St Jude Trifecta failure

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PARKSJU

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I received a St. Jude Trifecta in 2013 from Dr. Joseph Coselli in Houston. It has failed after 8 years. I am told others have recently experienced this early failure - the valve is no longer on the market. I now have Aortic Stenosis and need a new valve. My cardiologist recommended a TAVR, I just completed tests and work up for TAVR here in Fort Worth. They notified me yesterday I was a candidate, but also gave me an option/recommendation due to my age? for SAVR. They told me TAVR could last 10 years and SAVR tissue valves up to 15 yrs. I told the team leader that was my expectation when I received the tissue St Jude in 2013. I am going to visit the surgeon this after noon and discuss options. Have any VR members experienced this? Thanks for your feedback. Julie
 

Chuck C

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I received a St. Jude Trifecta in 2013 from Dr. Joseph Coselli in Houston. It has failed after 8 years. I am told others have recently experienced this early failure - the valve is no longer on the market. I now have Aortic Stenosis and need a new valve. My cardiologist recommended a TAVR, I just completed tests and work up for TAVR here in Fort Worth. They notified me yesterday I was a candidate, but also gave me an option/recommendation due to my age? for SAVR. They told me TAVR could last 10 years and SAVR tissue valves up to 15 yrs. I told the team leader that was my expectation when I received the tissue St Jude in 2013. I am going to visit the surgeon this after noon and discuss options. Have any VR members experienced this? Thanks for your feedback. Julie
Welcome to the forum Julie!
How long a tissue valve is expected to last has a lot to do with your age. How old are you?
 

Chuck C

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68 -12/31/1952
The older one gets, the longer a tissue valve is expected to last. If they told you to expect 15 years when you were age 60/61, that seems a little optimistic to me. I am 53 and was told to expect 10 years, give or take 2 years, if I choose a tissue valve. Now that you are 68, I think you are getting into the age range where 15 years might be a reasonable expectation, though certainly not a guaranty. And, it is probably correct to expect to get a few less years from TAVR, as they just don't have the long term data yet to predict otherwise.
That is a tough call. Face likely reoperation at about age 78 if you go TAVR or likely reoperation at about 83 if you choose SAVR. Is consideration for a mechanical valve even on the table? This would likely mean not ever needing a reoperation. When one is between 60 and 70, that is the range in which either tissue valve or mechanical valve are generally considered reasonable.
 
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PARKSJU

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Chuck, thank you for your very helpful reply. This is good information and I’m going to consider it today when I talk with the doctor
 

Unicusp

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Hello and welcome. Sorry to hear about the "early" (but average) tissue valve failure.

As Chuck mentioned, if you choose tissue again, you're then looking at 3 lifetime surgeries. Not a good idea. I strongly recommend a mechanical valve and be done with this issue. My opinion and also what I chose! Good luck!
 

PARKSJU

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Chuck, thank you for your very helpful reply. This is good information and I’m going to consider it today when I talk with the doctor
Hello and welcome. Sorry to hear about the "early" (but average) tissue valve failure.

As Chuck mentioned, if you choose tissue again, you're then looking at 3 lifetime surgeries. Not a good idea. I strongly recommend a mechanical valve and be done with this issue. My opinion and also what I chose! Good luck!
Unicups, Thanks for your response. It appears the comoumdin is manageable for you? BC of course that why I chose a tissue valve and know that has been the subject of numerous posts on VR.
 

PARKSJU

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Unicups, Thanks for your response. It appears the comoumdin is manageable for you? BC of course that why I chose a tissue valve and know that has been the subject of numerous posts on VR.
Coumadin.
 

Unicusp

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Unicups, Thanks for your response. It appears the comoumdin is manageable for you? BC of course that why I chose a tissue valve and know that has been the subject of numerous posts on VR.
Hello. Yes, Warfarin is simple and a non-event. Zero side effects and very easy to self manage. Proven safe & effective over many years.
My surgery was about 10 weeks ago. Full sternotomy. Pretty much back to normal and better than prior to surgery as far as aerobic capacity.
 

