repeat AVR looming after only 6 years!

[ALCapshaw2]

Al, Are you able to read those links with out paying? If so could you let me know how.

The full article from the First Link came up without the requirement of a subscription.
The graphs in this article are pretty interesting! (See Below)

The Second and Third Links do require a subscription. Sorry about that.

You might be able to see copies of the Journals at an appropriate Library.

'AL C'

From the First Paper which is a comparison of Structural Valve Deterioration (SVD) of Allograft (human) and Pericardial (Bovine) Prostheses
(some or all of the authors from Cleveland Clinic),

For patients under age 50 at the time of replacement
Freedom from Explant is roughly (reading a graph without lines)

90% at 10 years
60% at 12 years (drops rapidly after 11 years) (Bovine and Allograph track closely out to 12 years.... no data after that for allografts)
20% at 18 years (slowly tapers off after 12 years)

For patients age 50 to 60 at the time of replacement
Freedom from Explant is roughly interpreted from graph as

90% at 10 years
80% at 11 years
75% at 12 years
60% at 15 years
40% at 18 years

For patients over age 60 at the time of replacement
Freedom from Explant is roughly interpreted from the graph as

95% at 10 years
90% at 12 years
85% at 14 years
80% at 18 years

Note that there is likely some variation around each of those points.

See the original article for explanations and illustrations.

 

[Lynlw]

The full article from the First Link came up without the requirement of a subscription. The graphs in this article are pretty interesting!
Unfortunately, there seems to be a problem with my Ancient Browser (IE6) and the figures were not displayed (same problem here on VR.org with some figures/pictures).

The Second and Third Links did require a subscription. Sorry about that.

A friend 'in the know' sent the complete articles to me in an e-mail but requested that they not be forwarded,
other than the links which are in the public domain. You might be able to see copies of the Journals at an appropriate Library.

'AL C'

That's ok, I just thought if you posted them there was a way to read them with out paying, I'm sure they couldn't be forwarded since their copyrighted.

 

[daveguy14]

Tissue valves do not last as long in younger patients. I got a homograft at 18 and had it replaced at 7.5 years. It, like yours, suddently started going bad at 6. I suspect you didn't get a "lemon", but just that your young body ate it up quickly. You may want to seek a second opinion because timing of reoperative surgery can be controversial; I had two different cardios tell me entirely different things. Anyway I ended up having the redo surgery and got a mechanical--just couldn't possibly imagine a third surgery. Three months out, everything seems to have gone fine. I had minimally invasive the first time, but not the second; I think most surgeons do a full cut second time around. Best of luck to you -- it's a crappy situation, but one you can get through.

 

[Lynlw]

The full article from the First Link came up without the requirement of a subscription.
The graphs in this article are pretty interesting! (See Below)

The Second and Third Links do require a subscription. Sorry about that.

You might be able to see copies of the Journals at an appropriate Library.

'AL C'

From the First Paper which is a comparison of Structural Valve Deterioration (SVD) of Allograft (human) and Pericardial (Bovine) Prostheses
(some or all of the authors from Cleveland Clinic),

For patients under age 50 at the time of replacement
Freedom from Explant is roughly (reading a graph without lines)

90% at 10 years
60% at 12 years (drops rapidly after 11 years) (Bovine and Allograph track closely out to 12 years.... no data after that for allografts)
20% at 18 years (slowly tapers off after 12 years)

For patients age 50 to 60 at the time of replacement
Freedom from Explant is roughly interpreted from graph as

90% at 10 years
80% at 11 years
75% at 12 years
60% at 15 years
40% at 18 years

For patients over age 60 at the time of replacement
Freedom from Explant is roughly interpreted from the graph as

95% at 10 years
90% at 12 years
85% at 14 years
80% at 18 years

Note that there is likely some variation around each of those points.

See the original article for explanations and illustrations.

