Surgeon's final valve decision ?

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D

DANIEL

Hello to all and thanks to everyone for answering so completely my previous PM emails filled with lots questions and anxieties.....

My first post at VR. I am 50 yrs old, firmly scheduled on 7/01/03: Aortic valve replacement and aortic anuerysm to be taken care of.
Lived with this my entire life - asymptomatic. Am 90% set on
the Carpentier-Edwards Bovine Aortic Bioprothesis. Figure if this
lasts 12-15 years (nothing guaranteed) then I would opt for whatever is sensible at that time. Hopefully, to take advantage of
new developments, ie clot free/mechanical, etc. As I learn more
I am now aware that sometimes the surgeon will "sew-in" a different valve than what was earlier agreed upon. What "obstacles" could determine this aside from personal biases and going for the simpliler solution when you are on the op table ? Could one's required valve size be too large for tissue and therefore a mechanical valve is the only solution ? My meager knowledge is that Porcine valves are actual heart valves. The Bovine, as above, is "manufactured".....as is the mechanical,
are there size limitations for these as well ?

Please, any advice - suggestions - comments regarding this valve
issue and/or anything anyone can provide me related to this is gratefully appreciated.
 
Hi Daniel and welcome to the club.

Four years ago at age 17 I was scheduled for the Ross procedure. They had the donor valve to replace my pulmonary valve and everything else ready to go. When they got inside, they found that not only was the aortic valve defective, but the pulmonary valve wasn't much better. While it would still function fine where it was, it would not survive the stress of replacing the aortic valve. So on the fly, the doc decided to put in a St. Jude's mechanical. I was kind of surprised when I woke up and heard this ticking noise. Just one example of an obstacle that might occur. Thankfully everything's fine today.
 
GOOD CHOICE Daniel !

The Bovine Pericardial Valve is made from the pericardium of a Cow's Heart and shaped to resemble a human heart valve. Durability results are 90% at 15 years and counting. Some are pushing 20 years now.

This was my preferred choice and was agreed upon by my surgeon, BUT, after opening me up, he decided to implant a St. Jude Mechanical Valve for reasons of durability and findings which he did not elaborate. Communication was not his strong suit.

I've not had any significant problems with Coumadin but it does make further invasive procedures and/or surgeries more complicated.

The 21mm St. Jude mechanical valve does have a relatively small opening which limits the maximum blood flow and therefore limits one's maximum level of sustainable exertion. It's fine for normal activities but high level sports etc will probably be compromised.
I 'believe' the Bovine Pericardial has a larger opening but have not found any numbers.

'AL'
 
Welcome Daniel

Welcome Daniel

Glad to see that you are really looking into this issue of valve choice..you will be better off in the long run from what you learn. You don't mention - have you met your surgeon yet and is he/she willing to work with you on your choice of valves?

A primary factor in a surgeon changing his mind during the procedure is how well he or she thinks your heart could accept a prosthesis not only during the current surgery, but during another one or more surgeries down the road. A surgeon may not be able to predict the condition of your valve roots, for example, until he can get his eyeballs on it.

Welcome aboard
 
I met my surgeon possibly too early in the mental, learning process. I knew from my cardiologisit and years of watching my
valve development that I would someday need the big OP.
I chose the surgeon based on background, specific aorta valve
experience (years and # of AVR's), referrals from other doctors and his disco dancing ability, etc. When I did see him, about one month ago, he suggested the mechanical St Jude for the usual reasons. I had the usual early questions and left his office. I started reading more and more about my specific big OP and realized that I did have options and considerations. I spoke to the surgeon on the phone about two weeks ago and briefly discussed valve options. I asked him about a homograft and he replied a Bovine would be a better and a more appropriate tissue valve for me. Since this conversation I have continued my big OP studying (alot) and have 90% decided the Bovine is the tissue valve of choice, FOR ME.

Now I am still a month away from the big OP and reading maybe too much. I can see that sometimes the valve you want is not the
one you get. I realize in the end the surgeon may have some
biases re valve choice, etc. Therefore, I am curious re surgeon
valve issues so I can sort these out in advance. I want to feel the surgeon will use his best ability to "sew-in" the agreed
upon valve and not to change, unless truly necessary.

Maybe kind of over thinking everything, but once I settle an issue,
I do not look back. I need this issue settled, atleast in my mind for the time being......I plan to talk to the surgeon in about two
weeks to be sure I am clear re what to expect. I can see that I need to understand, in advance, all the relevant issues to get the
most out of our next conversation.
 
Hi Daniel-

Welcome to this wonderful site. It sounds as if you've been already doing lots of homework. That great. You really can't learn enough about all there is to know, and it's always changing and evolving. Many people here do lots of research on different aspects of living with valve problems, and having the surgery and how to enjoy life to the fullest afterwards.

There is a tremendous amount of excellent information here.

Best wishes.
 
Daniel

Daniel

Whatever you choose. valve type now..will be a good one. Now, in 2003..this surgery takes a good year to feel like your old self again.. You will have good days and bad days..good months and bad months..No one can say 12 years from now..it will improve..Will you have a good family to support you then..At age 62.. I had my one and only OH surgery at age 62. Was lucky to have a good hubby to help out and young family..Would never want to put them thru this again.. Now, I'm back to being the caretaker.:D :D :D Bonnie
 
Hi Daniel,

You sound alot like myself. I thought maybe I overanalyzed my choices. In reality, it was just a process I had to go thru until I felt comfortable with my decision. Don't beat yourself up, follow up on your questions until you're satisfied with the answer.

