Age and tissue valve

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Oslo73

My surgeon told me yesterday that at my age, 33, the biggest problem with
a tissue valve was that I might reject it. Since younger people have better immune systems than elderly people, he would put in an ON-X if the valve repair failed.
After reading much from this site, I thought calcification was a bigger problem.

Any of you out there my age been told the same?
If not my age, what are your thoughts on this?

I would also like to say that if they repair my own valve it probably won`t last more than 10-20 years before i need AVR. If I have to go through another OHS in 10-20 years, why not get a tissue now, and be free of clicks, bloodtests, and coumadin?

And NO, I will not have an ON-X now if I don`t have to!:mad:
Even with mechanical, I would probably need another OHS.
 
Hi Oslo,
I've been trying to local a particular thread written by one of our more informed members, Tobagotwo (Bob), but can't find it. I did find this post of his that I still think gives a pretty good look at tissue and mechanical, so I'm pasting it here. Maybe someone else can find the other post I'm thinking of. The age of the gentleman he's replying to is, I'm guessing, around 50, Arc Weld is the member's name. I believe he was having his aortic valve replace.

tobagotwo said:
The fact is that at your age, it is a real crapshoot.

You would likely require two more surgeries to continue with tissue through your life. That is no small thing, although a growing number of people have decided that way as tissue valves have improved. There are are issues that go with more surgeries, largely around scar tissue, that affect your odds and affect your likelihood of having atrial fibrillation, the most common reason for people to take Coumadin (warfarin) other than having a mechanical valve.

However, warfarin is not a negligible addition to your life, either. Each person's response to anticoagulation therapy (ACT) is unique, so another person's experiences may not mirror your own. Many people do very well with it; others fare poorly. For some, there is not much difference in bruising levels or even bleeding. For others, it can exacerbate nosebleeds, menstrual issues, or ease of bruising. A look through the last year's worth of the Coumadin/anticoagulation forum's files will give you a better understanding of some of the concerns that can accompany ACT for those who are not as fortunate in their experiences.

It is to be remembered that warfarin is not an evil thing: it's what makes it possible to put mechanical valves into people's hearts without causing clots and strokes.

The fatality statistics are similar for mechanical and tissue. They are slightly more favorable for mechanical valve recipients in younger patients, and a little better for tissue owners in older patients. However, the data for those studies comes from prior-generation tissue valves, so it is an open question what those statistics will look like later on.

A lot of making the choice has to do with your perception of risks and your tolerance for daily regimen.

Mechanical valves have a fairly constant, low-level risk of stroke and its alter-ego, bleeding problems. While this risk is enhanced when some medical procedures are required, it is generally just a background noise most of the time. You may find that you can ignore that risk over time, or that you feel empowered by controlling your warfarin intake and INR.

You are not proof from further OHS because you have a mechanical valve. If you have a bicuspid valve syndrome, you may have aneurisms that occur over time that require surgical intervention. If you have deterioration of the heart due to endocarditis or radiation treatments, your problem may be progressive, affecting other valves, which may then require surgery themselves.

Warfarin does require regular testing, sometimes from labs, and most people do have to balance their eating (and drinking) habits to keep their INRs in range. Coumadin and its effects are interactive with many other drugs and some common herb supplements. This reduces the number of pharmaceutical remedies that may be available to you, including over-the-counter pain relievers, like aspirin, ibuprofen (Advil, Medipren), and Aleve, as well as prescription NSAIDs.

There seems to be little accuracy to the doomsaying doctors who would deny Coumadin users so many activites out of fear of bleeding events. Those which bear some concern are activities which may result in head injuries, as it may be more difficult to halt intercranial bleeding. However, when Sonny Bono died after skiing into a tree, he wasn't on warfarin to my knowledge, so the risk may be somewhat elevated, but remains relative.

There is still a fair amount of ignorance among doctors about the proper treatment of people on Coumadin ACT, and you will need to become your own advocate to ensure that one bad doctor or nurse doesn't do you more harm than good. Doctors may improperly order you to go off of your ACT for procedures that don't require it. Some dentists may also demand you go off of warfarin for extractions or similar procedures. Your primary risk from these unlearned professionals is stroke, due to being off of your Coumadin. When you do have bridging therapy with heparin or lovenox, such as for Colonoscopy and some other intrusive medical procedures, it may include self-delivered injections.

So, it would be hard to accept a blanket statement that the use of Coumadin or the risk of stroke is nothing. That said, a mechanical valve itself is highly reliable, runs trouble-free, and rarely deteriorates. It can be an answer for life for some, with no further surgeries.

Tissue valves have peak risks at operation time, and lower risk in between. They have periods when they are in decline, much as your current, original valve is having, before they are replaced. That means a year or more of valve function problems in the future for this new valve, when it hits its useful life limit. And it will happen again in your case, with a second valve, before you are likely to keep your third valve for the rest of your life.

