Life Expectancy BAV Mechanical vs Tissue

[Jmprosser.lab]

Hey everyone,

hoping some can shed some light/positivity for a coworker of mind very discouraged by a new large Swedish study suggesting life expectancy post BAV replacement is significantly lower for younger patients. Can anyone provide some facts or info from their cardios/research.

The link to an overview of the study is below:

Life Expectancy Post-SAVR Varies by Age, Raising Questions for Treatment Timing

Knowing more about survival rates can help inform decision-making for physicians and patients, experts say.

www.tctmd.com

I told him about how this website saved me after I found my diagnosis. All the experienced veteran OHS survivors made me feel so much better. He’s also hopeful that minimally invasive will be an option as his surgery is coming up.
Thanks

 

[pellicle]

Read the stats VERY carefully.

In Australia most younger patients were doing well after 30 years.
I had my first at 12, and I'm 56 now

 

[tom in MO]

That's a link to a summary covering a paper and an editorial on the original paper. One of the editorialists is an employee of Medtronic. My take on it is that one should read the original paper and the original editorial, not a summary. They are both available. Also, if one cannot understand it, don't get upset. Ask your surgeon or cardiologist what they think of the study.

My personal experience is that I had a BAV. I was given about 3-6 months to live if I didn't get it fixed. I got a mechanical valve by fully invasive surgery at age 55 and am now 62. That's a pretty good change in life expectancy and I'm still ticking

We all die. My Irish side of the family used to say a quick death is a gift from God. The man who worked at the delicatessen in my home town used to say "Live fast, die young, make a good looking corpse." Don't worry about life expectancy but enjoy the life you have now.

 

[slipkid]

We all die. My Irish side of the family used to say a quick death is a gift from God.

I agree totally. Lingering on for months with endless treatments and torture that they involve, which has happened to multiple friends/family is not how I want to go.

The man who worked at the delicatessen in my home town used to say "Live fast, die young, make a good looking corpse." Don't worry about life expectancy but enjoy the life you have now.

Great advice! Love that make a good looking corpse bit...

 

[Superman]

I have no idea what younger means in the context of this study. Nor do I know how young you or your co-worker are.

I had my valve replaced in 1990 when I was 17. Safe to say I was in n the young patient category. Probably still am. Had an aortic aneurysm repaired via open heart again when I was 36. I’m 47 now and spent nearly 30 of those years taking Warfarin.

I guess I would remind your friend how statistics work. At one time the general population had a life expectancy in their 30’s or 40’s. People used to die younger due to infections and other illnesses that are treatable today. I would have been one of those people back then. It does stand to reason that for people like us, there may be more comorbidities that lead to an early passing than the general population. This will impact our averages. It does not mean that every one of us will live 4.5 years less than our peers.

 

[pellicle]

I have no idea what younger means in the context of this study

probably "what the surgeon thinks"

It does not mean that every one of us will live 4.5 years less than our peers.

I'm willing to bet some of my other activities will play the larger part in that:

 

[leadville]

@10.56 those ruts were nicely negotiated

 

[Brinntache]

It is my understanding that younger people wear our bio valves faster (in general) due to how certain elements in the blood affect the valve, accelerating AVD. It's a big reason why I am going mechanical in 12 days. As for your friend, the range of reasons a person in their 40's needs AVR is different than those in their 60's. When I was trying to find data to make my decision it was hard to find data that separated bicuspid issues from tricuspid issues, healthy active people from obese smokers, diabetic vs non-diabetic, clean living vs addicts.
The study did not look at any of that. " Differences in comorbidities as well as in the etiology and morphology of aortic stenosis across age groups might be at play, they comment. " It was a simple spreadsheet study, a 'maybe we should look at this' study.

 

[pellicle]

It is my understanding that younger people wear our bio valves faster (in general) due to how certain elements in the blood affect the valve, accelerating AVD.

That's pretty bang on.

It's a big reason why I am going mechanical in 12 days.

Best Wishes for a textbook procedure and an uneventful recovery.

 

[tom in MO]

They don't know what causes tissue valves to fail faster in some people than others. Blood components is a logical choice but they don't really know.

 

[Luckyguy17]

It is my understanding that younger people wear our bio valves faster (in general) due to how certain elements in the blood affect the valve, accelerating AVD.

I recently had a conversation with my surgeon on bio valves and longevity. He is convinced that it is more biometrics related, than age or activity related. In his experience, longevity of bio valves in a patient performed for a similar lifespan in multiple surgeries. In other words if my bio worked for 10 years, then it seems likely that a porcine or bovine replacement irregardless of brand would last about as long. For a patient that had a 20 year bio, a replacement would likely last similar length.

 

[Chuck C]

I recently had a conversation with my surgeon on bio valves and longevity. He is convinced that it is more biometrics related, than age or activity related. In his experience, longevity of bio valves in a patient performed for a similar lifespan in multiple surgeries. In other words if my bio worked for 10 years, then it seems likely that a porcine or bovine replacement irregardless of brand would last about as long. For a patient that had a 20 year bio, a replacement would likely last similar length.

I've attached a study published by Dr. Philippe Pibarot et al in 2018 titled: Hemodynamic Deterioration of Surgically Implanted Bioprosthetic Aortic Valves

They did find some markers which correlated with Hemodynamic Valve Deterioration of bioprosthetic valves.

From their conclusion:
"A dysmetabolic profile characterized by elevated plasma Lp-PLA2, PCSK9, and HOMA index was associated with increased risk of HVD"