Should I choose a mechanical valve or a tissue valve?

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Julian

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Hi!
I have a question regarding valve options that i have not seen addressed. Let us put aside the lasting factor, the anticoagulation issue, the noise, and all the well known pros and cons of mechanical vs tissue valves.
What about performance? I mean their efficiency as heart valves, allowing or avoiding blood flow. Are both options equally good? I ask this not only regarding normal life, where i imagine both to be good, but specially focusing on intensive physical activity.

Regards
Great question but I will step out on a thin branch and say that a tissue valve may have more natural blood flow characteristics. From what I've read mechanical valves have a more turbulent push of blood flow and with that can effect many factors of performance. I personally think TAVI will be the future of valve replacement at least until growing heart valves is perfected. I wouldn't be surprised if growing your own replacement valve will be reality in the next 20 years. All this of course is my opinion.
 

ski girl

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The performance question is an interesting one! I discussed this with my surgeon before my first AVR and he didn't have an opinion either way - mainly because so few AVR patients really push their bodies to see what they're capable of! I, however, expected to become 'instant athlete' with my new heart parts . . . .

I've now had one of each (tissue and mechanical) and while I only had my tissue valve for 11 months before bacteria got hold of it, I can't say I notice any difference in performance from either one.

And as I'm one of few people in the world young enough and willing (and who have had one of each type!) to really test out both flavours of artificial valve for performance differences, I'm not expecting a definitive answer to that question :)
 

pellicle

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Hi

Great question but I will step out on a thin branch and say that a tissue valve may have more natural blood flow characteristics. From what I've read mechanical valves have a more turbulent push of blood flow and with that can effect many factors of performance.
I'll join you on the branch...

I recall reading in one of the articles I have on modelling blood flow and thrombogenesis that the On-X and the ATS had superior closing or opening efficiency but that tissue had the best opening and closing efficiency. However they were slightly better than tissue for through put. Your native valve was the best.


Hope someone can set me straight on this trivial pursuit :)
 

ElectLive

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Here's what I found out today. Half of all valve replacements in Germany are done through the groin.
Very interesting. Citation available for that or is it "here say"
You know, one of our members who always stayed very up to date on new technology posted similar info about two years ago. I think the key point then was how half and replacement were defined, though. My understanding was it was 1/2 of bioprosthetic replacements, not all replacements and all valves. Perhaps your cardiologist, Agian, meant the same thing, perhaps not, I don't know, it is 2 years later also. But anyway, here's the thread: http://www.valvereplacement.org/forums/showthread.php?38586-Edwards-Wins-Panel-Support-to-Sell-First-Less-Invasive-Heart-Valve-in-U-S.

I remember at the time wanting to view the webcast cited as the source in that thread, but unfortunately never got around to it. Also, despite some of the information being already out of date, that thread did have lots of other good information on TAVI related issues for those with interest.
 

nigelp

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Here's what I found out today. Half of all valve replacements in Germany are done through the groin.
Robin Williams (the US comedian) had a replacement valve using a TAVI procedure through his groin. I saw him on a chat show talking about it:

"So, that confirms it. The quickest way to a man's heart is through his groin"
 

Agian

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Robin Williams (the US comedian) had a replacement valve using a TAVI procedure through his groin. I saw him on a chat show talking about it:

"So, that confirms it. The quickest way to a man's heart is through his groin"
I think TAVI is definitely on the horizon. There may be developments in other areas as well: Stem cell research, hybrid valves that don't need blood thinning, improvements in robotic surgery etc
 

SuzanneSLO

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Robin Williams (the US comedian) had a replacement valve using a TAVI procedure through his groin. I saw him on a chat show talking about it:

"So, that confirms it. The quickest way to a man's heart is through his groin"
Williams has a 9" scar from the AVR he had in 2009. The quote from his Weapons of Mass Destruction show was:

An angiogram is where they go through your groin to your heart, and who knew that the way to a man’s heart was through his groin, and many women are going “We’ve known that forever!”

-- Suzanne
 

tom in MO

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I have also read that a tissue valve gives better flow characteristics...more "normal". IIRC that's why mechanical valves can throw clots and warfarin is needed.

