Tissue Valvers second OHS

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I had second OHS about 18 months ago and chose bovine tissue valve in mitral position. I am so happy that is what I chose and no second thoughts whatsoever. Each of us must decide for ourselves (in consultation with our doctors) which is best. There is no wrong choice other than to not choose.

It's very hard making this important decision and I wish you the best.

AGE at the time of implantation is a Key Consideration which you did not address in this post. Over age 60, there is a high probabability that the Bovine Pericardial Tissue Valve can last 20 years or so.

At age 44 Lori would very likely need yet another replacement in her lifetime, maybe even before age 60, since Tissue Valves tend to 'wear out' faster in younger patients. It's a tougher decision for younger patients to have to make.
 
I am a Rosser who had the Ross procedure, then a mechanical. My father too had a AAA aneurysm and BAVD. Just thought I'd chime in there letting you know we had something in common.
 
Thanks for all this great info. I have been looking into the On-X - didn't know anything about it.

I made an appointment with Dr. Shemin this week while I am at UCLA doing pre-op stuff to talk to him about valve selection. My husband and I are compiling our list of questions. I think I will feel better with this one last face to face before I see him the morning of the 9th.

I really do not want another OHS but I am still waiting to hear from GI doc. I should have his opinion before my meeting with Dr. Shemin Thursday.

Thanks again,
Lori

Lotti - I knew this was a first name but only knew one other Lotti years ago. Lotti was my maiden name - family originally from Italy.:D
 
- It is extremely unlikely that you would get 20 years even from the newest tissue valves at your age. If you chose and stuck with tissue, the likelihood is that you would have a minimum of two, and more likely three further surgeries. The last one or two might be through transcatheter placement, but the first two would likely be standard surgery (my guess/estimation of the medical industry's readiness). I just had my second AVR five days ago. It isn't/wasn't fun, but it's doable. I did go with a tissue valve again.

-,

I too am in the valve choice stage and my gut has me leaning tissue right now, but I am 11 years older than our original poster Lori. I consider myself semi active. I don't climb mountains or run marathons or anything, but do work out, snorkel, garden, stuff like that. No kids to chase...

I don't want to hijack Lori's thread but maybe useful info for her too... Tobagotwo - Where are you finding your info about how the trials are going for transcatheter placement? I haven't even tried to look myself so taking the shortcut by asking someone who has evidently been there. One HUGE factor in my leaning with tissue is my belief that by the time I need a reop, I would likely be able to have the valve replaced via transcath . My cardio didn't think that was unrealistic at all. Haven't asked a surgeon yet.

Lori interesting hat you mentioned diverticulosis.... I have that too per a colonscopy but have never had an issue. My Dad did however have lots of rectal bleeding with his at one time (non warfarin user). He hasn't had another flare up. I just hadn't even factored that in to my deciision making and maybe should.

Best of luck in making the decision Lori. Everyone on this forum I think knows where you are coming from. It ain't easy.

Rhena
 
I don't want to hijack Lori's thread but maybe useful info for her too... Tobagotwo - Where are you finding your info about how the trials are going for transcatheter placement? I haven't even tried to look myself so taking the shortcut by asking someone who has evidently been there. One HUGE factor in my leaning with tissue is my belief that by the time I need a reop, I would likely be able to have the valve replaced via transcath . My cardio didn't think that was unrealistic at all. Haven't asked a surgeon yet.


Rhena

I would be interested to learn more as well, perhaps a seperate thread can be set up in advancements if there is a lot of information.
 
I too am in the valve choice stage and my gut has me leaning tissue right now, but I am 11 years older than our original poster Lori. I consider myself semi active. I don't climb mountains or run marathons or anything, but do work out, snorkel, garden, stuff like that. No kids to chase...

I don't want to hijack Lori's thread but maybe useful info for her too... Tobagotwo - Where are you finding your info about how the trials are going for transcatheter placement? I haven't even tried to look myself so taking the shortcut by asking someone who has evidently been there. One HUGE factor in my leaning with tissue is my belief that by the time I need a reop, I would likely be able to have the valve replaced via transcath . My cardio didn't think that was unrealistic at all. Haven't asked a surgeon yet.

Lori interesting hat you mentioned diverticulosis.... I have that too per a colonscopy but have never had an issue. My Dad did however have lots of rectal bleeding with his at one time (non warfarin user). He hasn't had another flare up. I just hadn't even factored that in to my deciision making and maybe should.

