one's orginal valve. For those who were asymptomatic (sp?) pre-surgery, this may not be a concern. But for those who are quite ill and awaiting surgery, please keep this in mind when making your choice of valve.
S
Susan BAV
I just had another thought...
I just had another thought...
I'm wondering what the ratio of men to women is regarding all of the earlier valve longevity data!
If the necessity of heart valve replacement for women was as sadly and ignorantly overlooked as diagnosing other heart conditions for women -- as it was as recently as a decade or more ago -- perhaps much of the valve data is primarily considering men.
What do you think?
I just had another thought...
I'm wondering what the ratio of men to women is regarding all of the earlier valve longevity data!
If the necessity of heart valve replacement for women was as sadly and ignorantly overlooked as diagnosing other heart conditions for women -- as it was as recently as a decade or more ago -- perhaps much of the valve data is primarily considering men.
What do you think?
Susan BAV said:
I think you are probably right, some of the symptons were probably blamed on hormones or nerves. it would be interesting to see