I'm 45 and need my second aortic valve replacement. My first was a homograft 14 years ago. I just assumed I would get the homograft again, until the surgeon said I should avoid a third surgery at all costs. So I'm going the mechanical route, agreeing that the risk of a third surgery is greater than any coumadin associated risk.

Since its your first AVR, your in a different situation. The Carpentier-Edwards PERIMOUNT Aortic Pericardial Biologic valve seems to be the valve of choice at Cleveland Clinic. I think its a good choice. When it wears out and you need another, you may be old enough to get a tissue valve and avoid coumadin altogether. Of course, the flip side is a likely second surgery in your 60's or 70's.

Talk to the surgeon about your concerns. Granted, they're not all great communicators, but at least get if off your chest. Then see what his reaction is. You should be able to tell if he's genuinely concerned or not.

Good Luck!

Rob
 
Hi Daniel,
I have the Saint Jude Mechanical. My heart surgeon is a very renown surgeon here in the Northwest, that travels around the country doing lectures. (the reason I bring that up is because he is a pretty ruputable source of information.) He told me the Saint Jude Mechanical was the best, (that was in 2000) and that I could do anything with this valve. I took him at face value, and will run my second marathon with this valve in October. Personally I am starting to set my sights on a Full Iron Man. So I have plenty of confidence in this valve. I know Les Barrett on this site, also ran a marathon with a Saint Jude. If the valve can handle a marathon, it can handle anything. Good luck in your decision. I wish so much I would have known about this site before my surgery. Some people have really researched this information, and have a tremendous amount of knowledge you can go back to your surgeon and or cardiologist with to discuss.

You'll do fine my friend ... Mark
 
hi daniel!
welcome! as you can see, this is a wonderful site. everyone is so helpful and supportive.
i think they've all said it... you've done all your research, have pretty much made up your mind about what valve to use,
and now if i'm not mistaken, you just want to make sure your surgeon puts that one in (if all goes as expected).
have you discussed this with your surgeon? have you discussed back up options?
where are you having the surgery done and who is your surgeon?
please keep us posted.
be well, sylvia
 
Levels of valves

Levels of valves

Hi Daniel,

i had an extended chat with Dr. Bavria's Nurse Assitant, Bill Moser during my pre-op workup. Here is the rundown of what will be implanted. (I also have a dilated aortic root which may need to be replaced)

1) St. Judes porcine Toronto full root valve (part of clincal study)...... if my pulmonary valve needs to be replaced (unlikely by possible) I can't be part of the study and we will go with

2) Medtronics porcine freestyle full root valve.... freestyle only goes up to 27 mm, so if my valve size is larger than that we go with

3) Carbomedics Carbo-Seal® Valsalva Ascending
Aortic Prosthesis in case my aortic diameter is too large.


Talk to your surgeon, ask what is your best case scenario for valve selection and why, and what substitions he/she will make based on what conditions he/she finds. I think knowing the best and worst case scenarios and the reasoning behind them can help put your mind at ease.

Remember the old saying... Hope for the best, plan for the worst. Either way you wake up comfortable with the desicions that were made.

Best of luck,
 
You guys are great

You guys are great

Thanks for all the good advice. The Internet is amazinng. This
week I am in Central America, on business in a small town, and
I can still check-in with VR.com. Instant gratification !

The count down is on. I will definitely talk to my surgeon in
the next two weeks. I like the suggestion to discuss his/my
primary and secondary options and the why's and what if's. This
is exactly what will set me into the final pre-op focus and settle my mind. It does seem obvious to have this complete discussion, but when someone puts it into writing so I can see it.....it is much
clearer to me. Thanks for your pre-op options example for me.
Muchas gracias.....
 
Another control freak

Another control freak

HI Daniel - I've been accused of being an overanalyzer along with a few others on the site. Its funny though, I really didn't get into valve type analyzing. In the end, I ran out of time, and only met the surgeon once before my surgery. I ended up being a St. Jude dude, and I'm comfortable with that. Best wishes to you as your clock ticks, and we hope to keep up with your progress on the site. Chris
 
I think I was too much in shock to wonder why I might have gotten a mechanical VS. a porcine in'89. My surgeon said he would try to give me porcine. Another well respected surgeon recommended that I get mechanical andbe done with it.
I would say to call and leave a message with the surgeon and ask him or her how they decide to use what valve.
I had an ascending aortic aneurism as well. I think the valve choice may have to do with size of opening, but I really never found out.
Gail
 
Rounding 3rd

Rounding 3rd

Spoke at length with the surgeon and in my situation, if C-E Bovine Pericardal is the valve of my choice, then this is the
one that will be sew-in. The situation with my anuerysm is
not an issue, the (my) valve size is not an issue (whatever size
is required will be available). No particular issues for the Bovine
as compared to the St Jude. Therefore, no secondary options
to be considered. The surgeon thought the C-E valve was
excellent. Only issue is calcification over time. He is aware of
a tissue valve lasting over 20 yrs. With coumadin there is risk
that is small each year, however, the risk is culmative over time.

Here is a decent look at/into the valve issue. A video that can
be downloaded/streaming with top heart surgeons. Let me ]
know what you think. I got this from a letter at another related
heart site.

http://europe.edwards.com/MedicalProfessionals/Education/ClinicalControversies/greatDebate.aspx

Thanks to all for your support. I would have been in a friggin'
vacuum, with no one to talk to, if not for you guys.

thanks
Daniel
 
I would have been in a friggin'vacuum, with no one to talk to, if not for you guys.
Click to expand...
That sir, is exactly why this site exists! I hope you will continue to contribute when all is said and done.

I'm glad to hear the choice has been made and your comfortable with it. Now all that's left is to get the job done. ;)
 
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