Valve Question

[Ray Norsworthy]

I was a vigorous, otherwise healthy 61 year old when I had my surgery & I thought the choice was easy (but that's me, I'm not saying it would be for others). There is no way I'd have a mech valve, with the clicking and coumadin. Most tissue valves nowadays last upwards of 15 years in a person following a relatively healthy life style. There's a man that posts here occasionally whose valve has lasted over 20. And anyway, minimally invasive percutaneous surgery will soon be commonplace, where a needle puncture in a blood vessel is used to insert a balloon catheter, mounted with the new valve. The balloon is used to expand the new valve inside the old valve, which it pushes out of the way. The technique is performed under local anaesthesia and light sedation. I had a pig valve & I'm snortin' right along. Good luck with whatever you choose.

 

[neil]

yot sorry to hear about your grandmother, but i think its realistic to believe you will not need 3 ohs for new valves at the age of 57 unless you are so so unlucky,i would think another 1 is a lot more realistic, theres no extended warrenty on any valve only stats and the information off the experts, my advice would be go for what you think is right for you, dont look back and eat chocolate lol

 

[Harley2000]

BGold WELCOME to the forum ,,,,another factor to consider is the advancements made RECENTLY in Trans cath replacement http://content.onlinejacc.org/article.aspx?articleid=1377006

http://content.onlinejacc.org/article.aspx?articleid=1377006 it should not be a sole factor but taken into account ....kind of like buying stock futures

I was reading up on this trans cath valve replacements and it seems that this procedure is being used where the natural "bad" valve is in place. The replacement is placed "inside" the existing valve, explanded to force the valve open, and is held in place by being inside the old valve. I was wondering if there are any instances where this procedure was used to take the place of an failing artificial valve either tissue or mechanical. Just wondering
Mike

 

[ElectLive]

I was wondering if there are any instances where this procedure was used to take the place of an failing artificial valve either tissue or mechanical. Just wondering
Mike

Previous valve replacement was one of the disqualifying factors for the transcatheter trials, and as such, very little evidence in comparison to the broad PARTNER trial which preceded FDA approval. Limited valve in bioprosthetic valve procedures have been done, though, including a few small scale studies, with generally positive results. However, the technique is only possible for those with tissue valves, not mechanical, and the size of the valve in place is a critical qualifying factor.

In some ways, though, TAVR is actually much more well suited to bioprosthetic valves than the leading type of native valves with dysfunction (bicuspid aortic) due to the "noncircular" anatomy of many bicuspid valves which would lead to regurgitation.

 

[tom in MO]

My surgeon indicated that one should not chose a valve type based upon a belief that "minimally invasive percutaneous surgery will soon be commonplace". He indicated that even if it gets wider approval, it will not be appropriate in all cases.

Both valves have equal plus/minus to them. With a tissue valve at a younger age, you are again "in the waiting room" waiting for it to fail and be replaced. You will also suffer whatever decrease in function that will come as the valve fails. With a mechanical valve you deal with warfarin but not valve failure. The "ticking" is not noticable for most, unless they want to hear it.

 

[BGold]

Thanks for all the informative input. I met with the surgeon on monday and have decided to go with Carpentier-Edwards PERIMOUNT
Aortic Heart Valve. I have to double check, Im not 100% its that model but it is a Carpentier-Edwards Bovine Valve. Surgeon is Kevin Accola at Florida Hospital in Orlando. Confirming date tomorrow, should be soon. Thanks again for all the great discussion.

 

[iheart]

"This was our hardest decision. My husband 50, healthy no meds prior and compliant personality struggled with which type of valve. Both mechanical and bio were better than his own, but neither are perfect and both come with risks which led to many discussions with various physicians, surgeons, reading many journals for months. As our cardiologist has said, if it was an easy answer, there wouldn't be so many publications regarding choice guidelines. Know that any valve is better than your own, and hope for smooth recovery and lengthy duration before you have to make any choice again!"

