My Valve Choices - two weeks out

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Perry

Well-known member
Joined
Dec 20, 2005
Messages
52
Location
Olney, Maryland (USA)
Folks,

I am narroiing down my choices with much help from this site. I am still waiting on my surgeon's position on valve repair, but at this time I am showing my list of desired remedies below. Please comment!!!

I am 42, active, in good shape, have young boys, and have what appears (so far) to be a leaky tricuspic aortic valve. My choices:

1)Ross Procedure (with aortic root reinforcement on the aortic side and anti-calcium treated stentless bio valve on the pulmonary (Medtronics, Carpentier-Edwards or equal).
2)Stentless valve (as above) replacing my aortic valve only (if my root is excellent).
3)Stentless valve (as above) w/root replacing my aortic valve and root (if my root is suspect).
4)On-X mechanical valve replacing my aortic valve only.

Gratefully,
 
4)On-X mechanical valve replacing my aortic valve only
This is your best choice at first sight, but the actual choice is the first step your skilled surgeon has to take, along with your cardiologist & PCP.
IMHO one is not prepared to make that kind of choice!
Best of lucks!
 
Another Perry is lurking!

Another Perry is lurking!

Hello and welcome to VR.COM from another Perry! I've been around awhile, but don't contribute much anymore. I'm in my 6th post-op year as a St. Jude's double clicker. Best of luck to you. I'm sure those boys will take pretty good care of their dad when he's at home recovering!
 
"That is the right choice for a person of your age, with your kind of activity, lifestyle & under your condition!" That was what my surgeon-wizard told me when I made my choice (On-x), and my situation is very similar to yours.
Browse past pages in this forum and you'll find more keys
for your choice.
Cheers
 
The only bell that goes off for me with the Ross Procedure is your mention of a leaky tricuspid valve as well. This makes me question whether you have some, as yet, unidentified issue a bit more complex than AR and root dilation (not that that's no big deal) that would question the use of any of your natural valves to replace the aortic.
 
Thanks all so far. I guess the choices going in may be effected by the TEE and what they see inside. Down the list they may go. I could come out with my head sewn to dog - there will be a bright side to that too!!!!!!
 
This is a private message I received today from Randy, member of the dynamic duo "Robyn & Randy".
Sorry Randy to make it public , but could be useful for Percy![/
:mad:
B]

Daniel,

Just thought I would let you know that I survived and am now the proud owner of a 25mm On-X valve.

You were right on the head about the clicking. I didn't hear it whatsoever until in a quiet bathroom. It doesn't bother me even at night. My wife has to put her head near my chest before she hears anything. What a relief!

I'm five days postop, was released yesterday, and just walked a mall today. Might pay for it tomorrow but it was a nice affirmation that I am still among the living.

Good luck with your continued recovery and thanks for the assurance you gave me.

Randy
 
Besides the stentless biolgical valves you might also consider a good stented biological valve like the Carpentier-Edwards Perimount Magna Thermafix.
Why?
Because it is not yet clear that the stentless valves will perform better and last longer compared to stented valves.
Because to implant a stentless valve is much more tricky and needs much more time for you beeing at the heart lung machine than for a stented valve.
And why taking the hazzle of getting a complicated surgery with a stentless one while a stented one could be implanted much easier and faster with lower risks und would have the same performance?


Greetings

Dirk
 
Perry I was originally going to have a Ross however my condition deteriorated before surgery and it was considered to risky. I received a stented valve at 41 years of age; when I asked the surgeon why stented was the choice his reply was it was easier and quicker to install and seeing because of my age I would require at least one redo it was also easier to replace in a redo than a stentless valve. He prefers stentless valves for older patients that are unlikely to require a redo. :)
 
Thanks for the stented info. Isn't the advantage with a stentless that you have a larger flow diameter, compared to stented, for the valve that fits?

I have been told that information to date , echoes and such, show that I am a good candidate for the Ross. I may not know otherwise until I wake up post-op. A stentless, vice a homograft, would be the choice on my pulmonary side with the Ross. But if not the Ross, I think a stented valve is more what I would want if only my valve needs replacing and not the root.

With all do respect to everyone who has had the Ross, bio valve or mechanical......my surgeon at Hopkins has primarily focused on the Ross, if doable, and the St Jude as a fallback. I have talked to him about the On-X which I think is a more comprehensive design than the St. Jude - though it surely lacks the track record.

His motivation is to keep me from needing a second surgery. I like the Ross as my first choice. I have since considered the risk of warfarin issues to the point where I am trying to decide if sure re-op with a bio valve is no worse than the chances of having a warfarin complication. Perhaps the On-X will pass the aspirin test, but perhaps a failed bio valve (or any valve) can be fixed via catheter in 10 years. Tough choice.

I think the On-X option is fast becoming my #2 choice. I am grateful for all the feedback (so far).

Perry (13 days out)
 
Perry, even for the Ross you must consider a redo.
At least, the biological valve you get into the pulmonic position will not last foreever.

Greetings

Dirk
 
Dirk,

True about the pulmonary side. But I have been convinced that you can tolerate leakage on that side (unlike aortic leakage). If the bio valve doesn't shrink due to calcifying but the valve wears out, you may not need re-op. If a tissue valve leaks on the aortic side I am back to where I was.

That is why the Ross could be a one time deal.