Chuck C

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Unicups, Thanks for your response. It appears the comoumdin is manageable for you? BC of course that why I chose a tissue valve and know that has been the subject of numerous posts on VR.
If being on Coumadin was the reason that you chose tissue valve, as you indicate, there is a wealth of info here and many threads on the subject. I can speak for myself, having been on Coumadin for 6 weeks that it is no problem for me at all. I just had to give up boxing, but I doubt this is an issue for you :).
There are folks on this forum that have been on Coumadin for many decades- Dick has been on it for about 52 years. They will certainly chime in here and share their lifetime of experience on Coumadin. If you do a search and enter Coumadin or Warfarin in the subject, you will get a lot of threads on the subject.
Here is one: Coumadin & Sports

There are many many myths about Coumadin. When you do the research and communicate with people actually on Coumadin you will discover that the vast majority of the fear about Coumadin is overblown, if not outright false.
As Unicusp indicated, you should really try to avoid a third operation, especially if it would be happening when you are 78+, as it obviously is more challenging to recover from surgery the older we get.
 
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PARKSJU

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It was the reason. I was in denial and hopeful the tissue valve would last me a long time. And then at some point a Tavr or related type of less invasive solution would be in available. I will check out the posts as you recommend. The TAVR ‘s not going to last me the rest of my life.
With the mechanical using Coumadin I can eat and drink anything I want if I’m consistent?
 

tom in MO

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It was the reason. I was in denial and hopeful the tissue valve would last me a long time. And then at some point a Tavr or related type of less invasive solution would be in available. I will check out the posts as you recommend. The TAVR ‘s not going to last me the rest of my life.
With the mechanical using Coumadin I can eat and drink anything I want if I’m consistent?
You can eat and drink what you want while on warfarin as long as you routinely test your INR. I believe Medicare allows weekly home testing.
 

rich01

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It was the reason. I was in denial and hopeful the tissue valve would last me a long time. And then at some point a Tavr or related type of less invasive solution would be in available. I will check out the posts as you recommend. The TAVR ‘s not going to last me the rest of my life.
With the mechanical using Coumadin I can eat and drink anything I want if I’m consistent?
I had TAVR at age 70. I don't expect to make it to 90, so hopefully, I get 10 years out of this valve before it needs to be replaced with another TAVR valve. By then, we can hope the valves are even longer lasting.

I spent 1 night in the hospital and I was able to drive after a week. I was awake for the entire process, I think I could have gotten off the cart and walked to the recovery area. I don't remember exactly how long the procedure was, but I think it was about an hour. No heart/lung machine.

If the cardiologist didn't explain it to you, they can do TAVR inside TAVR. So if you have TAVR now they most likely would be able to replace that valve in the future with another TAVR procedure. They are careful to make sure the valve is large enough so that TAVR in TAVR will be an option.

People may start throwing numbers and studies at you that supposedly show problems with TAVR and that SAVR is an overall better option. If those studies are not from the last 3 or 4 years, I would ignore them. There were problems with the early TAVR valves, but we are years past those early valves. In many areas, TAVR offers better results than SAVR.

This site is probably at least 99 people who have had SAVR for every one of us who has had TAVR, so just realize people are commenting based on what they know and they experienced.
 

dick0236

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It was the reason.......
.........With the mechanical using Coumadin I can eat and drink anything I want if I’m consistent?
I am 85 and have been on Warfarin (Coumadin) longer than just about anyone.....55 years this coming August. Dietary restrictions have never been an issue for me. I eat and drink whatever I want and always have. I do watch the amount of "dark greens" I eat but have never taken any food or drink completely out of my diet. In fact, warfarin, when taken properly and routinely monitored has had very little impact on my life or lifestyle over all these years.
 

Luckyguy17

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Welcome ParksJU, you have kicked off another heathy debate, on mech/bio/SAVR/TAV

I am 6 months younger than you are and have just undergone replacement of a failing SJM ESP bio valve. My valve did just over 10 years. My surgeon is convinced, our individual bio composition,is the primary factor in early valve calcification For some.
Because of the placement of my valve from 2010 and the direction of the regurgitation, TAVR/TAVI procedure was considered a higher risk surgery this time than would be SAVR. So a few weeks ago, i had a new bio valve installed, applying the evolving TAV standards to this surgery. If i am lucky, this was my last SAVR.