Second or third surgeries tend to be more difficult and run longer, although in non-complicated cases, the risk factor is only mildly elevated. Scar tissue and adhesions tend to cause the most difficulty for the surgeon. However, other health issues, even unrelated to the heart, that come up as you age may make that surgery more difficult for you, or raise your risk level for it substantially.

With multiple surgeries, you also run the risk of restrictions to heart movement due to scar tissue in the heart or in the pericardium which surrounds the heart. Your likelihood of arrhythmias increases as well, as some electrical conductivity and contractility in the heart muscle is diminished in scarred areas.

Having a tissue valve does keep you free from the requirements of valve-related daily medication and testing. You are essentially normal between valve deterioration cycles, with no short-term restrictions on your activities or diet (getting fat is still not a good idea, as it causes overall stress on the heart).

However, having a tissue valve does not always make you free from having to take Coumadin. If you develop atrial fibrillation, or if you are felt to be susceptible to stroke, you doctor may prescribe it for you anyway. Paradoxically, having multiple surgeries is a causitive factor for atrial fibrillation, as is advancing age.

It is to be noted that, with a normal heart structure, you can switch from or to either valve type at any time a surgery is already required on the valve. For example, if you were to have a tissue valve now, and wind up on Coumadin anyway, you could change over to a mechanical valve when replacement of the current valve comes due.

Despite your surgeon's bent toward the stentless valve, the tissue valve with the best track record for longevity is the bovine valve, which has consistently averaged five years' longer useful life than any of the porcine valves to this point, stented or stentless. I would not consider going the tissue route without at least discussing that with your surgeon. His perception is currently based on marketing, not actual patient use study data. Although new anticalcification treatments and perservative techniques have recently been introduced for both types, the structures of the valves have not been changed from their predecessors, so the historical data is likely to still follow through.

Future advancements may change the scenery, but don't hold your breath - or your surgery. The On-X mechanical valve is undergoing trials to see if aspirin ACT provides enough anti-clot safety to allow patients to use it in place of warfarin. However, the results will be unknown for some time.

On the tissue side, if you are older and have other problems, your tissue valve might be replaceable with a catheter-introduced valve, in a more complicated angiogram-like procedure, rather than through more OHS. Some of this type of valve are undergoing trials at this time. However, catheter-placed valves are currently inferior with regard to valve opening size and longevity, and are only being used in compassionate cases.

Each choice is has its appeal and downsides. It is best to look within yourself for the choice that most works with your personal bent, your tolerance for different types of risk, and your ability to faithfully follow some elements of a required routine in life.

Best wishes,
 
Oslo73 said:
After reading much from this site, I thought calcification was a bigger problem.

And that a younger person's body chews up a tissue valve more quickly. I realize that my quoted post above doesn't directly deal with your question, but thought it provided some good info for you on both types of valves.
 
oslo73,
you are in the same situation i was in last year when i had my surgery at 31. look at my posts around may 31, 2005. my surgeon was never concerned about my body rejecting a tissue valve.
 
Hi Oslo!
I had my aortic valve replaced with a bovine valve last year at age 38. No one said anything to me about possible rejection and, to the best of my knowledge, you are correct in saying that the major issue with tissue valves for someone in their 30's is the speed of calcification. I'm wondering if your Dr. was just being sloppy with his terminology, thinking that rejection is a concept most people are familiar with and would be easier to understand?

I can relate to your hesitancy about Coumadin - it is what led me to choose a tissue valve at a much younger age than recommended. That said, many people on this site seem to not have much trouble with it. However, if you feel strongly that you don't want to go mechanical this time, I'd consider going with the repair if your surgeon thinks it might last you 20 years. Repairs sometimes fail early on, but that is certainly longer than you are likely to get from a biological valve at your age. At 38, I'm hoping my valve will last 12 years, but was told it could be as little as 8.
Best of luck, Kate
 
Hi Oslo,
I was never told my body would reject a tissue valve. I asked about it though. My friend had a heart transplant and he is on all the anti-rejection meds. I wondered why I wouldn't have to take them? I was told by my surgeon that you only have to worry about rejection if you are sewing living tissue into someones body. The tissue valves they use are dead tissue and are soaked in chemicals that help your body to not reject the valve. In all the pros and cons I considered when making my choice, rejection wasn't one of the issues. That is why I am intrigued you were told it IS an issue.
Secondly, while it's true that the younger you are calcification occurs quicker, I was told that pre-pubescent youth or youth going through puberty calcify their valves the very fastest. You are I may chew through a valve quicker than say a 50 or 60 year old, but still it will be slower than a teenager. So, a tissue valve is becoming a more acceptable choice for someone our age. It is a tough decision choosing the type of valve...especially at your age. While I fully respect people's decision for a mechanicle or tissue valve, I must say, I am very happy I chose tissue and have enjoyed feeling as normal as possible (feeling/hearing no clicks and ticks and on no meds). But I have future surgery looming over my head too....who knows when. Hopefully not for a looooooong time! You can PM me if you have any other questions. Good Luck! --Janea
 
Your surgeon was probably simplifying his answer for you. Rejection is absolutley not a problem with xenografts (animal tissue valves) or carbon valves, for that matter. What happens with young people and their active chemistries is that they calcify the valve much more rapidly than older folks do.