Best of luck in making the decision Lori. Everyone on this forum I think knows where you are coming from. It ain't easy.

Rhena


There are a couple threads in the advancement forum about percutaneous valves you just have to go to the display option and pull up all thread from "last year"

also IF you are really interested the AATS (american assoc thoriacic surgeons) conference from last year has quite a few sessions on them you can watch the webcasts from http://www.aats.org/2008webcast/
 
Dtread has posted access to the trials above, and corrected one of my statements as well. I didn't realize that the aspirin trial in the US still included Plavix.

But it's still a very low maintenance drug (always one pill a day, no INR testing), with a currently better safety profile for bleeds.

Percutaneous valves aren't in general use yet, although there are several that have been approved, including one very recently specifically for pulmonary valve replacement (Ross Procedure folks take note).

I believe you can only get one at this time if you are unable to withstand the rigors of ordinary OHS.

Best wishes,
 
The trials for the pulmonary valve (the melody) are not being done on just people that can't handle OHS. They ARE currently only being done on people (mainly children /young adults) who already have had a PVR. Pretty much anyone that has a PVR that meets the criteria and needs a replacement is able to be in the study if they want to travel to one of the centers. It can be their 2nd surgery or 5th ect (I picked 5th because we talked to Boston about this for Justin for his 5th, but he ended up not needing his valve replaced just a section of his conduit)
Here is the criteria http://clinicaltrials.gov/ct2/show/NCT00740870 They have been doing them in the UK now for about 10 years with great results and the kids are very active, no restrictions ect
The also have already replaced percutaneous pulm valves with new percutaneous pulm valves in the UK
 
I find the disucssion around percutaneous pulmonary valve replacement very interesting. Thanks for sharing this, Tobago and Lynw. There doesn't seem to be many members on this forum with pulmonary valve issues. I am one of the lucky few. :D

In my case, the cardiac surgeon is going to attempt to repair my pulmonary valve during replacement of the AV. If he is unable to, he said that surgery to replace this valve would be about 10 years away. When I asked if this would be through the standard open chest surgery, his reply was "no it would be through the percutaneous route". In others words, I would have it first time around without a previous PVR. Sorry to move this discussion in a different direction, but do appreciate this information.
 
Most of the PVRs I know of are people with congenital heart defects (or had the Ross) in the adults with CHD forum there are quite a few people with PVR. Most of the docs I've talked to said Justin will get his next pulm in the cath lab,(hopefully not for a decade at least...I pray) but since that will be his 6th OHS (and 8th heart related surgery) I guess he is considerred high risk. The next thing I'm hoping for is the improvements in Tissue engineered valves (from the pateints own cells) so hopefully THAT surgery would be the last one Justin would need.
 
I had a tissue valve put in 8 months ago and didn't really have the option of a mechanical as it was the pulmonary valve. If I DID have the choice, however, I think I still would have gone the tissue valve. For me the advantage of potentially avoiding further surgery down the track with a mechanical has to be weighed against the constant INR monitoring and the possibility of being driven to distraction by a ticking valve.... I struggle with a clock ticking anywhere in the room - if it was my heart and I couldn't block it out, I would go crazy.

While I will almost definitely require another OHS down the track (unless PVR's will be available via catheter by then), I do love that I really don't have to think too much about my heart on a day-to-day basis - other than doing all I can to stay healthy and fit (which is something I aspire to anyway). That is a trade-off I can live with, but we all need to make decisions which tick the right boxes for ourselves.

Just remember, there are no right or wrong choices. Both have pros and cons - I guess it's which ones you think best suit YOU!


A : )
 
When I had 'the talk' with my surgeon,( one that people come from all over the world for repeat surgeries), there was no mention of the risk of being on coumadin, but the risk is SCAR TISSUE from previous surgeries! Many talk of having 4 or more surgeries like, oh, ho hum, but, really, a 12 hour surgery, like mine, is serious business. That being said, I briefly, in my imagination, wondered about having a homograph for this 3rd surgery. But, I am so better off with another mechanical. A 4th surgery thru the sternum? Scarry!
 