Socalhome, what valve did your husband choose? I am 50 and will be having surgery next month. I started out thinking I would get a mechanical valve, but due to other health considerations am strongly leaning towards a tissue valve at this point. It's a really tough choice!

 

[socalhome]

"This was our hardest decision. My husband 50, healthy no meds prior and compliant personality struggled with which type of valve. Both mechanical and bio were better than his own, but neither are perfect and both come with risks which led to many discussions with various physicians, surgeons, reading many journals for months. As our cardiologist has said, if it was an easy answer, there wouldn't be so many publications regarding choice guidelines. Know that any valve is better than your own, and hope for smooth recovery and lengthy duration before you have to make any choice again!"

Socalhome, what valve did your husband choose? I am 50 and will be having surgery next month. I started out thinking I would get a mechanical valve, but due to other health considerations am strongly leaning towards a tissue valve at this point. It's a really tough choice!

He has a bio-bovine. He really went back and forth until 2 days before surgery. I think he would be just as happy and thankful today with a mechanical. The surgeon leaned a bit towards bio valves (he participated in TAVR original research teams and is currently placing valves in replacement bio valves in next arm of US study). He was very encouraging about the that possibility in the future. We equally thought in the future if another valve is needed, he'd wouldn't have an issue with a mechanical given hopes of reduced warfarin loads and new meds coming on market. I think my husband's final decision to have a bio valve was current lifestyle: he enjoys isolated backpack/outdoor excursions (days away from medical help), and international travel. Those two leisure and work activities for next years, and not wanting to "worry" about coagulation while gone helped him lean towards the bio. He is almost 8 weeks post op, feels great. I hope as the spouse we have MANY MANY years before another visit to the surgeons office. Again as many have said, it really is a hard decision for some, but once you make it...don't look back! IT WILL BE THE RIGHT DECISION FOR YOU!

 

[ottagal]

Thanks for all the informative input. I met with the surgeon on monday and have decided to go with Carpentier-Edwards PERIMOUNT
Aortic Heart Valve. I have to double check, Im not 100% its that model but it is a Carpentier-Edwards Bovine Valve. Surgeon is Kevin Accola at Florida Hospital in Orlando. Confirming date tomorrow, should be soon. Thanks again for all the great discussion.

So glad you have made a decision...now you can move forward.
BTW. I have the CE perimount valve and so far so good! :thumbup:

Wishing you all the best with your upcoming surgery.

 

[escargome]

Well from a fellow bovine valver, best wishes on your upcoming surgery. I have had my little cow friend in for almost 5 years and there have been no problems. I look forward to your updates.

 

[neil]

ive had my porky pig for over 5 years and he or she is honking merrily away,

 

[pellicle]

Doc says it’s time to replace aortic valve, I’m 57 years young and know the book says I should get a mechanical valve. ... but thought I would check with all you seasoned experts that I thank for all the informative input I get.

My feeling is to minimise the needs for surgery. Things can go wrong. Like car accidents, rare but can happen to you

http://www.valvereplacement.org/for...nd-feelings-(some-may-find-images-disturbing)

 

[virginian777]

i just 30 days ago tomorrow got a bovine valve to replace a mechanical one that was leaking and it was less that 10 months old i hated the warfarin monthy blood test, the more i read the more i think my choice was the right one more and more i have heard drs that are getting cautious of warfarin and with the new technogy to replace a bovine is done thou the leg.and like my surgon said who know what new things will come about in 10 years.but remenber anyone you choose is the RIGHT ONE

 

[Cheriejolay]

I had kind of a different scenario than the others described. My (otherwise) healthy aortic valve was perforated during an attempted ablation of an accessory electrical pathway in my heart, in 1991, and was assured at the time "oh, you won't have a problem with that leaky valve, for at least 20 years, and that turned out to be pretty accurate.

However, in 2010, at a Mayo Echo conference (that's my career; cardiac sonographer), I met the Drs there, and they felt fairly certain that they could "repair" my valve, without replacing it. And that, in fact, is what happened. They took some of my own pericardium and patched the "hole" in late December, 2010.

