New member trying to decide which valve is right for me.

[BrooksM]

Hello everyone, I've spent the last few days reading as much I can in this wonderful forum. I'm a 30 yr old father of 4 boys needing an AVR. I had a congenital leaky valve which has gradually gotten worse. Last summer after a little basketball mishap I needed to have my knee reconstructed and the night after surgery I threw a clot into my lungs (pulmonary embolism.) A spiral CT scan in the ER diagnosed the PE as well as a aortic aneurysm. After a week or so in the hosp. I saw my cardiologist after many (stupid) years of neglecting to follow up. He said my valve leak was moderate to severe and I would need 6mo follow ups and probably a new AV within 5 years. Anyway in a recent visit to one of the local surgeons I was told the AVR should be done within a year to avoid any heart damage. My energy level is dropping so I think I finally believe them. So now I need to decide!
Has anyone had any experience with the ATS mechanical, it looks like it was approved in the US in Oct. 2000, after quite a few years of very good results in Australia, UK and South Africa. I haven't found any unfavorable comments about this new valve. Supposedly because of design there is decreased risk of thrombosis and are recomending INR levels of 1.5 to 2.0. I have spent some time on Coumadin already without too much problem but keeping my levels up around 2.5 to 3.0 for the rest of my life does not really appeal to me ( I am VERY active in sports and chasing kids.) The surgeon I have been seeing is very high on the freestyle porcine and says the 8 to 10 year data from their office is very promising. I am concerned with my young age that the porcine will calcify and I'll be back in again before I'm 40.
Sorry for being so long winded, I plan on being a very active member in this forum and I'll share any info I can find.
Thanks for listening.

Brooks

 

[hensylee]

Welcome to our home, Brooks. I can't help on the valve question as I had other surg, but many will follow who will give you specific info. They should be coming in any moment now so just stand by
God bless

 

[Nancy]

Welcome Brooks

Welcome Brooks

You'll be so glad you found this forum. It's a terrific place to make heart valve buddies. Everyone here understands the heart valve situation.

You've got a lot of things to decide, but I'm sure you will find helpful information here, and we'll all be here to help walk you through your potential surgery.

There was a wonderful thread started by our own Peter Easton on valve selection. He did exhaustive research and there are comments from many other members. Here's the link for that.

http://www.valvereplacement.com/forums/showthread.php?s=&threadid=304

Here is a very good heart info. site and a copy of what they have to say about different categories of valves.

http://www.focusonheart.com/script/main/hp.asp

Aortic Stenosis
Replacement aortic valves processed from pigs (porcine) or cows (bovine) are called bioprostheses. Bioprostheses are less durable than mechanical prostheses (discussed below) but have the advantage of not needing life-long blood thinning (anticoagulation) medication to prevent blood clots from forming on the valve surfaces. The average life expectancy of an aortic valve bioprostheses is 10 to 15 years. Bioprostheses rapidly calcify, degenerate and narrow in young patients. Therefore, bioprostheses are primarily used in patients over 75 years old or in patients who cannot take blood thinners. Recently, aortic valves from human cadavers have been used in younger patients to avoid the need for anticoagulation medication. However, the availability of human aortic grafts is limited. Though probably better than the other bioprostheses, its long term durability is unknown. The new "Ross Procedure" consists of moving the pulmonic valve to the aortic position and replacing the pulmonic valve with a valve from a human donor. This procedure has not been performed long enough to evaluate the long-term performance of the pulmonic valve when moved to the aortic position.

Mechanical prostheses have proven to be extremely durable and can be expected to last from 20 to 40 years. However, mechanical prosthetic valves all require life-long anticoagulation with blood thinners such as warfarin (Coumadin) to prevent clot formation on the valve surfaces. Otherwise, blood clots dislodged from these valves can travel to the brain and cause embolic stroke or embolic problems in other parts of the body. The original caged-ball Starr- Edwards prosthesis of the 1960s was replaced by the tilting disc Bjork-Shiley of the 1970s and early 1980s. Although the Bjork-Shiley valve provided a larger opening for blood flow, a second generation model of the valve posed the risk of potential breakage resulting in death, and is no longer available in the United States. The tilting pivoting disc Hall-Medtronic valve and the two leaflet (bileaflet) carbon St. Jude valve are commonly used mechanical prostheses in the 1990s. These valves provide excellent flow characteristics but require life-long anticoagulation with blood thinners such as warfarin (Coumadin), to prevent embolic complications.

 

[Gerry]

Hi Brooks

Apart from reading information on the ATS website, I can tell you the following :

ATS was founded by the former owners of St Jude and their aim was to produce a "next generation" of mechanical valve. Whilst the ATS valve works on the same principle as the St Jude valve (2 flaps made from pyrolytic carbon), the main difference is in the hinge mechanism. The ATS reverses the male and female sides of the hinge in the St Jude. They claim that this puts the hinge recesses closer to the blood flow, thereby reducing little side pockets where blood could clot. As a result, lower INR levels are claimed to be possible, therefore lower doses of Warfarin.

However, to exploit this advantage, you need to find a surgeon who is "sold" on the ATS, rather than you (the patient) instructing the surgeon to use it. Also, I am not sure if any surgeon in the USA is yet prepared to lower the INR with an ATS, however, subject to more years of resuilts becoming available, there is the potential for such reduction the future.

Hope this helps.

By the way, I had AVR last year (at age 55) and after a lot of research, I chose a Homograft - human donor valve, with a fall-back to the ATS valve if the Homograft turned out not to be possible.

Regards

Gerry

 

[RobThatsMe]

Hi Brooks,

Welcome to the site. I hope you find many of your questions and concerns answered here. Please post as many of them as you have on your mind.

My take on the INR comparison that you made is this. If you are on Coumadin, and have a recommended INR range to maintain, it doesn't matter if your target range is 2.5 - 3.0, or 1.5 - 2.0. IT is still a balancing act to stay within your range, and you will face the same issues maintaining any target range.

Don't let that be the driving force for your valve selection.

Wishing you good health,

Rob