I also chose a tissue valve at age 42 to replace a severely leaking tricuspid.
The tricuspid valve doesn't have as much pressure on it as a mitral,and
so I was hoping that this may give the life of my valve a few more years in
spite of my 'youthful-chemistry'. Now it looks as if my valve is leaking again.
And if I needed another surgery,I would really be unsure of what to do.
There are good and bad points on both sides, so I believe what is most
important is to make the decision for yourself and your lifestyle,don't allow
anyone to make the decision for you-- as long as you are well informed,
and there is no specific medical reason why you would need one type of valve
over the other, it should be your personal choice.
Wishing you the best - Dina
 
There are at least three percutaneous valves that are approved in the US, one of which is for the pulmonary valve. Acceptance is confusing, as international requirements and approved types are not the same as US requirements, and these valves have been in use internationally for quite a bit longer than in the US.

However, my cardiologist, who is also a top-flight interventional cardiologist, pointed out that the catheters and valve stents that he's seen for this are five times larger than the type used for standard cardiac catheterization. This requires that the blood vessel used (usually femoral artery, I believe, top inside of thigh, groin area) has to be cut down, the introducer sheath then has to be sewn into the artery to keep the patient from bleeding to death, and afterwards, the sheath has to be removed and the artery stitched. This makes it an operation requiring anesthesia, rather than a simpler, light-dose procedure.

Of course, there may be devices in use internationally that are ahead of this design issue.

There is also still a fairly high percentage of placement and collapse results, which are very bad. This is one reason why most applications for percutaneous valves in the US require that the individual be unable to endure an open-heart procedure.

He acknowledged that once in, the valves are lasting well. He also said that they are finally starting to come down in size. I don't believe he is thilled with them yet, in their current state.

Best wishes,
 
Hi there,

I am coming up to my 2nd AVR. I had my 1st AVR 11 years ago at 29 and chose tissue at that time. Surgery and recovery wasn't all that bad for me.Worse for my friends and family. Worst bits I remember were: the trans-esophogeal Echo done before surgery, felt like I was choking whole time, next worst was being stuck in bed not being able to get up. That passed after a couple of weeks.
Was back to work in 6 weeks.

This time we are planning to rent an electric hospital bed to try avoid the trapped feeling.

I am leaning toward Tissue again. My Brother has collitis, my sister Crohn's . I don't want to risk coumidin yet as I have occasional Irritable Bowel.
Looking at the risks of reop, I am thinking that the 3rd reop, probably around 60-65, will possibly be a mechanical as the risks for reop get worse after the 3rd and make coumidin the lesser or the risks at that point.
 
Al,
I've gotten together your info on the mechanical valves for my own impending replacement and want to thank you VERY MUCH for sharing your wealth of information.

Dianne (NJ)
 
Lori, I had my second OHS two years ago and it was a tissue replacement. That's what my surgeon thought was the best way to go. So far it has held up, but as everyone else, I sure don't look forward to getting another surgery, which is almost certainly inevitable.

As everyone here says the final decision is up to you and your surgical team; make sure you have confidence in them. You are doing your homework, which is great. I hope you are comfortable with your final decision. Please keep us posted.
 
Hello.
I had my first tissue valve at the age of 24. It was a homograft. At the time, it was one of the more promising "new" flavours of the month. I was told they expected to get 25 years+ out of it based on all the research, etc. that had been done to date.

That one burnt out in the year 2000. In 2001, I had my second AVR. This time it was a Medtonic Freestyle Stentless Pig Valve. Excellent chance of this being the last valve I'll ever need, etc.

It's 2009 and I'm going for AVR number 3 sometime in the near future.

I used to read all the research and listen to all the doctors and I suppose I was always very optimistic about new techniques and technologies. Each time, I had hoped that "by the next surgery, they'll have something better".

While my case may not be typical, I can honestly say that I do regret not going mechanical last go around.

The first and second operations were not easy, but they were tolerable.

Now that I am looking at number 3...... I'm done. I will go with the most proven approach they've got to avoid a 4th operation. Not only because the risks go up dramatically with each one (due to scar tissue, etc.), but because I believe this has exhausted me. I dont' think I would be able to pick myself up and believe that something else will come along that will be less invasive, longer-lasting, etc.

I decided not to live in the future anymore with this stuff, but to just get it handled and hopefully get my life back to normal.

You have a difficult choice to make, Lori... but never forget.... the choice is one of a active and fulfilling life either way. Please do let us know what you decide to do.

We all know how difficult this decision can be, but once you've learned the information you need - go with your instinct.
Kev
 

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