Long Term Complications

[Clicker]

I am looking for sources of information on long term complications following AVR (mechanical valve) - including life expectancy statistics.

Thanks

 

[ALCapshaw2]

Your Question is quite Broad in scope and frankly, a bit vague.

Are you looking for help with complications you are having?

Or are you (pre-surgery) and *assuming* there are (always) complications that have to be endured?

Your Question about Longevity suggests that you are skeptical about the prospect that you may actually get FIXED and enjoy a Long and Productive Life (which is a common if not typical outcome).

FWIW, we have members who have had their artifical valves for 30 and even 40 years and are 'still kicking'.

FYI, the National Morbidity and Mortality Rates for First Time Valve Replacement Surgery for patients under age 60 (or is it 65?) is 1% in each category versus almost certain demise if you Decline Surgery to repair / replace a defective valve.

Remember, almost everyone here is either a Survivor or a Family Member of a Survivor. We've lost VERY FEW members out of the Thousands of patients who have come here and gone-on with their lives after 'getting fixed'.

'AL Capshaw'

 

[lilteach3234]

I kind of wonder if Clicker feels as though I do. I still feel I have alot of unanswered questons. I know I had one of the best hospitals and surgeons that I could have asked for, but I was discharged with alot of unanswered questions. My surgery was so sudden, I didn't have alot of time to research and look at alot of information.

I know since I've been post op I've wondered about a million things.

I will be glad to get into cardiac rehab, so I can work with the various members of the team to get questions answered.

I can't say I even understand 100% all the things I had done in surgery. My hubby does, but I've not even had the energy to sit and listen to it all.

I am not sure where Clicker is coming from or asking, but I can see his point if he's feeling like I am.

 

[netmiff]

Clicker, I have been clicking for over 18 months now, and nothing, absolutely nothing in my life has changed. I do take a few more meds than before, and I poke myself in the finger on a regular basis, but apart from that life has gone on as normal.

It can be overwhelming at first, or before, but give yourself time, you will get used to it!

 

[Ross]

I am looking for sources of information on long term complications following AVR (mechanical valve) - including life expectancy statistics.

Thanks

About the only thing I can answer is life expectancy. Plan on living a full life!

The complications part is something that is very hard to study because they don't usually acquire stats from all age groups, but usually the elderly, which skew the results.

1st time surgeries are the least worrisome. Usually no commorbidities and a 2-3% mortality and honestly, I think it's more like 1 or 2. With each successive surgery the chances of commorbidities rises. This applies whether you have mechanical or tissue or Ross.

As for sources, check the must have references in the references forum. There should be something there and if I get time (Which I don't seem to have enough of right not) I'll see what I have in my stash of goodies.

 

[sue943]

I had a medical negligence going on until recently as my endocarditis was caused by another procedure. Eventually the lawyers pulled out as in the UK it is so difficult to prove negligence and as endocarditis could, in theory, have been caused literally by me brushing my teeth although we knew that this wasn't the case it would have been impossible to prove in a court of law.

What that is leading to is the 'expert' opinion of a top cardiologist who reported for our case. He said that my life expectancy was 'slightly shortened'. I have two mechanical valves, not one.

Presumably I could have further problems and potentially re-surgery and who knows, I might not survive that. I could also get run over by a bus or hit by a drunk driver. Other than that I might or might not have a slightly shortened life but whatever, without my surgery I would have been dead now so I really don't care if I have a slightly shorter lifespan than I would have had if none of this happened.

 

[lb151]

I worry more about one of these tourists taking me out on the highway,,honestly!!

Live Life

 

[dick0236]

information on long term complications following AVR (mechanical valve) - including life expectancy

"Heart valve replacement surgery" is still a relatively new procedure, 50 or so years old and questions of life expectance and long term complications are still "a work in progress". The Internet is full of info...sound and foolish, positive and negative, right and wrong. The simple fact is that it restores a quality of life that is not possible thru any other way. I worried about the questions you pose for a long, long time. Looking back, that was a total waste of time.

At the time of my surgery life expectancy, of a young male my age, was 73. I passed that age on Feb. 21, 2009.....so, from here on out "its all gravy". I spoke with Dr. Starr (inventor of my valve) a couple years ago and he told me that there were still a number of "my" valves in use.