Unfortunately, that was only slightly two years ago, and we just found that my valve repair has failed. No one has an explanation. They really won't know what happened to it, til they get in there and look at it, which will be this Monday (March 18, 2013).

Our surgeon talked, at length with my husband and me, about the pros and cons of each type of valve, but given my particular circumstances. (I essentially just HAD OHS), and the gamble of future possible technology (without having OHS) was just too much for me. My Dr agreed that if this was my FIRST surgery, he would steer me towards bioprosthetic, but given what I have already had done, he totally understands that I have NO desire for a third or fourth surgery (I just turned 54), and he did comment on advances that are being made with blood thinners, so we have decided on a St Jude Bi-leaflet mechanical valve. Of course, my aorta is not big enough to hold the size of valve they need, so will need some enlargement of my aorta, as well.

As everyone else has pointed out, it is very much an individual decision, and you will, hopefully, be supported by all! Best of luck to you!

 

[JeffM]

PLuses and minuses with either choice. I went with tissue at 53. 4.5 years and going strong so. My concerns about mechanical (not in this order) were: 1) I knew I'd need several orthopedic surgeries and I didn't want to deal with bridging; 2) concern about the ticking; 3) anti-coag. therapy - having to be consistent and potential stroke bleed dangers as I am a migraine sufferer (evidence of increased stroke risk) and an avid cyclist; 4) better hemodynamics of a tissue valve (in my own mind perhaps) contributing to better athletic performance); 5) the possibility of another type of surgery either open or transcatheter being available when this 3rd generation valve has run its course, hopefully 15+ years (no guarantees) after installation. Finally, again, my own thinking here, since I never developed any stenosis (no calcium; pure regurgitation for decades) on my original bi-cuspid aortic valve, I'm hopeful that my body will perhaps produce less calcium on the porcine valve I've received. Only time will tell. Obviously, a good deal of my decision was based on non-scientific "I just have a feeling" stuff and, on the other hand, both my surgeon and cardiologist, based on my lifestyle, were recommending tissue. Bottom line: valve choice is an entirely personal decision because we all have unique bodies, preferences and circumstances in our lives.

 

[pellicle]

Hi

PLuses and minuses with either choice.

most certainly. The actual process of decision should be more guided by doctors consultation than just web searching and reading some opinions

pardon me making comment, I comment on the points not your decision to make your choice.

My concerns about mechanical (not in this order) were:
3) anti-coag. therapy - having to be consistent and potential stroke bleed dangers as I am a migraine sufferer (evidence of increased stroke risk) and an avid cyclist;

I fit into both those categories, but my understanding was that potential stroke and bleed dangers were substantially less than the words may make it seem. Modern pyrolytic carbon valves seem to have been in operation with exceptionally low stroke issues even with totally absent anti-coagulation.

something from a site which is now no longer:

BETWEEN 1998 AND 2004 AN AVERAGE OF HOW MANY PEOPLE PER YEAR IN THE UNITED STATES BLED TO DEATH FROM AN OVERDOSE OF WARFARIN?

32
1998 = 12
1999 = 17
2000 = 39
2001 = 39
2002 = 27
2003 = 44
2004 = 46
Total = 224 over 7 years for an average of 32 per year.

This is data from death certificates listing this as the cause of death. There were an estimated 30,600,000 prescriptions filled for warfarin in 2004. This is an estimated increase of 45% from 1998. So for every 10 million prescriptions filled for warfarin, approximately 1 person died with the primary cause of death being anticoagulation.
Reference: Wysowski DK et al. Bleeding Complications with Warfarin Use. Arch Intern Med. 2007;167:1414-9

As I understood it having a tissue valve did not make it a certainty that you will not need anti-coagulation therapy either. I understood it was something like half those receiving tissue prosthetic valves still required anti-coagulation therapy anyway. If my understanding is true then this makes such a basis of choice a little shaky.