Since the person who started the thread is 35 now,and wants a mechancal valve, I hate hijacking this thread with all this data so will just mention
The First article, is the one I keep posting, since it started in 1981. It is all from CCF

Don't forget the <50 group is a pretty big range, 1/2 of the people were less than 40 years old for the perimount and MOST were younger than 30 for the allo which makes it hard to see what is average for each decade 20s, 30s, 40 ect of course the under 30 will bring down the numbers for the 40- 50
Table 1 (I'm typing this from the chart so hope it shows up in rows (at least I tried )
bovine Allo
<30 5 47
30-40 19 21
40-50 27 27
then for the other groups since people might be interested since I putt the other ages

50-60 87 203
60-70 185 98
>70 155 37

ps The reason the reason there is no data for the allographs after a certain number of years, is because they weren't studied as long (in THIS study) as the perimount .
"Methods: From 1981 to 1985, 478 patients received pericardial prostheses during
premarket approval; from 1987 to 2000, 744 patients received cryopreserved allografts.
Mean age of patients receiving allografts was 49 12 years, and that of those
receiving pericardial prostheses was 65 11 years; pericardial valves were used in
138 patients younger than age 60. Mean follow-up was 15 5.1 years for
pericardial valves (4674 patient-years of follow-up) and 5.6 3.1 years for
allografts (3892 patient years of follow-up)."

Sorry edjspi
As far as REDOs, The fact you are young and don't have alot of other medical problems and are in really good shape going into this surgery all play into your chances of having a good recovery. (with a surgeon who has experience with REDOS)
I hope it helps to know that quite a few people (even members here) had a better recovery for their 2nd or 3rd OHS than they did their 1st. Maybe partly because they were being watched and were in better shape going into their REDOS? My son's 4th OHS was his shortest hospital stay and easiest recovery. Even his 5th he was out of CICU the next day and home in 4 days (he was re-admitted 10 days post op for a sternal infection, but that could happen no matter what surgery it is 1st or 6th)
Now of course the surgery WAS much tougher on his surgeon, but thats why you go to the experienced ones.

 

[pikacat]

Tissue valves do not last as long in younger patients. I got a homograft at 18 and had it replaced at 7.5 years. It, like yours, suddently started going bad at 6. I suspect you didn't get a "lemon", but just that your young body ate it up quickly.

i can only conjecture, but i would guess this is most likely the reason, too. i'm 30 and my surgeon said that given my active lifestyle i would most likely go through a bio valve in 7 years at the top end, maybe even faster. i really didn't want to have a third surgery in just a few years, so i opted for mechanical. he joked around with me saying i was going for mechanical because i was sick of heart surgeons. no offense to him, of course. he seems like a nice guy and all.

 

[Shobu]

Hi Eddie. Sorry to hear about the redo; I've just gone through something very similar myself, having a Cryolife human donor valve fail after only 7-7 1/2 years. (It was a replacement for myy failing BAV) My docs were very surprised as well, having expected a much longer lifespan and we all decided on a mechanical replacement given the likelihood that my body would do the same thing to a replacement biological valve.
As for the valve being defective, in both our cases, it would probably be more along the lines of us being on the lower end of the statistical curve for valve life, rather than something inherently wrong with the valve, especially given the great results you had been getting up to the point where it started to fail. (I had pretty much the same thing happen; great echo's till about 5 months prior to surgery, where the valve started to fail, then things got rapidly worse, to the point where the surgeon called my cardiologist into the OR to show him what my failing valve looked like (massively calcified and stenotic) once they removed it.)
Not that that is a definitive medico-legal opinion of course, but I imagine it would be pretty easy for someone defending such a claim of defect to show statistical data as to the lower end of bio valve life, as well as 5+ years of great functioning (or 7+ years in my case). Plus there is all the uncertainty as to what what our immune systems can or will do to valves once they are put in, which would probably be a field day for a good defense lawyer who deals with these things. Anyway just my 2c on "defective" valves.
I went with the On-X valve and am almost 7 weeks post op. Been very happy with the results, although with the increased number of complications I had post-op vs my first OHS and the longer recovery time, I'm happy that I might not need OHS again in the future. Add to that the fact that I'm very active and the mechanical valve shouldn't affect my activity level or the activities I participate in, the chance my body would do the same thing to another bio valve in another 7ish years, and I'm very happy with the mechanical option.
Good luck with your upcoming surgery and recovery. See you on the flip side!

