One valve for life?

[chilihead]

I just got back from the heart surgeon I plan to use fo rmy AVR. He is a super guy who has done over 150 ROss procedures and can do a mechanical with minimally invasive techniques.

He told me something I had not heard to date. I am 39 years old. He said that it really did not matter which valve I chose, I would have to have another operation later in my lifetime. He did say that the mechanical would last longer, but that my lifestyle would have to change due to the coumadin. He pointed out that a pig valve may require reop in 12-15 years, versus a mechanical that may last 30 years. He also noted that I would be better off having my second surgery at say 55 instead of age 70!

I was previously under the impression that a mechanical would be the last operation necessary.

St. Jude's "one valve for life" motto may not be necessarily true.

Any way, I liked the surgeon and am now contemplating 3 options.
1. Regular Pig valve
2. Ross with Homograft
3. Ross with Pig valve in the Pulmonary position.

Regards,

Jim Johnson
Needing AVR in the next few months.

 

[Jack]

Jim,

Just ask your surgeon which valve or procedure he is most at ease with, he is right about the realities of valve replacement.

The surgeon has the last call, he can select a different valve during the surgery if he has difficulty implanting the valve that the two of you selected.

I had my first pig valve at the age of 36 and my second one 17 years later at the age of 55, my lifestyle is normal; now I have to look for replacing the same valve at the age of 70. I don't know what is worst, valve replacement or old age?

Good luck and hang in there,

Jack.

 

[Peggy in Alaska]

Which Valve?

Which Valve?

Jim:

I know knowledge is a good thing, but sometimes it can become so muddled. I think sometimes the best valve choice depends on which valve is being replaced. I was thinking I might want to go mechanical when I have surgery because I can't stand the thought of more than 1 OHS in my lifetime, but I don't think I can choose mechanical because my problem lies in the tricuspid and somewhere along the road I heard mechanicals don't work as well on the right side of the heart, because of the lower pumping pressure there. Maybe it was something about more chance to have clotting and that leads to lots of serious problems.

I'm supposed to get a pig valve when the time comes, and at my age they are supposed to last a pretty long time. In younger people, I've heard calcification is a big problem with tissue valves.

 

[LUVMyBirman]

Hi Jim,

Was under the same impression myself until the surgeon throughly explained the following

#1 at the time of my surgery.... they only had 25 years or so of data on the mechanical valves to make such determination.
#2 when they state the mechanical will last for life..... generalizing the age of the individual at implantation in the 50-60+ category. If you were in your 50's, 60's or 70's, yes, your valve may just "last a lifetime".

Was 30 when I had my mechanical mitral implanted almost five years ago. Based on the data....I can expect to return for a re-op between the ages 55-60. If I were to have gone with a tissue valve (if it were available) I could have expected an operation every 10 years or so. That would bring me to age 50 and surgery #3. Mortality in much higher with every subsequent surgery. Limit is usually 3, but have known other to survive. Scar tissue and other factors play a role in surgical success as well.

With the mechanical, it's usually not the valve that wears out...it's the sutures and sewing ring location that becomes worn. Have come to the determination....there is no guarentee of longevity with any choice. Each individual case is different.

Hope this helped. Good luck in you decision process!

 

[rcatalano]

One thing is certain, there are no guarantees no matter which route you take. It's also apparent there is no consensus among surgeons.

I believe you find a surgeon you believe in, then let him do what he does best.

Good Luck!

