I'm thinking tissue?

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ccummins

ccummins

Well-known member
Joined
Feb 2, 2009
Messages
172
Location
Chicago, IL
So I just met with my first surgeon today. He was really great at not pressuring me either way on a type of valve. He did say that most people my age (38) get mechanical valves to avoid more OHS's. He also said that the next surgeries get more complicated and are not nearly as easy as the first one. So a couple of questions. Is there anyone out there that has had thier tissue valves repaired? It seems like most posts are from people that recently got the tissue valves and haven't needed them replaced. Another consideration that I am having is that in 10 years the valve replacement probably won't require OHS. With the links to new procedures already I would think that in 10 years it would be common place. Any help is appreciated!!
 
my humble thoughts: Percutaneous procedure for valve replacement is now in trial and proved to be successful...for now, it is limited only to those with fragile health who cannot go through OHS. We hope it will be the normal procedure for all in very near future.
 
Tissue valves can't be repaired- once they start to go, they need to be replaced. The newest ones have anti-calcification treatments that they hope will keep them going for 20 years, but there are no guarantees.
 
I would caution in thinking that in 10 years tissue valve replacements won't require OHS. They are just now starting trials on people who cannot survive a surgery. As far as I know they have not yet begun looking into it as an option for the regular, otherwise healthy population. They will need to do studies to see if the valves that are placed via cath will hold up to regular activity, or the very physically active person. The wheels of medical testing and trials go very slowly.

If you choose tissue - do so figuring you're going to have to have at least one more OHS before technology catches up.
 
I have yet to see an answer to the Question of how large is the Effective Area of a valve delivered by catheter and sewn inside your native valve vs. the Effective Area of a Valve Replacement.

It's hard for me to believe that a valve sewn *inside* your existing valve will have an area equal to your native valve and therefore the pressure gradient across the valve would be higher than your original valve which means that you may have reduced exercise capacity and tolerance.

'AL Capshaw'
 
i'm 44 and had tissue installed last month. i expect there will be medical advances
before i'm due for a replacement, but i made my decision on the assumption that any
advances won't apply to my situation, that i'll have to do the same procedure once
again. i can live with that.

a new valve plugged inside the existing valve would definitely have a smaller area.
depending on age and lifestyle, would reduced exercise capacity and tolerance be
a reasonable trade-off to avoid another ohs?

in my case, first avr at 44, second maybe at 55-60, which would put a third at 70-80
years. i'd like to think i'll still be running marathons at 80, but how realistic is that?
 
At 38 I think you'd be nuts to consider a tissue valve and I really dont understand why it's ever a consideration except in the case of woman who want to have children and those with no choice for some reason.
I've heard of too many cases now of them needing replacing in around 6 yrs, far short of the 15/20 estimated. It's not like they're live tissue that hook up and work in harmony with your body, they're not, they're just very thin and very dead cusps taken from a farm animal and treated with some magic jollop to maybe make them last a little longer.
When you're reoperated on in maybe 6 years time it'll be harder and more complicated than the first with more chance of needing a pace maker fitted afterwards. I saw a film recently about this and the surgeon pointed out how several bits and pieces on the "inside" had fused together due to the scar tissue from the first operation. This made things pretty tricky to get at.
I had OHS a couple of months ago and it still hurts when I cough or sneeze, as a rude reminder of the severity of the operation and I also have quite nasty side effects from being on the heart lung machine with all those little bubbles wizzing round my brain !
To want to volunteer to put yourself though all that again in a few years you'd need your head examining, never mind your heart !
Can you tell I'm having a bad day ? I am, still in bed because I over did it yesterday and my chest is hurting so much when I move about, so the thought of opting to go through all this again as soon as your tissue time bomb fails really is beyond my comprehension ?
The flip side is mechanical with ACT. The valve should last for up to 100 years, so should see you through and as for Warfarin, it's really not worth worrying about so long as you can simply remember to take a pill a day and have blood tests it's pretty easy stuff really.
Good luck.
Justin
 
