Cardio chat and future of valve replacement

[Gail in Ca]

I saw my cardio today to discuss my latest echo. I finally remembered to ask him if he has any patients with long lasting (20 yrs) tissue valves. He said he has a few, and that what comes to mind for him are the ones that don't last as expected. He has had 2 male patients lately whose tissue valve only lasted less than 4 years. One valve had a tear and the other had small holes in it as if the patient had infection, but none was found.
He said that they tell patients to expect 8 to 20 yrs from tissue valves. Also, I asked about the cath replacements for valves. He said I would not be a candidate because of aorta issues. Only people with no aorta problems could have this type of replacement. And he also mentioned it is for aortic valve not mitral. I found our discussion interesting. He felt that the valves are lasting longer as they are improved, so that's great to know.
My echo showed a pulmonary issue, and he's not worried by it, yet, but wants me to have an echo every 6 mos instead of yearly, and I'm to have another cardiac MRI soon, as it's been 3 yrs since my last one.
Time flies. I have had a couple of mornings lately with crackling in my lungs, but it goes away as soon as I get out of bed. It seems to co-inside with swelling in my ankles. He just said to let him know if it happens again and he will try me on Lasix and potassium. Otherwise, my echo was unchanged.

 

[epstns]

Well, Gail, for many of us, an "unchanged" echo is a good thing. As long as we are doing well as things are, we kind of like to keep them that way. Let's hope it stays stable for a long while.

One of these days I am going to ask my cardio for some info sources to see the distribution of lifespans of tissue valves. In other words, I would like to see the graph that shows the typical "bell-shaped curve" of how long the tissue valves lasted. It would be more comforting (I think) to know that "Most patients get XX years between valves" than to know only the minimum and maximum spans. If this information is out there, I missed it. . .

 

[newmitral]

....... Also, I asked about the cath replacements for valves. ..... he also mentioned it is for aortic valve not mitral.

Hi Gail,

I found that statement particularly interesting, since my valve replacement was a mitral valve, and I went mechanical. At the time, I knew nothing of valve types or surgical techniques and my only concern was not to have to go through it again. However, I was wondering if your doctor might have touched on a question I have about the TAVR (or future TMVR) valves.

It seems to me that there would almost certainly have to be a compromise in the valve design to allow for transcatheter insertion. To make the valve collapse for insertion and expand again for attachment would almost certainly mean the hemodynamics would not be as optimal as current OHS placed valves. I would think that it would therefore require warfarin (or similar anticoagulants) for transcatheter replacement valves if indeed the hemodynamics were worse than current tissue valve designs.

Does anyone know if this is the case?

P.S. I did find some interesting links googling on development studies underway for transcatheter mitral valves. It is clearly not at the same stage of development as the aortic. This article (link below) reports the first successful transcatheter mitral valve replacement in Denmark.
See:
http://www.theheart.org/article/1415389.do

 

[ElectLive]

One of these days I am going to ask my cardio for some info sources to see the distribution of lifespans of tissue valves. In other words, I would like to see the graph that shows the typical "bell-shaped curve" of how long the tissue valves lasted. It would be more comforting (I think) to know that "Most patients get XX years between valves" than to know only the minimum and maximum spans. If this information is out there, I missed it. . .

Steve - For your valve (and mine) the "official" longevity data (and graphs) is here: http://ht.edwards.com/resourcegallery/products/heartvalves/pdfs/clinicalcommuniqueaortic.pdf. For folks with mitral instead of aortic, it is here: http://ht.edwards.com/resourcegallery/products/heartvalves/pdfs/clinicalcommuniquemitral.pdf. There are countless other independent studies etc, usually comparing several valves against each other, but when Edwards advertises that their particular valve should be expected to last this many years in this percentage of patients, they always cite the same source: Data on File at Edwards Lifesciences :rolleyes2:. However, all the specific numbers I've seen that they do give match up exactly with that Clinical Communique.

As you can see, the # of patients studied is moderate (267) and as would be expected, many patients died of other causes along the way. By the way, for anyone who checks these out, please note that actual freedom and actuarial freedom are two very different things...only actuarial takes into account the percentages relative to just those still alive. Obviously, twenty year data is inherently old and reflects only the predecessor of our current valves. Edwards ThermaFix treatments started around 2005, so we just have to wait maybe 7 - 12 more years to find of if actually works!

Gail - Thanks for posting this conversation with your cardio for the benefit of the rest of us.

 

[ElectLive]

It seems to me that there would almost certainly have to be a compromise in the valve design to allow for transcatheter insertion. To make the valve collapse for insertion and expand again for attachment would almost certainly mean the hemodynamics would not be as optimal as current OHS placed valves. I would think that it would therefore require warfarin (or similar anticoagulants) for transcatheter replacement valves if indeed the hemodynamics were worse than current tissue valve designs.

Does anyone know if this is the case?

It is a compromise, probably most so in positioning and paravalvular leak, followed by the opening size issue you mention next. It certainly is more likely to be a good option for those with larger native valves. I wondered the same thing about the possible need for anticoagulation, but for a different reason, since one of the most important complications thus far is stroke. However, the standard protocol is only long term aspirin, and not Warfarin. I've asked two different surgeons, and for the stroke issue, it is much more procedural and short term, not a function of the valve itself being dramatically more prone to clotting. It's hard to take anything for granted yet, though, only evidence in a more "normal" population will really illustrate what device related risks there really are.

 

[Gail in Ca]

Yes, Steve, I should have asked about the typical longevity, as I think all cardiologists know the average life span of a tissue valve. When I got mine in 1989, after the fact, I was told by my cardiologist at that time that the life span was 8-10 years, but average was only 8 years. My 1st surgeon had led me to believe mine could last 15 years, so I was very surprised at the 8 year average. Still, I thought mine would last 15, Ha Ha! Only got 11 yrs, but that was considered good at the time. I read on this site that the average is 12 yrs right now. So, it seems that we are told a wide range of years, but in reality the lesser numbers seem to be the more average life span. So, since '89, the average life span expected has only increased 4 years. I know I always expected great advances after my 1st surgery, but 24 years later, things are very much the same.

 

[Duffey]

My surgeon said to expect 12 years when my Edwards was implanted in 2005. I thought that was low compared to what others reported they were told, but maybe Dr. Kouchoukos wanted to be precise when quoting the literature. Thanks for passing the info along, Gail.

 

[T in YVR]

As I understand it from my own research, as well as my expected surgeon, my cardiologist etc., the longevity of the tissue valve is dependent on so many factors such as age, health, metabolism, activity level, etc. So, it gets hard to really peg a # against how long these will last doesn't it?....it would be great if they had a better way to provide a realistic range based on certain criteria. Its hard for them to say a valve will last from x to y years and then base that on the whole population of AVR people that get one...
Tony