Perry
 
Perry said:
I have since considered the risk of warfarin issues to the point where I am trying to decide if sure re-op with a bio valve is no worse than the chances of having a warfarin complication. Perhaps the On-X will pass the aspirin test, but perhaps a failed bio valve (or any valve) can be fixed via catheter in 10 years. Tough choice.

Yes, these are indeed tough choices that there will be no clear answer to until you have one in you and it's worked for several years. But if you read this link from one of our rather informed members, you'll get a good overview of some of your questions. (We have all referred to this link so often that we had the moderator put it in our Resource Material forum permanently.)

http://valvereplacement.com/forums/showthread.php?t=14330

While the possibility of easier technology in the future is encouraging, it's my personal opinion that this should not be your single biggest reason for choosing a valve, whether it's catherter replacement (for there will be instances that it will not be possible) or a safer replacement for warfarin, it's an unknown and I would not feel comfortable placing most of my eggs in that basket.

Unfortunately, as Tobagotwo mentions in the above thread, at 42 you are in a very muddy area. I've had a lot of very successful, active years with my mechanical. If for some reason I needed it replaced now (at 47) I would have a hard time deciding whether to continue on with a mechanical or go for a tissue. Although I would lean more to mechanical. I think my plan of action would be for me to find a surgeon I greatly trusted who believed both choices are good choice, have him/her get in there, look at the shape of my heart and tissues and make the choice for me. Might be the procrastinator's way out:D , but if I had such a surgeon as I described, I'd be comfortable with it.

Best wishes in your choice. Make the one you feel most at ease with and then don't look back.
 
Karlynn,

I am onto the link you sent me. I think I visited that thread early on and couldn't make sense. I can now.

I am aware that I may not take part in the final decision (they won't wake me I hope). That's why I feel I/we need to see the benefits of all remedies. I almost wish there wasn't so many options - I will be fine when the surgeon wakes me and says "this is what we found.....this is what we did for you". I know better than some in many areas. When they open me up - they know better.

Thanks again,
Perry
 
perry...i had my avr replaced about 9 months ago and went through the same thing you are going through. the plan was to have the ross procedure done and my surgeon recommended the medtronics freestyle aortic root heart valve as a backup....which is a tissue valve(porcine) turns out that once he got in there that replacing my valve was the best choice. everyone is different so you need to do research on what is best for you. in my case...being 31...the odds of me having another surgery for my heart in my lifetime are pretty high no matter what choice i made. you can read my prior posts around may 31, 2005 that will give you an idea of what i experienced. i was and still am in great shape and i did not have any problems with this surgery. the stress and worrying before surgery turned out to be the worst for me...but again...everyone is different. my surgeon has done over 200 ross procedures and i recommend that you find a surgeon that has done over 150 of them. my surgeon also told me if you have no problems in the first 5 years of the ross procedure...concerning the aortic valve...that most cases are very positive and you should get the results that you are looking for. the pulmonary valve is a donated human valve....when having the rp...that is the valve what gives out over time. it does not do as much work so the replacement is usually 20-30 years...not sure exactly but around that long. i was also informed that they are already doing pulmonary valve replacements via cath. and that in the next 10 years it will be common practice. so if you get to have the ross done...it is very possible that may be the only open heart surgery you will have to deal with. there are some aortic valve replacements being done via cath right now but that is a lot more tricky and may be some time before that is common practice...hopefully not too long. but also try to be realistic when deciding on what is best for you...don't get too caught up in what may be available down the road.
 
MMarshall,

Same story it looks like. Your info on the Ross P. is about what I have heard. I hope that is what can be done and so does the Surgeon and Card.

With much help from this site I am deciding option #2. Either way I look forward to being done with this ordeal (as done as I can be).

Perry
 
We are still praying for you

We are still praying for you

10 days now. Gosh. Sorry, can't stop counting and praying.

Just remember, your beautiful son did this. You can too. As parents, we want to step in and stop the pain. That we can't. Remember how it felt?? Ok, take some deep breaths. . . . It is your turn now. You can do this.

Also, maybe, like it was suggested in other posts, that the worst is all the stress and wondering. Also suggested, cath procedures will be way more commom, normal, in about 10 years. So pick what you want, for now, for what you think.
 
Some thoughts...

On the Ross Procedure, I feel that there is fair reason to believe that the pulmonary could be replaced via catheter, were it to become necessary. It's actually a better fit for that technology than the aortic valve, because it is under less pressure. I would not personally rule out the Ross due to concern about the pulmonary side. While a number of the homograft pulmonary valves have an episode of semi-rejection, it usually stops in time, and then the PV goes on to serve a very long time.

On stented vs. stentless valves: both types have the same excellent record for cardiac remodelling (the heart shrinking back to normal size), and the difference in bloodflow is minute (especially vs the supraannular-mount bovine stented). I've found no study showing a measurable physical improvement caused by the very slight stentless flow increment, other than for marketing purposes. There is also no data showing that it will last as long as the stented valves, much less longer. The base pattern the design is taken from lasts 15 years+-, whereas 90% of the base CEP design last 18 years, 80% last 20 years (assume average age of 60+). These are from the pre-calcification treatment days, so there should be some improvement. Be very aware that you should not expect the full life from any tissue valve at your age.

For a carbon solution, I also favor the On-X. I feel it has the most advantages of any mechanical available at this time. The others are also excellent, but my personal belief is that it has the slightest edge right now.

Best wishes,
 
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