4) better hemodynamics of a tissue valve (in my own mind perhaps) contributing to better athletic performance);

This is not as I understood the situation. My reading of the current results are that modern mechanical valves outperform tissue valves by a an amount.

http://www.ncbi.nlm.nih.gov/pubmed/4096074

The hemodynamic properties of modern mechanical prostheses are superior to those of tissue valves because of the significantly more favourable relation between total prosthetic valve area and effective prosthetic valve orifice area, conditioned by design. These unfavourable hemodynamics are manifest especially when prostheses of smaller sizes are implanted.

5) the possibility of another type of surgery either open or transcatheter being available when this

I find this transcatheter being raised frequently but as has been mentioned here a number of times they are not always suitable (diameter being a factor). I would love to have minimally invasive surgery options for a valve replacement as much as the next guy.

I for instance have needed another valve replacement because an aneurysm developed on my Aorta while my homograph was still functioning acceptably. The aneurysm was in all likelihood a direct result of my prior surgeries (valvotomy ~10YO - homograph ~28YO). So with other surgeries involved my understanding is that this makes a transcatheter less likely.

Its something that interests me, but its not an option for me ever in the future now anyway.

Bottom line: valve choice is an entirely personal decision because we all have unique bodies, preferences and circumstances in our lives.

exactly. I do however sometimes get the feeling reading things here that people talk them selves into a tissue prosthetic even with the surgeon leaning slightly towards the mechanical, for reasons which may not actually be sound.

Ultimately for me there is no further choice. I have a mechanical, there was not really a sound basis for a tissue valve as a 4th operation would be very unwise (this has been supported by the post surgical difficulties that I am having now). So I'll probably die with what I have now.

 

[Jkm7]

Pellicle:

As I understood it having a tissue valve did not make it a certainty that you will not need anti-coagulation therapy either. I understood it was something like half those receiving tissue prosthetic valves still required anti-coagulation therapy anyway. If my understanding is true then this makes such a basis of choice a little shaky.

Do you have some credible data to back up that statement that something like half having tissue valves require ACT?

I've never heard a percentage anywhere near that and would really like to read your reliable reference.

Thank you.

 

[Rebecca]

Anytime you go into surgery for a valve you should have plan A, B and C. I was hoping for a repair but as my surgeon (one of the top aortic surgeon in Atlanta Dr. Chen) started to try to repair my valve, it just was not working. I ended up with plan B a tissue valve. Plan C would have been an On X valve. What valve to use is a very personal choice that has to be made by you and your surgeon. My damage valve was damaging my blood cells and my body could not keep up making new blood cells. For four years my iron and red blood count was always low. I was taking RX iron for four years and when my blood was finally tested to see how much iron my body had in it, I had toxic levels of iron. Normal for a woman is 15 to 150 and my level was 618. At 1000 you start to have organ failure. After having surgery I am no longer anemic and my red blood count is normal. My level of iron in my body is now at 312 and with time I am hoping that it will return to normal. I think it is rare for someone to be on Coumadin with a tissue valve, but it does occasionally happen. Just like most with mechanical valves do not need another heart surgery but occasionally it does happen. If you are not consistent with taking medicine you should get a tissue valve. All of us with valve disease live with heart disease and as we age like everyone else we may be put on Coumadin for other reasons like a stent. Good videos to watch: http://www.heart-valve-surgery.com/videos/ Good book to read is:Thriving with Heart Disease a Unique Program for you and your Family Live Happier, Healthier, Longer
by Wayne M. Sotile, Ph.D.

Rebecca Life is not about waiting for the storm to pass, it's about learning to dance in the rain.

 

[Jkm7]

Most tissue valvers who require Coumadin (after the initial 3 month post op course some surgeons order) take it to treat afib.

Anyone can develop afib and coumadin/warfarin is most commonly prescribed to protect again blood clots with the irregular heart rhythm.

 

[pellicle]

Hi

Do you have some credible data to back up that statement that something like half having tissue valves require ACT?