 

[Granbonny]

Jack

Jack

Why did you op for a pig valve at age 55?..instead of a mechanical? I was age 61 when I had my mechanical..and I, too, live a normal life. I eat, drink and be Merry everyday. My INR stays in range every month. No bleeding or brusing. I was lucky to still have a hubby and wonderful children to help out..after surgery...but think..what if Hubby passed on..and children live their own lives ( and should)..Who would be around to help me out with another VR at age 75? If my mechanical lasts until I am age 91..Guess, I'll have help in the Old Folks Home. Plus, I'm too active to take another year off. waiting to be back to the 100% Normal feeling...I would love to hear if there is anyone who has had this surgery..that really felt they were normal before 1 year?..Again, all valves are great valves..or we wouldn't be here.. Bonnie

 

[Granbonny]

Chillihead

Chillihead

One of my favorite members is Marty (Physician- working part-time)..He had his mechanical at age 72.. He posts often to many of our health problems. Thank you again, Marty...Bonnie

 

[ALCapshaw2]

Jim,

Interresting information about the mechanical valves!

I think I would do some more research on the durability of the pig valve as 15 years seems like the far end of the curve, with 8 to 12 being more typical. UNLESS, he is talking about the stentless pig valve which I 'think' will last longer.

I would also ask your surgeon about the Bovine Pericardial Tissue Valve which seems to be the 'valve of choice' at the Cleveland Clinic. Studies show 90% durabity at 15 years and counting. Some early placements are still working at 20 years. The Bovine Pericardial valve is made from the pericardium of a cows heart and shaped to resemble a human valve.

'AL'

 

[chilihead]

Al,

Good point. My biggest decision now is whether to go with one as you mentioned or opt for the Ross since this surgeon is one of the few who seems to be experienced and at ease with it.

Regards,

Jim

 

[Nancy]

The fewer surgeries you can have in your lifetime, the better.

Joe's had 5 thoracic surgeries, 3 valves and 2 lungs. He would have to be drawing his last breaths before they would probably operate on him again.

Your body just continues to break down with each subsequent surgery. Scar tissue and adhesions are problems, but so is the potential of having multiple blood transfusions, and the prospect of picking up other diseases in the hospital. Those are things that people don't usually think about, but they have been big concerns in Joe's case.

Even though the blood supply is quite safe, there are still things that are transmitted when you receive others' blood. It was a factor in an extremely high fever (106.7) which never had a diagnosis, but was thought to be caused from an unknown infectious agent in some transfusions he had. This kept him in the ICU for about 10 days.

Then another time he picked up C. Diff diarrhea. It was a monster to get rid of, it was very debillitating and it took 3 months to be gone. That is a nosocomial infection.

He also became sensitized to an antibiotic used during thoracic surgery. It was something he had had before and never had a problem with, then all of a sudden he came down with a life-threatening caes of serum sickness which had him in ICU again for about 2 weeks, and left him with permanent stiffness in his feet and ankles.

These are all things which couldn't have been forseen. They are just the results of Joe having to have multiple surgeries.

He is now hyper-reactive to almost everything.

You really have to weigh many things when choosing a valve, not always the obvious.

Joe is mechanical all the way, and he still has had these problems.

 

[sylviayasgur]

minimally invasive surgery..

minimally invasive surgery..

hi jim!
about minimally invasive surgery, there are several folks here who have had it and feel the recovery has been much speedier than the conventional thoracic surgery.
you might want to do a search on that.
didn't melissa just have that? also, a gentleman named rich had that done in NY this past year.
gina and bonnie are right, all valves are a good valves.
be well, sylvia

 

[chilihead]

Sylvia,

That caught my ear yesterday. However, he can only do the minimally invasive surgery on the mechanical valve. I think he said the pig valve required more sewing and thus the standard chest opening. What really got me was that he told me I would have to stop bicycling if I go mechaical, especially mountain biking. I actually went mountain biking right after the appointment yesterday afternoon. I'd hate to give it up!

I'm studying up on the Carpentier-Edwards PERIMOUNT Bioprosthesis model 2700 and 2800.

Regards,

Jim

 

[Susan BAV]

Very interesting information, Jim! Very logical and reasonable!

 

[rcatalano]

Jim,

Interesting he said you would have to give up biking with a mechanical valve. My surgeon told me the exact opposite.