Woodbutcher said:
At 38 I think you'd be nuts to consider a tissue valve and I really dont understand why it's ever a consideration except in the case of woman who want to have children and those with no choice for some reason.
I've heard of too many cases now of them needing replacing in around 6 yrs, far short of the 15/20 estimated. It's not like they're live tissue that hook up and work in harmony with your body, they're not, they're just very thin and very dead cusps taken from a farm animal and treated with some magic jollop to maybe make them last a little longer.
When you're reoperated on in maybe 6 years time it'll be harder and more complicated than the first with more chance of needing a pace maker fitted afterwards. I saw a film recently about this and the surgeon pointed out how several bits and pieces on the "inside" had fused together due to the scar tissue from the first operation. This made things pretty tricky to get at.
I had OHS a couple of months ago and it still hurts when I cough or sneeze, as a rude reminder of the severity of the operation and I also have quite nasty side effects from being on the heart lung machine with all those little bubbles wizzing round my brain !
To want to volunteer to put yourself though all that again in a few years you'd need your head examining, never mind your heart !
Can you tell I'm having a bad day ? I am, still in bed because I over did it yesterday and my chest is hurting so much when I move about, so the thought of opting to go through all this again as soon as your tissue time bomb fails really is beyond my comprehension ?
The flip side is mechanical with ACT. The valve should last for up to 100 years, so should see you through and as for Warfarin, it's really not worth worrying about so long as you can simply remember to take a pill a day and have blood tests it's pretty easy stuff really.
Good luck.
Justin
Click to expand...

Justin, No offense, but there are quiet a few of us on here with tissue valves, including myself, who are in no way "nuts" because we happened to choose differently than you. Even though I can't recall anyone on here who has had their tissue valve fail in 6 years I'm sure it has happened but I also know of several people on here with mechanicals whose valves did not last "100 years". Nothing is guaranteed. My surgeon, who I believe has had much more experience in this area than you, told me he only has had one patient come back at 5 years with a failed tissue valve, and he felt that his lifestyle, which included taking drugs and heavy drinking that he was living, contributed greatly to that happening.

We all make choices based on the risks that we, personally, are willing to live with. Just because they are different than yours doesn't imply that we are basically the village idiots for making that choice.

Kim
 
I would highly encourage you to not look into what the future may or may not hold for surgery. Things might very well not pan out like so many are saying will. It's much too early in the game to be able to decide the outcome and even then, it's a crap shoot.

You must decide on which of the pro's and con's of each valve selection you can best live with. None of us can do that for you. The only wrong choice to make is to do nothing at all.
 
Why is no one talking about the ross proceedure... is that massively out of date now or something ?? Sorry to bring this down to my still, relatively ignorant level, haha . Any info, could be interesting , though !! Bit of a chicken
 
I was a young 55 and wanted a sure thing to last for my lifetime. Even with a history of bleeding duodenal ulcer my choice was mechanical.

Believe me, you don't want but one heart surgery in your lifetime, if it can be prevented.

Therefore I see only one choice for your age.
 
KFay... The last thing I want to do is offend you or anyone, and I'm really sorry if I did. I got out of bed on the wrong side today, or didn't get out as the case may be. Feeling a bit better, and just been for a long walk along the beach ...
I'm sure most people have very valid reasons for choosing a tissue valve and some may have no choice ?
I stand by my thinking though that unless you have a medical or physical reason for not having a mechanical valve then surely mechanical has to be the sensible option ?
I'm sure mechanical valves wouldn't always last 100 yrs, you're right, but I'd rather a top end estimate of a hundred years than 10-15 yrs anyday of the week.
However, I have to say, if mine does last a hundred years I'll probably go for a tissue one next time as I'll be pretty old by then and might start forgetting my medication.
 
bit of a chicken said:
Why is no one talking about the ross proceedure... is that massively out of date now or something ?? Sorry to bring this down to my still, relatively ignorant level, haha . Any info, could be interesting , though !! Bit of a chicken
Click to expand...

There have been several posts about the Ross procedure, with varying results. In the hands of the Top Surgeons (e.g. Dr. Paul Stelzer in NY or Dr. Ryan in Dallas) results seem to be pretty good.

I seem to recall a post to the effect that the Cleveland Clinic has either discontinued doing the Ross procedure, or at least is not promoting it's use after experiencing 'premature' failures. (anyone else remember the details?)

When it comes to the Tissue vs. Mechanical Valve Debate, my position is that it is a Highly Individual Decision which usually comes down to which set of negative aspects the patient believes they can best live with.

The KEY is to make a "Fully Informed" decision based on an understanding of both the positive and negative aspects of each option.

