DO MACHANICAL VALVES FAIL

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rr3972

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May 20, 2011
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Mechanical valves are supposed to last a lifetime, but do they always? If tissue valves fail they usually give you warning signs . If a mechanical valve does fails would it just stop? I've seen lots of post with mechanical valves that have lasted, but are there post that state they haven't?
 

pellicle

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the short answer is essentially no.

the more detailed answer is I've read of two failures of a modern pyrolytic carbong valve (a St Jude) failing. It essentially made headlines in the medical literature at the time.
https://www.ahajournals.org/doi/full/10.1161/01.CIR.0000070590.42796.F0

some other readings:

https://academic.oup.com/ejcts/article/23/1/86/379787

Structural stability and excellent mechanics resulted from the choice of a titanium alloy for the housing combined with the decreased thrombogenicity of the pyrolitic carbon coating. The hinge design was based on the principle of rolling without sliding. Consequently, uninterrupted washing of the hinge surfaces is achieved at each point of the cardiac cycle with controlled blood leakage.

https://academic.oup.com/ejcts/article/25/6/953/381607

Two patients who suffered acute failure of their St Jude Medical Masters aortic valve prostheses due to leaflet arrest that were unrelated to suture material are presented. It was hypothesized that the valves failed because force applied to bear upon the valve annulus caused the hinge mechanism to become restricted or to arrest.

These are definately edge cases, and to my knowledge the two main reasons for "failure" of mechanical valves remain external to the valve. These are:
  • pannus (a tissue growth obstructing the valve, I understand this effects tissue prosthetic valves too
  • thrombogenic obstruction (where blood clots form on the valve and block its operation. This is preventable with proper adherence to Anti Coagulation therapy (warfarin) and when it has progressed (through non compliance with AC Therapy) can in the main be treated now with non surgical options such as TPa ( https://www.ncbi.nlm.nih.gov/pmc/articles/PMC4625813/ )

The general surgical guideline is that a mechanical prosthesis is recommended if the expected lifespan of the patient is longer than the expected durablity of a tissue prosthesis. This is of course most likely going to happen in people under 60.

Best Wishes
 

pellicle

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Perhaps others (as well as @dick0236 )may appreciate this nice simple demonstration of the hamodynamic flow issues created with the old ball cage valve ... if I find one on bileaflet I'll post.

But the turbulence flow patterns are interesting and demonstrate why Anti Coagulation therapy is more than just a good idea with those older valves (considering flows on the other sides of the wires and the potentials for clots to form and be bashed off back there)

 

Warrick

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I remember reading of 2 failures , one was a mitral leaflet dislodge,it was caught in the aortic arch and the patient survived, the other was an aortic bileaflet (not sure of brand) and they did not.
The St Jude Silzone valve was recalled after large numbers re-ops due to paravalvular leakage.

They describe failures as catastrosphic.. but extremely rare.
From what Iv read the failure rate is in the tenths of a percent for all the thousands implanted worldwide.
More chance of getting run over by a bus..
 

dick0236

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Thanks for the demo Pellicle. I knew you could add some good scientific fact. Incidentally, I've known for some time that the blood flow dynamics of my ball valve increased the chance of stroke........ yet I have been on ACT for 51+ years with only one stroke.......and that was in the early '70s and was primarily due to my own sloppy PT (INR) management coupled with a lack of professional understanding of the relationship between mechanical valves and anticoagulants.
 

pellicle

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.... Incidentally, I've known for some time that the blood flow dynamics of my ball valve increased the chance of stroke..
yes, I expected that. I posted it because I've also had experience (in personal off site communications) how many people have read your report of stroke but not understood how different your valve is to (say) mine.

Educating people is an uphill and relentless battle. I hope you didn't mind me taking advantage of that moment
 

JaneF

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I used to worry about the same thing for the first 6 months. I was a nervous wreck about it.

I finally came to gripes with the fact that my surgeon had made the best choice for me. I went into surgery expecting a repaired valve and came out with a mechanical one.

I have decided to not worry anymore about that and just be thankful my problem was diagnosed and fixed and be thankful and enjoy every single day.
 

Duffey

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I remember reading of 2 failures , one was a mitral leaflet dislodge,it was caught in the aortic arch and the patient survived, the other was an aortic bileaflet (not sure of brand) and they did not.
The St Jude Silzone valve was recalled after large numbers re-ops due to paravalvular leakage.

They describe failures as catastrosphic.. but extremely rare.
From what Iv read the failure rate is in the tenths of a percent for all the thousands implanted worldwide.
More chance of getting run over by a bus..
As Warrick mentions, the St. Jude Silzone did turn out to have a defect in its coating. One of the early VR members, Billy, joined the forum after his wife died following implantation of the St. Jude in the mitral position. The failure wasn’t immediate, I seem to remember it being six months to a year post-op, but it was unexpected and catastrophic. She was tired, laid down to take a nap, and was dead when Billy checked in on her. He later sued the manufacturer. Nothing is certain when it comes to valve replacement.
 

vitdoc

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In the good old days prior to the St. Jude valve there were tilting disc designs that had a significant failure rate. I believe these have long been discontinued but there probably still are significant numbers still out there.
 

thomas999

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Jul 18, 2012
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sterling heights, michigan, usa
i have had my st. Jude aortic valve prosthesis for almost 32 years now, and have been very active. I always hear good things about that particular valve has lasting as long as a person lives, and dying of something else besides valve failure. I don't know how many times I've heard the stale joke that says 'I don't have to worry about valve failure until it stops working', or some version likewise. Of course I would probably be dead when it fails, none the less, I get tired of hearing that silly joke. If St Jude aortic valve last 32 years and counting in my body which has been very active, it makes a very good case for the Integrity of these particular mechanical valves.
 

pellicle

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She was tired, laid down to take a nap, and was dead when Billy checked in on her..Nothing is certain when it comes to valve replacement.
No point in going into specifics, but nothing is certain when it comes to life...

Never fail to say I love you when you have the urge, nor hesitate to resolve that conflict when you have the chance.

Life is uncertain and death most often unexpected.
 

tom in MO

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In the US, by law problems with medical devices have to be reported to the US FDA. You can take your valve model number and research any failures on their website. After my operation, 2/2012, I investigated and found my St. Jude 23AGFN-756 had one reported failure which resulted in death. I don't plan on checking it regularly :) and I am happy I didn't check before!

One of the things about an "older model" valve is it has a history so your surgeon can be more sure about durability. My cardio and surgeon indicated that my valve will last long enough for me to die from something else :)
 

JonML

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Dec 22, 2014
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Erie, PA
That's why at doctors appontments they listen to the heart for crisp closing sounds.
1976 had a Lillehi-Kastor(?) aortic valve put in (what I was told was they were just coming out with the St. Jude valve). Basically it was a disc that would lift during pumping and hit 2 "fangs"...looked like rattlesnake fangs. That did go bad in 1990 with growth around the disc so there was leakage. They put the St. Jude in and no problems (29 years). Had the mitral valve developed tears and had to have that replaced in 2000 and it was a St. Jude with the silzone. They had a recall but I ain't giving it back!! Apparently what I read was they had test groups of approx. 400/400(?) without silzone and same number with it. It turned out that there was maybe 1-2 more failures with the silzone so I feel it is inconsequential. Oh and was told the Liliehi-Kastor had a 140 year guarentee and that the St. Judes was longer.
 
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