--Dan

 

[pikacat]

Not that that is a definitive medico-legal opinion of course, but I imagine it would be pretty easy for someone defending such a claim of defect to show statistical data as to the lower end of bio valve life, as well as 5+ years of great functioning (or 7+ years in my case). Plus there is all the uncertainty as to what what our immune systems can or will do to valves once they are put in, which would probably be a field day for a good defense lawyer who deals with these things. Anyway just my 2c on "defective" valves.

in pretend legal land:
it's a good legal opinion what that data would do for the defense is that even if a plaintiff in a case like this could show on the offchance that the valve was defectively manufactured, he would not be able to show any damages because there was no injury aside from hoping that the valve would have lasted longer. and that data would show that the plaintiff could not have expected the valve to last much longer and therefore suffered no injury. aside from all that though, as i said before, in this sort of case, you need a physical injury, not just the emotional injury of having a surgery sooner than expected. so this kind of case would not proceed anyway. you'd need something like idk. a defective valve that exploded causing multiple surgeries that were previously unnecessary. /legal blabla

haha sorry everyone will be glad when i have something better to do than waste my time on legal hypotheticals on this board because my surgery got postponed.

 

[ARGreenMN]

Your honor, I object! Not really, just like saying that

 

[pikacat]

I MOVE FOR A BAD COURT... THINGY. -- lionel hutz, esq.

 

[Nancy]

Frankly, I think there is too much evidence that tissue valves do deteriorate in younger people faster, and it would be very hard to sue for that reason.

 

[Philip B]

Liability?

Liability?

Interesting comments in response to the initial post, but I'm curious... since when do replacement valves, tissue or mechanical, come with any kind of guarantee of longevity? Sure, on occasion, there's been some kind of class action law suit or recall if defective manufacturing is discovered, but how many of those have there been?

From time to time, we hear from members whose tissue valves require replacement long before the predicted years of longevity had elapsed. This happens on occasion with artificial valve receipients as well. There are no guarantees with the replacements we receive. Odds of longevity are simply better with artificial valves, but, of course, there are trade-off's.

Discussing potential legal action against the valve manufacturer seems somewhat premature.

While you may get lucky when they remove your "old" tissue valve and discover that it was poorly manufactured, odds are more in favor that your body just did its thing and made the valve deteriorate more quickly than you or us would had preferred.

-Philip

 

[pikacat]

valves don't come with a guarantee of longevity. someone bringing a claim that an item was guaranteed would bring a warranty claim. like if i bought shoes that said on the box, "best hiking shoes guaranteed!" and they fell apart when i went hiking in them for the first time.

this, hypothetically, would be a products liability claim. that the product, if you could prove it, was defectively manufactured and caused an injury. for all anyone knows in this forum, his doctor did say that the cause could have been a manufacturing defect and he could show this. however, the problem is that, even if he could, is that he has no physical injury.

those are two separate claims (one is contracts, the other is tort law) with separate elements. the lack of guarantee of a time frame is irrelevant to the torts claim. the issue simply is that no physical injury occurred because it's required that you demonstrate an injury to win.

actually, there's one more claim that he could bring, maybe. that his doctors failed to get his informed consent regarding the length of time the valve might last and he may bring a medical malpractice claim.

http://www.ashcraftandgerel.com/Medical-Malpractice/medical-malpractice.html

 

[edjspi]

thanks for all the replies to everyone!

I feel like I've opened a can of worms here that I certainly did not MEAN to! :eek2:

MY question about recourse on a faulty valve was really just me wondering out loud. I honestly didn't think there was anything to it, especially since my cardio told me what several have echoed here: it most likely had something to do with how my body reacted with the valve, there was nothing I did to cause it to deteriorate quickly, and the bottom line is that we will never really know what the cause was...