How confident were they that they could repair your natural valve? If they can feel confident about 10-15 years, you're on a par with what a good tissue valve would be able to do for you at your age. And the ten is probably closer to reality for the tissue valve at your age. Less damage to your heart for them to do a repair, if they can feel it will be a solid fix for that time period.

Do you have any idea about when they might have to do another surgery anyway? Or is it that they're just anticipating that you may have aneurysms or other issues? Timing may be key to keeping the number of surgeries down.

Best wishes,
 
tobagotwo said:
How confident were they that they could repair your natural valve? They were more than 90% certain.

Do you have any idea about when they might have to do another surgery anyway? Or is it that they're just anticipating that you may have aneurysms or other issues? Timing may be key to keeping the number of surgeries down.
If I get to keep my valve they gave me 10-20 years. There is some kind of tissue growing inside my heart that seems to grow by time. It stops the natural flow of blood to the aorta, and as of now also presses up against my valve to such a degree it stops the natural movement of the valve.
Best wishes,

This growing tissue will also have to be removed if I have a mechanical. More than 1 OHS after this one on 12.5 is a given.:(
 
Oslo73 said:
Even with mechanical, I would probably need another OHS.

Is this due to the "growth" inside your heart? my main reason for going mechanical is to not have any further surgery.

Being 37 a week after surgery i'm told the valve will outlive me so i'd be interested if you have heard different.
 
Magic8Ball said:
Is this due to the "growth" inside your heart? my main reason for going mechanical is to not have any further surgery.

Being 37 a week after surgery i'm told the valve will outlive me so i'd be interested if you have heard different.

Yes! The mechanical will probably outlive me too, even though I am going to be a 125. :D
It`s that damn (pardon my French) growth inside my heart that causes me these OHS.

If you don`t have my problem, the mechanical will almost 100% certain be for life. At least that`s what my doctors tell me.
 
I wouldn't personally suggest that a tissue valve would have a twenty-year lifespan for someone in their thirties. It might be possible with the new valve treatments, but no one has shown it yet.

However, if there's very strong reason to believe you'll have to have surgery again in a decade or so, a repair or a tissue valve makes sense. If the repair is uncertain, a tissue valve makes more sense, as you wouldn't want yet another extra surgery for a failed repair.

Assuming I am understanding it correctly, in your rather unusual circumstance, a carbon valve would only bring more complications, due to the required anticoagulation therapy.

The use of a carbon valve is only of value if it negates the risks that would accrue from further surgeries. If you are having the surgeries anyway, you instead accumulate all of the risks of both types of valves: bleeding/stroke and resurgery. And surgery is more complicated and has added risks when anticoagulation is thrown into the mix. To my thinking, your surgeon's wig isn't on straight, if he hasn't considered this.

Continuous cell growth in the heart will also block a carbon valve (there are several here who've had to have reoperations on their mechanical valves due to scar tissue), so having one would not appear to provide any benefit in this scenario.

Best wishes,
 
Oslo, I'm a bit confused. Why is your surgeon recommending an On-X if you are facing more surgeries anyway do to the way tissue grows in your heart? It would appear that if you are definitely looking at more surgeries, tissue would be the way to go if a repair wasn't possible.
 
Confused

Confused

Karlynn said:
Oslo, I'm a bit confused. Why is your surgeon recommending an On-X if you are facing more surgeries anyway do to the way tissue grows in your heart? It would appear that if you are definitely looking at more surgeries, tissue would be the way to go if a repair wasn't possible.

The main reason was that my body might reject the tissue valve. He made me feel the risk was high that it would. That would mean another OHS very soon I guess. Or sudden death? I`m not sure!

I`m not totally convinced by him yet, so I still might choose tissue over mechanical. I have until Desember 5th to decide.
 
Oslo73 said:
The main reason was that my body might reject the tissue valve. He made me feel the risk was high that it would. That would mean another OHS very soon I guess. Or sudden death? I`m not sure!

I`m not totally convinced by him yet, so I still might choose tissue over mechanical. I have until Desember 5th to decide.


IF your doctor worries about your rejecting a tissue valve , to me that would be a huge sign to get a second opinion, since I personally know hundreds of people with tissue valves and have never heard of one being rejected, since as others have said, it is not live tissue like an organ would be which is why you don't have to go on rejection meds, Lyn

edited to add. I would call the surgeon and ask him to explain about the rejection, maybe there was a misunderstanding or he just didn't explain it well enough and used the word "rejection' to simplify what he meant?
 
I have to agree with Lyn....my surgeon said there was no rejection possibility.
 
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