Your options are even greater than they were in 2013.
Technology is evolving at a very rapid rate
We are living an amazing time
Talk to you cardiac pros about your options.
 

PARKSJU

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Thank you lucky guy 17.. We are living in an amazing time. I appreciate your information. It’s encouraging to hear that people have so many good options and are having good experiences. I’ve got a lot to think about but after talking to my cardio today I don’t think I will consider a mechanical valve based on his recommendation. So ,I do have to think about do I want a SAVR tissue or a TAVR. Thanks again for your help!
 

Unicusp

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I'm curious as to the rationale the Cardio gave you against mechanical. Please share some details.
I'm also very surprised that they can do a TAVR in place of your current tissue valve. What size valve do you currently have? I'd also recommend that you speak with experienced surgeons for their expert opinions as well.. Thanks and good luck!
 

pellicle

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Hi and welcome

It appears the comoumdin is manageable for you? BC of course that why I chose a tissue valve and know that has been the subject of numerous posts on VR.
Basically there are only a few corner cases where warfarin (coumadin is but one trade name, rather like saying "Ford" for cars) and in the greater majority of situations its quite managable. Indeed as you age you may find that its preferable to be on some sort of anti-coagulant to prevent strokes ...

The reality of warfarin management is reasonably simple:
  1. you have an INR range to remain within (lets leave aside that acronym for now) and you simply keep it in range with small *(usually no) adjustments in dose as needed.
  2. the INR numbers you're assigned are reasonably gracious and falling out side of those for a short time is not as critical as it once was (with older valves back in the 70's and before)
  3. you need to ensure that you do maintain your dose and don't skip taking your pills (much) and put in place systems (like a pill box and some alarms) to make sure you don't forget
Point 1 implies monitoring your INR levels which is done simply at home with a machine such as a Roche Coaguchek, or as a last resort going to a lab (I have been monitoring at home for nearly 10 years now, and some here on this forum even longer.

There is a lot of myth around things like foods and drinking a few beers, but they just don't bear rational scrutiny.

I have a blog post written to the managing INR here:

its not specifically intended as a quick introduction but as a resource. However it begins like this:

Firstly - the good news
I wanted to say that managing my INR myself is incredibly simple and takes me about 5 minutes per week. Learning to use an INR monitoring machine is dead simple (a quick video provided) and (almost) any idiot can do it. If you buy strips online they cost so little that if you are an able bodied person you just couldn't consider doing it any other way.

By using the Coaguchek XS I have been essentially free to travel as I wish (moved from Australia for a year in Finland, traveled to the UK and other places) and more or less unbound in any way by being on anticoagulants.

As a bonus its been really cheap, with tests costing me less than $6 per test.

In this post my main focus is on those of us who are on anti-coagulants for the fact that we have a mechanical heart valve. As I understand it there are quite a few out there who simply do not monitor their INR after their heart valve replacement, and perhaps bumble along with a fixed dose and no idea if its good or bad.

So my Valve Brothers and Sisters if you are still reading its all good news. I encourage you to go to eBay and buy a Coaguchek XS (or simmilar) get online for strips and look after your health, for your self by yourself!

In a nut shell what I do is:
  1. sample my blood to determine my INR
  2. write that down (spread sheet, but book works)
  3. determine if its been over time falling or rising (a graph on a SS really helps)
  4. make a small adjustment to my dose if needed to correct for my INR falling or rising (usually adjustment isn't needed and its better to leave it alone, more later)
That's it ... compared to a diabetic, life on warfarin is really simple.

some posts from here you should consider fishing through


feel free to hit back with questions.

Whatever you decide you want when you actually have a truthful view of the facts is exactly what you should do.

Best Wishes
 

ATHENS1964

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I'm curious as to the rationale the Cardio gave you against mechanical. Please share some details.
I'm also very surprised that they can do a TAVR in place of your current tissue valve. What size valve do you currently have? I'd also recommend that you speak with experienced surgeons for their expert opinions as well.. Thanks and good luck!
They can put a tavi in an tissue valve, after putting a device like a balloon, they break the ring of the old valve and then place the new one. The difficulty is not to damage the fabric of the ring. The new resilia edwards valves simply have a mechanism in the ring that allows it to grow in diameter, the question is whether it will work after 20 years that it will be inside the human body.
 
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