I have found NO long term complications from heart surgery....so far. Warfrin usage, if monitored, will cause few, if any, problems. That said, Warfarin is not a drug that you "screw around with".....I know because I did and I "paid the price".
Use the "grey matter between your ears" and warfarin is, no more, no less a problem than any other maintenance drug.

My Cardiologist tells me that "sooner or later I will die of something....but it probably won't be from the valve".....who knows. I do know that I spent a helluva lot of time worrying about something that hasn't happened.

Good luck to you....and by the way, this is one of the Internet sites where you get sound, positive and right information.....most all of the time

 

[sheridan07]

I am no help to your question, but I am still kicking. lol

 

[Nancy]

My husband had his first heart valve surgery when he was in his mid forties. Several years later he had another valve done, then a couple more years later had a repair on one of the valves.

He was always athletic and active.

He passed away at age 75, and his mechanical valves worked fine right up until his last moments.

He outlived all of his close high friends, many of whom died of heart problems which they should have had taken care of, but didn't.

This surgery is a life saver, without it, your valve will continue to deteriorate, and your life span will diminish.

 

[Karlynn]

I know your questions are something we all think about. If you aren't currently having issues - my recommendation is to assume your life will be long, healthy and complication-free. And if complications come - take them as they arise. It took me a while to stop "borrowing trouble" after I had my valve replacement. I do my due diligence on my appointments, tests and meds and let each day come as it may. Over 17 years clicking so far.

Best wishes.

 

[ponygirlmom]

I am looking for sources of information on long term complications following AVR (mechanical valve) - including life expectancy statistics. Thanks

Two complications with which I am familiar are pericarditis (the inflammation of the membrane around the heart) and constrictive pericarditis (the hardening of that membrane, so that the heart cannot expand correctly.)

Constrictive pericarditis usually develops over a long period of time. However, I began to develop it shortly after surgery. This is because my body is hypersensitive of just about everything, and that included having someone mess around with my heart.

I have been on a course of steroids for eight months, and I have about a month left to go. As the steroid dose decreased, I began taking large doses of non-steroidal anti-inflammatories (NSAIDS.) I'm not sure how long I will have to take these.

The steroids seem to have worked, because my heart is no longer constricted, and it also does not look as if my pericardium is currently inflamed.

As you can see, my case was not "long-term,"; however, constrictive pericarditis is something that a person can develop over a long period of time (even if they do not have heart surgery.)

 

[Rick]

When I first was diagnosed, I was obsessed with finding out life expectancy numbers. No one really answered this question and it frustrated me. Here is what I understand:
1. MDs have a hard time with this question. They have data on solutions utilized 20 years ago and scientists have worked at addressing some of th deficiencies in past solutions from this. Will these solutions work? Will current valves be a significant improvement and how much? MDs tend not to want to answer this questions because they hope current solutions work out much better. Patients tend to not want to feel as if they have an expiration date so some dont like the subject much either.
2. Data for historical solutions on my case - close to 40, require AVR and Aortic aneursym solution - cited roughly 17 years as average life expectancy. Somehow knowing this helped me for the first time in my life accept my own mortality. Intellectually I have always known that we all die but I had not truly confronted this until I was diagnosed. From this experience thus far I have choosen to try to live my life differently since and enjoy my life more -- in a strange way, the diagnosis has encouraged me to live life more fully. Also, averages are just that, averages -- I intend to follow MD instructions better than average etc.. This may mean that I live like some of the ones who post here - for 40+ years with only small issues or it may mean I pass away sooner than average (and hence wont be able to email my perspectives on the matter). I guess the point I am trying to make is that there is no one who can tell you how long you live; how well newer valves will fare; and that the hardest thing is to let go and focus on doing what you can to improve your odds and also live life better.

This is just my own personal experience with this question -- I am not an MD but know I was frustrated at receiving no straight answers to the life expectancy question.

Best regards,
Rick

 

[netmiff]

I never thought to ask about life expectancy, I knew it had to be replaced before it stopped working. Clicking sure beats silence !

 

[sue943]

My cardiac surgeon did make a 'strange' comment to my daughter immediately after surgery, it seemed strange to her but logical to me. He said "We won't know just how successful the surgery was until she is dead". Think about it.