'AL Capshaw'
 
I'm not sure about your question has anyone had their tissue valves repaired, since they can't repair them, but quite a few members have had their tissue valves replaced and quite a few memebers who've had several surgeries. I also would NOT count on caths in a certain time frame, but wanted to say for the aortic trials right now, they are doing them in just people not healthy enough for surgery BUT the pulmonary trials right now are mainly in young otherwise healthy adults and children who ARE leading active lives. In London they've been doing them for 10 years now with MUCH success.
Also they don't sew new valve in to the old one, they use stents that smush the old valve open and the valve is in the stent.

as for calling someone nuts for their valve choice, I THOUGHT that was NOT allowed.

FWIW Cleveland did a study on valves in people in their 40s and their tissue valves were lasting much longer then they expected which is why Cleveland now uses Tissue valves in most people

PS I wanted to add, I know we discussed a few times wonderring IF a tissue valve replaced by cath could be replaced again by another cath and one of the AATS 2008 videos showed that, they smushed the old one out further and put the new one in
 
steady on here people,its common sense to think which valve we choose to be the best for us,we hardly gonna pick the one we dont like,its a bit harsh to come on here saying mech is rubbish tissue is rubbish etc etc,we choose the one best for us,its very hard to try to advise someone else which choice to make,its a very personnal thing,we can go round in circles trying to choose the right one for US,nobody else US,so take all the info and work out which is the one you want,both have pros and cons you could pick tissue and still finnish up on medication,my cardio told me he has known mech fail,remember whichever you choose is the right call for you ok,i have a tissue and know the pros and cons re op etc,but would never come on here and say people who have mech are nuts,sorry woodbutcher but had to get that out lol,hes a good lad really i think he must be having a bad hair day lol,...........right think thats my rant over,...........remember whatever you choose is the righthoice for you,..neil
 
Neil ! You're so right ... Bad hair day ! Nothing like a healthy bit of Mechanicals vs Tissues sparring, which is what these threads always seem to come down to ?
Sorry about the "nuts" thing, each to their own I suppose, I just cant imagine opting for another OHS !?! One was enough for me .
I'll shut up before I dig too bigg a hole .......
 
Justin,
Quit while you are ahead. I will forgive you for calling me nuts for choosing a bovine valve. I read the pros and cons for both and made the decision I thought best for me (another OHS or not, I will deal with it). Now go put some gel on that wild hair you woke up with. :D
 
Everyone makes their choices based on their own needs, fears, limits. My biggest belief is that you should make the decision based on what is available TODAY and not what is hoped for in future technology. When I was 8 I thought for sure we'd be all flying around in George Jetson cars by the time I became an adult. :D In the 70's, had there been an internet and a heart board, people probably would have been excitedly discussing how in 10 years heart replacements with mechanical hearts would be Standard Operating Procedure. We now know that never came to be. However, what was done with mechanical hearts did lead to great accomplishments in temporary heart sustaining devices.

If you go tissue at your age - go in with the thought that you'd like it to last 10 years, be prepared for it to possibly not last 10 years, and be happily surprised if it lasts 20. Then think - and wouldn't it be cool if I didn't have to have OHS for it to be replaced, but count on OHS.

We've seen many members come in feeling like they'd been given overly positive opinions of the valve they had put in (mechanical and tissue and Ross) and were mad or very disappointed when it fell far short.

I'd tell you to ask Mary for her crystal ball, but after the Super Bowl commercial - we see how it gets used. ;)
 
Woodbutcher said:
Neil ! You're so right ... Bad hair day ! Nothing like a healthy bit of Mechanicals vs Tissues sparring, which is what these threads always seem to come down to ?
Sorry about the "nuts" thing, each to their own I suppose, I just cant imagine opting for another OHS !?! One was enough for me .
I'll shut up before I dig too bigg a hole .......
Click to expand...

We aren't going to spar over valve selection any longer. Each side can provide the facts relevant to their case and from there, it's up to the person to choose which set of pro's and con's they can best live with.

By the way, there is no written rule that says a person cannot say "Nuts". It's just something that needs to be retermed to not be so abrasive when presented. Anyone doing it can suffer the wrath that I have in the past. It ain't purty. So please, don't go there. ;) I've learned in the past to think how something sounds to someone else and even then, sometimes I get hate mail and the like anyway. It's just not worth it.
 
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