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AgilityDog

Well-known member
Joined
Nov 5, 2007
Messages
1,637
Location
North Texas
A la George Carlin keep going through my head. I just got back from the cardiologist, and it appears my aortic valve has to be replaced now, too.
I was really hoping to get more time between the mitral and whenever the aortic finally deteriorated, but that is not to be. Dr. E. says sometime this year, but please do it before the ventricle deteriorates. Yeah, no kidding. I had intially thought maybe May, but remembering how much damage was done by the mitral in 6 months before I was diagnosed, and seeing how quickly this went south (April Echo was stable) I'm thinking maybe February or March depending upon what the TEE says, if Dr. M. agrees with the need and can put me in the schedule.

We're scheduling the TEE shortly, and I'll have another cardiac cath, too.

I've got a St. Jude's and I'm already on coumadin, so I'm not so sure I need to look at an on-x. Anyone have a valid reason I should care which valve he puts in?
 
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So sorry that you have to go through this again now, but maybe sooner is better than later; and I hope you regain your energy and health after this surgery and be healthy for ever.

I do not have much knowledge about the difference between valves, but my surgeon who is a leader in valve replacement recommended SJ. Regent valve for my aortic and here is an exerpt about it:

"The SJM Regent valve provides better hemodynamic performance than you might have imagined possible with a mechanical heart valve. Single digit in vivo pressure gradients in valve sizes as small as 19 mm, considerably larger EOAs (effective orifice areas), and excellent patient-prosthesis match result in significant LV Mass regression."

If you like to read more about it, here is the website:
http://www.sjm.com/devices/device.aspx?name=SJM+Regent+Valve&location=us&type=18

Discuss it with your surgeon and seek his input. Good luck.
 
Understanding this your mitral is mechanical ....correct and you need a

aortic valve now? if i read it right i can identify with my mech.aortic 16

years ago was done and my surgeon said for my 2nd surgery ,on thursday

will replace my native for mech but even though my arotic stopped click

last nov.due to mitral not pushing enough blood through the aortic,it will

again click,theres nothing wrong with it and hes not fixing something that

doesn't need repair,but it crossed my mind at cath and tee tests in sept

2008 why not change both so i dont have to do it again.......NOT

and it's good for lifetime now my mech aortic is 16 years old,so yeah

as far as changing it,he said no........but with surgery round the corner will see what happens:eek: Good luck to you:)

zipper2 (DEB)
 
Since you are already on warfarin and that is unlikely to change then I think the choice is pretty strait forward ...go mechanical. Your dose won't even have to change. I've got a mechanical St.Jude mitral and my aortic valve is being monitored but the stenosis has not increased in 2 years. If the time comes that the St. Jude mitral has to be replaced for any reason then I'll probably go tissue and do the same for the aortic valve. While it is working so beautifully though (as long as I can still take warfarin) I wouldn't have it explanted to implant a tissue valve even if I had to have the aortic vave surgery done. I hope everything works out well for you. Sorry you are facing this so soon.
 
I wouldn't necessarily throw out the idea of one of the newer mechanical valves.

The hemodynamics of some of the newer models, such as the On-X, claim to be improved, particularly where it comes to slow spots and pinch points.

The slow spots are like eddies in the current, which allow blood to linger and consider clotting. The shape adjustements that smooth the flow and make it continuous, along with the slicker, non-silicone-enhanced surfaces are what make it possible for On-X to even attempt to have a non-ACT clinical trial.

Also, the hinge "pinch points" have been reworked to reduce blood cell damage, and the soft closure also reduces the amount of blood cell damage. This may help to reduce the risk of excessive hemolytic anemia, which is raised somewhat in those who have multiple replacement valves, especially mechanical. Hemolysis is common with replacement valves (from http://emedicine.medscape.com/article/780702-overview ,
Eric Kardon said:
Low-grade hemolytic anemia occurs in 70% of prosthetic heart valve recipients, and severe hemolytic anemia occurs in 3%.
), but some develop it to a point where it becomes a problem.

The slicker surface is unique to the On-X valve at this point, as it's a property of the unique type of pyrolytic carbon material it's made from, but other relatively new mechanical valves have also updated flow characteristics, reworked pinch points, and added soft closures.

Just somethng else to chew on.

Best wishes,
 
This afternoon I finally got around to looking at the on-x web site. I do like the idea of less cell damage and increased blood flow, as well as the chance of less tissue overgrowth with the newer valves. I will speak to Dr. M. about the On-x and the SJ Regent, as well as chances for minimally invasive surgery--faster recovery would be nice.

My nurse this afternoon was so proud of me self-managing my coumadin. That was nice. The're a really proactive, pro-patient and caring group of people.

One interesting note, my cardiologist and surgeon both office with Dr. Ryan (the Ross guru, not that I'm looking at that) at Plano Heart Hospital, so all the way around, I feel I'm in good hands not matter which valve I go for.

I'm just mad, sad, disappointed, terrified. I had so much fun the first time, I'm not looking forward to a repeat performance. But this time I want to get it done while I'm healthy and before damage is done the to ventricle like it was done to the atrium and the aortic valve as a result of the mvp.
 
Here is what Donna (a.k.a. djacq) wrote about her St. Jude Regent Valve on October 23, 2008 in response (#7) to the thread "2 models of St. Jude" in the Valve Selection Forum:

Not sure if this applies here BUT my Regent valve is blenderizing my red blood cells. Maybe just an anomoly? Talk about being tired!