 

[tobagotwo]

Porcines, I was told, last perhaps 25 years, and I would have to take anti-rejection drugs.

Complete malarky. Whoever told you that has no knowledge of tissue valves. There are no anti-rejection drugs involved with tissue valves whatsoever. Many come through the surgery with no prescriptions at all after the first few months (or just their regular BP meds). I am aware of no cases where antirejection drugs were used for tissue valve recipients.

Life expectancy is a loaded question, because there are so many variables involved. Most expectancy numbers are compromised by the large variations in the conditions of the people in the study. Generally, it's given that a successful, standard, valve-replacement procedure in a heart that doesn't have other damage won't materially affect life expectancy of the bulk of recipients. (Example form above: if the average age is 60 in the survey, and the average life expectancy is 17 years, than that meets the average life expectancy of all males - so no effect.) None of the studies I am aware of are calibrated to 40- or 50-year-olds. However, there are some added risks that affect a margin of those who've had the surgery, and it's difficult to determine where these fit in with the numbers.

There is a consenus that life expectancies are a wash between mechanical and tissue valves. The main negative factors of each path cancel each other out over time and people.

There can be a number of long-term issues from valve surgery. If we remove the issues that occur because the surgery was done too late, and the heart was permanently damaged, these are probably the most significant:

- Atrial Fibrillation or other arrhythmia, apparently due to the cutting and healing of the heart. These are annoying at the least, can decrease the effectiveness of the heartbeat, and in some instances can even cause strokes or death. Anit-arrhythmic drugs are often given to reduce the frequency and duration of misbeats. In cases of AFib, warfarin may be prescribed as well, to reduce the chance of strokes. Ablation (usually the MAZE procedure or a variant) may be performed to try to stop the misrhythm altogether. This is a selective damaging of the nerve pathways in the heart to control the conduction of the signals that cause the Atria and ventricles to contract to pump the blood.

- Patient Prosthesis Mismatch is a situation in which either a valve too large has been put in, and the valve's opening and closing is interfered with by the surrounding tissue, or a valve too small has been used, and stenosis is present, with its concurrent burdens on the heart. The only fix is to replace the new valve. This can happen with any valve type.

- Pannus (usually scar tissue) growth can interfere with the operation of the valve over time, causing valve regurgitation (leakage or insufficiency) or stenosis, depending on what way it interferes with the valve's movement. The only fix is to replace the new valve. This can happen with any valve type.

- Postoperative Constrictive Pericarditis is a rare condition in which the pericardial tissue that surrounds the heart becomes inflamed or reduced in size or elasticity. In effect, it "shrink wraps" the heart to some extent, keeping it from being able to expand or fill completely. The constriction causes the right and left ventricles to compete for space when filling up with blood. While breathing in (inspiration), the right ventricle fills best, restricting size (and thus the filling) of the left ventricle. While breathing out (expiration), the left ventricle tends to dominate, restricting the size of the right ventricle, and the amount of blood it can pump. Usually the person attempts to live with this situation, often with prescription drugs to reduce the force of the heartbeat and sometimes steroids to attempt to reduce the inflammation of the pericardium. Surgery to strip off the pericardium is performed only if necessary, as the inflamed pericardium tends to attach itself to the coronary arteries and the myocardium (heart muscle), so it's easy to do damage during surgery or to leave enough untouched that the results are partially or mostly unsuccessful. Pericardial surgery can have a mortality rate over 5%.

Please be aware that aside from arrhythmias, these are not all that common. They should certainly not interfere with your decision to have the valve replaced. If a severely malfunctioning valve is not replaced, the result is always disablement, followed by a very unpleasant patient death, usually within a matter of only a few years.

Best wishes,

 

[ticktock]

Clicker you raise questions that everyone of us has asked (me thinks) at one time or another. Thank goodness I never spent a good deal of time on it. I have had 4 valve surgeries, the first being in 1960. They told my folks I wouldn't live to 15, so "enjoy her while she is here". HA I'm 53 next month, and I keep on ticking!!

Ignore the numbers. They don't come with a guarantee anyway. Just live.

 

[Sunshine susan]

Read my post...

Read my post...

Clicker, read my post of a week or so ago in Heart Talk re "10-Year Anniversary".....says it all!