 

[chilihead]

Rob,

He stated I could bike as long as I don't fall off! He said running was probably not a problem, but that serious road riding and mountain biking was out. I'm on the competitive side and love to kick but at both of these activities.

I also found out that Arnold Schwarzenager had the Ross and blew out one of the rings beause he was riding the exercise bike vigorously on the 2nd day afer surgery! They had to go back in and sew the thing back on!

Go Arnold!!!!!!!!

Jim

 

[Jack]

Granbonny

Granbonny

Granbonny,

I don't know, I had very good luck with the pig valve for 17 years, I wasn't taking any medication at all. When the time come to replace the valve we, the surgeon and I, decided that the improvements in valve design may give me the same time span. After the surgery the surgeon told me that the worn out valve had no calcification at all but the membrane between two of the leaflets was torn.

I was back from the hospital and at home sleeping on the second floor exactly 72 hours after the surgery and back to work in five weeks. The only aggravation that I had was keeping my INR level for the short time after arriving at home, it took them three weeks to find the right combination of daily Coumadin pills and by then they started weaning me off the Coumadin.

 

[bvdr]

I know most of you are talking about aortic valve replacements and I just had my mitral replaced 16 days ago with a St. Jude Mechanical. But today I had a treadmill to see if I was ready for cardiac rehab and I am! My cardiologist was thinking it was pushing it a little so decided he better clear it with Dr. Glower before signing his name to the papers. Dr. Glower called him right back and told him that if I felt up to it he had no problem with me water skiing. My cardio pointed out that he thought that might not be in my best interest but I assurred him I wasn't ready for that yet. Anyway, I felt so poorly before surgery it didn't take much to make me feel better than before. I did more on the treadmill today than I did last December. I didn't go real long because my resting heart rate was 112 before the test so he only let me go 6 minutes but that is an improvement. I truly feel better than I have in months.

I don't feel at all limited because of my mechanical....I expect to do everything I ever did but possibly a little more carefully.

 

[LoraW30]

I've had 4 openheart surgeries, 3 of which were avr. All three were mechanical replacements. Each time, I was told to stay away from motor bikes, atvs, and contact sports. I rode bikes, climbed trees, ( when I was younger), and later I've worked in jobs involving heavy lifting. For me, the replacement surgeries, weren't because the valves wore out, or malfunctioned. It was mainly because of growth. The valve I recieved at age 5 had to be replaced at age 12 because of scar tissue. The valve I recieved at age 12 had to be replaced at age 27 because of a growth spurt I had when I was a teen, it was just too tight. The one I have now, they are saying should last for about 20 to 30 years or longer. I was just as active as ever until this last spring, when I was diagnosed with cardiomyopathy and hypertension. Still, this diagnosis has nothing to do with my mechanical valve, rather all the surgeries I've had in the past and the fact that I was born with congenital difficulties.


So back to square one. I really think it's more a question of how a person takes care of themselves than which is a better valve. IMHO of course.

 

[Les]

Jim,
To quote your idol Lance: "It's not about the bike...." It should be about what's best for you to allow your family to have you around for as long as normal and possible. You can't shop for a valve as you would a car. Many of us had no choice in the matter...facing imminent death. We were thankful for the valve selected for us to continue life...We worked around whatever obstacles they presented and live normal, productive, and certainly active lives. Good luck with your decision.....you have been presented with that gift, but think of the big picture down the road and include in making your choice what your family wants and needs....you, and only you. The bike doesn't matter...
_________________
Les AVR '93 / '95

 

[maxximom]

I had my AVR almost 2 years ago and I received a St Judes Toronto Stentless Porcine Valve. I was age 70 at the time of surgery. Dr Glower feelt that the valve should last 12 years to 20 years (big span here) at my age. I opted for the tisssue valve and encouraged him to go for the tissue valve if he could.I felt that at my age, I would give it less wear and tear than you young ones and by the time that I might need to have it replaced, that the technology may be much more advanced

Joan