Since I am at the beginning stages of arthritis and have some tendon problems, to me the biggest down side to warfarin, right now, is that many (most) of the drugs to treat arthritis and joint/tendon problems are contraindicated with warfarin.
 

charlottekaye

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I had a tissue valve, now a mechanical. Just a teeny, tiny little issue with anitcoag

I had a tissue valve, now a mechanical. Just a teeny, tiny little issue with anitcoag

My history: Age 25, replaced bicuspid aortic valve with porcine valve (Dr Wm Gay, NYH)

Age 40: Re-replaced tissue valve with Carbomedics mechanical valve, (Dr Douglas Murphy, Atl St Josephs) have been on coumadin first, now HMO uses warfarin.

My therapeutic INR was originally 1.8-2.4 (I was really comfortable with that; still am.)

HMO moved my therapeutic range to 2.5-3.5. Don't like it - would prefer to be around 2.0, and - that's kinda where I live.

3 years ago, I felt very, very tired. Couldn't get out of bed. On the second day of feeling like that, I asked my guy to take me to the dr. I could walk and talk, but - was just tired.

Thank goodness my primary dr sent me for a ct scan 2 hours later - showed a brain hemorrhage. They took me to the ER, where the drs could not believe I could walk and talk.

My INR had jumped to 7; not sure why. I think it was a contraindication that was unknown at the time. I was hospitalized, kinda lost speech the next day, left side was completely numb.

After a few months, I had rehabbed pretty well, 18 months out I was about 98 percent. My right pupil is a little non-reactive; don't think that will improve, but -it's OK.


Now - if I had gotten to the dr on the FIRST day when I felt too tired to get out of bed, I would have been able to prevent any long lasting problems from this hemorrhage and probably avoided hospitalization.

So - 2 things to look out for on coumadin/warfarin: jagged looking bruises, and sleepiness. I'm sure there are other things, too - but: just never ignore those two symptoms.

I am going into my 17th year of being on warfarin. My HMO still will not approve a home test, which is just so wrong.

I am out-of-region as I write this, and had to track down a place to get a protime drawn.

This all being said: I've had both: tissue, and mechanical. No way would I have had another tissue valve; I never felt as good with it as I did with the mechanical. (But, that's just my experience.)
I am very happy with my Carbomedics valve, which Dr. Murphy suggested. Plus - it is very quiet, too!
 

Gail in Ca

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I'm not sure that endocarditis is usually treated and cured before surgery.
After my surgery to replace and repair affected aortic and mitral valves, the surgeon's notes said "Amazingly, she was treated quite well with antibiotics and did not require urgent operation." That made me think that it was unusual to go through the 6 weeks of IV antibiotics, not needing surgery until treatment was completed.
My surgeon never said giving me a homograph would've been the way to avoid endocarditis in the future. He would've only given me a homograph if my heart and aortic tissue was too damaged by the endocarditis to accept another mechanical valve/graft combo. He did everything possible to give me another mechanical, even moving it up along the aorta to provide me with the largest mechanical valve that he could. The surgeon is everything, folks!
 

kimcdougc

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Interesting article. Guess that means I am already behind times with the On-x valve I got. :) Thanks for sharing.
 

pellicle

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very interesting. I wonder about the assumptions behind it i some places it seemed to dramatising things, but that is not to discredit that its good to see progress
 

Agian

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The arguments against current options are a bit clumsy, but the comments on the limitations of TAVI (in its current form) seem valid. The references used are old.
Ideally, the replacement leaflets would be introduced through the groin, after the insertion of the initial docking station. Having said that, things will continue to evolve and improve.
 

nigelp

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Just read this article:

http://www.westchestermedicalcenter.com/documents/HeartCenter/Current Developments in TAVR (Tang, Lansman, Spielvogel, Cuomo, Ahmad, Dutta).pdf

I've got a congenital bicuspid aortic valve. Here's a quote from the article:

"Several reasons have so far precluded the widespread use of THV <Transcatheter Heart Valve> in bicuspid aortic valve disease: (1) asymmetric distribution of calcium in a stenotic bicuspid
valve, especially one with a raphe, may preclude complete apposition of a THV against the annulus and valve leaflets, increasing the risk of PVL, (2) a bicuspid valve more commonly has an elliptical annulus, making a circular expansion of the THV difficult, and potentially affecting the integrity and durability of an implanted THV, and (3) bicuspid valve have larger annular diameters, requiring larger THV sizes, such as the 29-mm Sapien XT and 29-mm and 31-mm Core-Valve to be suitable for implant."

Okay - I don't fully understand what the authors are saying here but essentially it looks like there are good reasons why TAVI procedures aren't commonly used for patients with bicuspid aortic valve disease (i.e. congenital bicuspid aortic valves). Hmmm
 
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