SO, what I'm really focused on now is whether or not to get a second opinion from an unrelated cardio at another hospital. To address a few questions/comments that were made:

Yes - I know of Dr. Nicholas Kouchoukos in St Louis - I even spoke to several nurses and my own cardiologist about him the first time around. he is probably the most well respected cardio in the St Louis area, and definitely one of the most experienced. I chose not to go down that path the first time because my cardiologist would not have been able to oversee my post-op care because he is not on staff at the same hospitals as Dr. Kouchoukos.... thus one of the reasons I'm hesitant to look elsewhere this time.

I did have my first AVR at Barnes Hospital in St Louis, and I still go there for everything (was there Friday for my cath). I know my surgenon (Dr Marc Moon) is one of the if not the most well-repected and experienced at Barnes in terms of AVR, and people come from all over to see him...

I think I'm leaning more toward the opinion that if I do get a second opinion it will probably be similar to the first, but I may still do it for peace of mind, if nothing else!

Thanks again for all the replies and please keep them coming, especially if anyone else has an experience simliar to mine or know someone who does...

-Eddie

 

[ALCapshaw2]

Eddie,

If you decide to discuss surgery with your original surgeon, be sure to ask him (or any other surgeon you interview) how much experience they have with ReDo's and the associated Scar Tissue Issues.

IMO, you should get your second opinions from Surgeons. There's not much that a Cardio can do for you once they have diagnosed the problem and Surgeons have Way More "Hands-On" Experience with the problems. I also happen to believe that Surgeons have a better 'feel' for timing.

'AL C'

 

[pikacat]

thanks for all the replies to everyone!

I feel like I've opened a can of worms here that I certainly did not MEAN to! :eek2:
-Eddie

naw, man. i'm just bored and an argumentative law type :/ my surgery was supposed to be tomorrow, then it got pushed back. now i've got nothing but time to argue hypothetical products liability apparently. this is like "fun" for me.

i like to pretend this may one day be helpful for someone wondering what legal recourse they have. maybe. and i'm not just a big bored jerk

 

[nngbwh]

Sorry to hear you are going for your 2 surgery. Keep us posted.

 

[Philip B]

Second Opinion

Second Opinion

Good luck with the second opinion. It's never good news to hear about a member needing to do valve replacement surgery again.

Bottomline, artificial valves have a better track record of longevity. Speaking of records, here's another case of, "Geez, my doctors were really surprised that my tissue valve didn't last as long as expected." This stuff is beginning to sound like a broken record. And yes, I do respect those who opt for tissue for whatever reasons they have for doing so.

Bored... sure, let's talk lawsuits and malpractice... if one is really bored perhaps a research project on how lawsuits affect medical costs in this country might be a good way to pass some time.

-Philip

 

[pnwcoast]

naw, man. i'm just bored and an argumentative law type :/ my surgery was supposed to be tomorrow, then it got pushed back. now i've got nothing but time to argue hypothetical products liability apparently. this is like "fun" for me.

i like to pretend this may one day be helpful for someone wondering what legal recourse they have. maybe. and i'm not just a big bored jerk

Not a jerk. Please keep up the posting and the advise. Its fun to have a trained JD drop a bit of free opinion!

 

[fischje]

My bovine valves lasted a little less than seven years. I was 27 when I got them --had them replaced w/ mechanical in February. They opened me in the same spot as last time

 

[pikacat]

Bored... sure, let's talk lawsuits and malpractice... if one is really bored perhaps a research project on how lawsuits affect medical costs in this country might be a good way to pass some time.

-Philip

that cost is actually negligible, whereas giving back to a person who lost their livelihood is invaluable.

Those claims rest mainly on a single 1996 study by two Stanford economists who said caps on damage awards could hold down overall medical costs by 5% to 9%. They studied heart patients who were hospitalized, compared costs in states with and without limits on malpractice lawsuits, and then projected their findings to the entire health-care system.

But both the GAO and the CBO now question their sweeping conclusion. When the CBO attempted to duplicate the Stanford economists’ methods for other types of ailments they found found “no evidence that restrictions on tort liability reduce medical spending.”

“In short, the evidence available to date does not make a strong case that restricting malpractice liability would have a significant effect, either positive or negative, on economic efficiency, ” the CBO said.

http://www.factcheck.org/president_uses_dubious_statistics_on_costs_of.html