I never make any comments without either a reference to some facts or studies or with out the qualifications that "I don't know for sure" and / or "it is my impression".

the reference I have is from this company:
http://www.onxlti.com/heart-valves/...echanical-and-tissue-heart-valve-performance/

The advantage of tissue valves is that in approximately 50% of patients, anticoagulant medication is not needed on a long-term basis

However they cite another references for their assertion. So (as they have a vested interest) I chased up that ref,
it is here: http://www.ncbi.nlm.nih.gov/pubmed/15225017

Tissue valve patients usually receive warfarin for the
first three months after valve implantation, and anticoagulation
is continued in a significant number of tissue
valve patients for co-morbid conditions. The literature
reports that 40-70% of mitral tissue patients and 15-
35% of aortic tissue patients receive long-term warfarin
therapy (6,7,11-17,29).

(emphasis mine)
Those references (6,7,11-17,29) (which you can verify by reading that above paper) are provided here for your convenience.

6. Rahimtoola SH. Choices of prosthetic heart valves
for adult patients. J Am Coll Cardiol 2003;41:893-904
7. Cohn LH, Soltesz EG. Review: The evolution of
mitral valve surgery: 1902-2002. Am Heart Hosp J
2003;1:40-46

11. Jamieson WRE, Burr LH, Tyers GFO, et al.
Carpentier-Edwards Supraannular porcine bioprosthesis:
Clinical performance to twelve years.
Ann Thorac Surg 1995;60:S235-S240

12. Masters RG, Walley VM, Pipe AL, Keon WJ. Longterm
experience with the Ionescu-Shiley pericardial
valve. Ann Thorac Surg 1995;60:S288-S291
13. Cohn LH, Collins JJ, Jr., Rizzo RJ, Adams DH,
Couper GS, Aranki SF. Twenty-year follow-up of
the Hancock Modified Orifice porcine aortic valve.
Ann Thorac Surg 1998;66:S30-S34
14. Jamieson WR, Burr LH, Munro AI, Miyagishima
RT. Carpentier-Edwards standard porcine bioprosthesis:
A 21-year experience. Ann Thorac Surg
1998;66(6 Suppl.):S40-S43
15. Legarra JJ, Llorens R, Catalan M, et al. Eighteenyear
follow up after Hancock II bioprosthesis inser-
tion. J Heart Valve Dis 1999;8:16-24
16. Yu H. Long-term evaluation of Carpentier-Edwards
porcine bioprosthesis for rheumatic heart disease. J
Thorac Cardiovasc Surg 2003;126:80-89
17. Jamieson WRE, Lipinski OV, Germann E, et al.
Performance of bioprostheses and mechanical prostheses
assessed by composites of valve-related
complications at 15 years for mitral valve replacement.
J Heart Valve Dis (in press)

29. Hirsch J, Dalen JE, Deykin D, Poller L, Bussey H.
Oral anticoagulants: Mechanism of action, clinical
effectiveness, and optimal therapeutic range Chest
1995;108(Suppl.):231S-246S

If you do continue this by reading those please post if the Steven Phillips was incorrect in his assertion of what the literature held . I did not follow up past his literature review. This seemed enough and given the journal (The Journal of Heart Valve Disease) is more credible than some TV show host claiming X Y or Z.

I've never heard a percentage anywhere near that and would really like to read your reliable reference.

I feel there was an amount of sarcasm in your reply and based on other conversations we have had I feel that you don't like me or my views. That is of course your prerogative, but I take unkindly to harassment on a forum. I had hoped this forum would be more educated. Perhaps I'm wrong.

If I may ask you to in future to be a little less accusative in tone I would appreciate it. I am not a moron and anyone who has read any of my comments (and you have certainly commented enough to imply you have read them) would know that I don' like mis-information, try my best to make only factual and scientifically verifiable assertions.

If I wanted to fight I'd go pick up discussions on Apple or Android phones.

Facts are not football teams. You don't barrack for them.