I am intersted in any further info on this thread and will follow it closely. Not that I am thinking of changing mine!!!!

Donna
__________________
AVR, St Judes 12/04/02
Dr Singh
Rhode Island Hospital

[End Quote]

There was an article in the June 2005 issue of
"The Journal of Thoracic and Cardiovascular Surgery", page 1446,
entitled "Acute Leaflet Arrest in St. Jude Medical Regent Aortic Valve"
by Eivind 0vrum, M.D., Ph.D. and Geir Tangen, M.D., Oslo, Norway.

The article discussed 3 cases where the valve leaflets were
"completely arrested and rotation was impossible."

In 2 of the cases, they reported that "subvalvular tissue was seen bulging into the hinge mechanism."

The surgeons replaced the failed valves with either a smaller Regent Valve in one case, and a Carbomedics valve in the other cases.

A similar issue was discussed in an on-line Forum for Surgeons (which I can no longer access) that was reported a few years ago by another VR member.

From what I have been able to determine, the St. Jude Regent Valve was introduced around 1999, 3 years after the On-X Valves were introduced to the World Market.

The On-X valves have reduced turbulence due to their 90 degree opening, larger effective valve area in the smaller valve sizes than the older mechanical valve designs, reduced hemolysis (to approximately the same level as in Tissue Valves), and have not had any reports of "impingement" that I am aware of.

I have been unable to get much more information on this issue. On the other hand, I have not seen more reports of this issue and obviously we have members who are doing just fine with their Regent Valves. I'm wondering if the impingement issue was due to trying to put in a somewhat larger valve into a tight opening which 'pinched' the structure. Whatever the cause, it may be that surgeons have now learned how to implant the Regent safely.
 
Al, I don't believe that article from Norway has any bearing on current implantation techniques of this valve.
It is merely an account and poor example of one surgeons problems and/or errors with sizing and sewing. If it were in ANY way true at this time, my surgeon would never have offered me the valve.
 
Laurie, I completely understand your reasoning. While none of us likes to go in for another surgery, putting it off will only give that valve time to rear its ugly head. Plus, as we all can attest, the waiting is the absolute worst part. If you do it sooner, you have less time to stress and worry!

I have no input on valves, as when I got mine I had not yet found VR and didn't know people got a choice! Good luck with that decision.

So will your surgery take place at the Heart Hospital? I can verify that the hospital is a nice one to stay in (if you've gotta be in the hospital). The rooms are huge and the food is actually decent. Kinda spoiled me for Southwestern... That hospital sucked. :( Let me know when your surgery is and I'll be sure to come visit! :)
 
Laurie, I chose OnX because of the reduction in damage to blood cells, possibility for a lower INR after the clinical trials are complete, and the hemodynamics. I am very happy with my choice of valve. Is your surgeon going to look at your St Jude while he is in there to give it a clean bill? I am amazed at the number of people here on VR that have 2 mechanical valves. I picture the valves, in my mind, as to being so close together inside their hearts that it's a wonder they don't tap each other.

No matter what you choose, I wish you the best of luck and peace with your journey.
 
Good luck with your surgery--glad you are getting it done early and hope it is speedy and uneventful!!
 
Love your avatar - nice shot of the "A" Frame. I used to agility with my Cavaliers.

Do wish you the very best ......you know we'll leave the light on for you.
Blessings
 
Thanks everyone. I'm really leaning towards the ON-X, since I have time and knowledge to have input on this one. Now, if Mitch will listen to me....
I looked at the SJM Regent, but I think the ON-X looks better.
Yes, I'll be at Plano Heart Hospital. 3rd time for me in that Baylor Plano complex in 30 months (boo, hiss). Nice rooms, good food, but I really preferred the Honeymoon Villa at Iberostar Grand Paraiso in Playa del Carmen last month! Snicker.

Nicki, you can come visit any time. I hope you are getting your energy back.
Now, if they'll just call back about that TEE....
I hope I can convince DH to post an update after my surgery. Or I can just pm Nicki with my or DH's cell phone number and she can check on me afterwards!

oh, and we're getting a new used treadmill off of craigslist this weekend for my rehab and to keep Jet sane while I recover. Cheaper and more convenient than official rehab, and I can now do that part myself. Besides who wants to walk in the cold rain around here this time of year?
 
Whoooopie! TEE scheduled

Whoooopie! TEE scheduled

For Friday afternoon. It'll be nice to get a better picture of this regurge. It would be nice if the original echo were wrong, but I doubt that.
Maybe I'll hear the results before I leave. Wishful thinking.
 
Happy Dance, Happy Dance!!

Happy Dance, Happy Dance!!

:D
TEE says the regurgitation is only moderate (surprised me and the cardiologist). Sooooo No AVR for Now!!!

It will come some day, for sure, and we'll still keep and eye on the valve, of course, but at least I get a reprieve without too much danger of further damage.
 
:D
TEE says the regurgitation is only moderate (surprised me and the cardiologist). Sooooo No AVR for Now!!!

It will come some day, for sure, and we'll still keep and eye on the valve, of course, but at least I get a reprieve without too much danger of further damage.

Great news! What a relief that must have been.
 

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