What's the longest someone's bovine aortic valve has lasted?

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ALCapshaw2

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You didn't say how old you are.

Age at the time of replacement is a Major Factor in Tissue Valve Longevity.
The younger you are at replacement, the faster tissue valves tend to 'wear out'.

It is my understanding that 'some' patients who received a Bovine Tissue Valve in their Aortic Position at an age over 60 (or was it 65?) are approaching 20 years.

Unmodified Porcine Tissue Valves typically last 8 to 12 years.
The 'improved' Porcine Tissue Valves are 'hoped' to last longer but have not been out long enough to know at this time.

There have been cases of "Premature Failure" of both types of Tissue Valves, sometimes in as little as one year.

I think it best to 'just get on with your life', get regular follow-up examinations (annually),
and report any changes in performance or symptoms as soon as they occur.


'AL Capshaw'
 

Greg a

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Hello all,

Some info on me. I was born with a bicuspid aortic valve. Had replacement surgery in Jan 2009. Had enodcarditis on and off for the next two years (was in the hospital 3x due to this). They never could beat the infection per se -- it just kept coming back after laying dormant for a while.

So, I had re-replacement in March 2011. The surgeons also replace my aorta which had enlarged a bit and relocated some peripheral arteries.

My life style is about as healthy as you can possibly get and it has been for some time -- long before I ever had open heart surgery. I eat nearly perfect (zero processed food, zero added sugar, etc, ever basically), I exercise everyday
(I miss maybe 5 days a year)
, practice stress reduction like meditation daily, take important supplements like omega 3's, live a low-risk life style, no drinking/smoking, healthy BMI, etc.

Anyway. I do everything I can to ensure that my heart and body stays low in terms of risk-factors for heart/health problems.

I understand that to a certain extent, how long my valve lasts will be out of my control. But certainly by maximizing all of these things, it will last longer than if I wasn't a bit of a health nut.

What is the longest you have heard of cow/pig valves lasting?
Adam, a heart felt WELCOME to our OHS family glad you found the site, my father was in his 60s and as Al said the older the better, his lasted over 24 years and was not a factor when he died , there is a wealth of knowledge here for the future .....


Bob/tobagotwo has up dated a list of acronyms and short forms http://www.valvereplacement.org/forums/attachment.php?attachmentid=8494&d=1276042314

what to ask pre surgery http://www.valvereplacement.org/forums/showthread.php?26668-Pre-surgery-consultation-list-of-questions

what to take with you to the hospital http://www.valvereplacement.org/forums/showthread.php?13283-what-to-take-to-the-hospital-a-checklist

Preparing the house for post surgical patients http://www.valvereplacement.org/forums/showthread.php?19034-Getting-Comfortable-Around-the-House&p=218802

These are from various forum stickies and there is plenty more to read as well


And Lynw recently added this PDF on what to expect post op
http://www.sts.org/documents/pdf/whattoexpect.pdf

By the way....... just kidding as I wish I did as much on five days a year as you miss
 

normofthenorth

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Al, with respect, you really should read the newest data on the durability of the Hancock II pig valve, based on 1100+ patients over more than 25 years, before you make those unfounded claims about the durability of porcine/pig valves! The article's entitled "Hancock II Bioprosthesis for Aortic Valve Replacement: The Gold Standard of Bioprosthetic Valves Durability?" by Tirone E. David, MD, Susan Armstrong, MS, Manjula Maganti, MS, in Ann Thorac Surg 2010;90:775-781, abstract at ats.ctsnetjournals.org/cgi/content/abstract/90/3/775? . (That's the Tirone David of "the David Procedure".)
As I've posted before, that article meticulously compares the AV-durability data for the Hancock II with a number of other tissue valves including the few bovine/cow valves that have been around for 15 years or more -- and it finds that the Hancock II has been lasting a few years longer, on average, apparently in all the age cohorts (hence the "Gold Standard" label).
In the entire cohort, they found "The freedom from structural valve deterioration at 20 years [post-AVR] was 63.4% +/- 4.2%. . ." That's not from the same planet as your
"Unmodified Porcine Tissue Valves typically last 8 to 12 years.
"The 'improved' Porcine Tissue Valves are 'hoped' to last longer but have not been out long enough to know at this time."
Back to the OP's question, I think Al has it just about right on the bovine valve, and it's extremely sensitive to the patient's age at the time of the AVR: the older the patient, the longer the average time before the onset of structural valve deterioration -- NOT apparently because the valves "wear out", but apparently because the blood chemistry of younger people leads to calcification and failure sooner. (But if the mechanisms were perfectly understood, the manufacturers or the cardiologists would have fixed the problem by now!)
And Adam, the biggest and latest studies now seem to show that moderate drinkers of alcohol outlive tee-totallers (and have lower rates of several nasty diseases), so you may want to re-think that one lifestyle choice! :)
 
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neil

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agree norm there seem to be lasting well, theres a lot of anti tissue posters on here, Al to be fair not one of them,so try to get a rounded case on it all,good luck which ever you choose
 

Julian

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My CV surgeon (Dr. Koshal) figured i'd be up for re-operation at around 40 or 45.
You and I are about the same age. In about 20 years I truly think advancement is going to be AMAZING. In your case cath re ops will probably be 99.9% the standard and darn near perfected.

I'm going to step out on a limb here and say I would be surprised in 20 to 30 years if a mechanical valve is not developed and approved that requires no ACT. Its a great time to be alive and if we make it for 20 to 30 more are chance of living out into our 80's has never been better tissue or mechanical. We just got to pray the world doesn't implode on itself before then :tongue2: SERIOUSLY.
 

ElectLive

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I was told pre-surgery, at age 35, to expect a tissue valve to last anywhere from 6 to 20 years, with an average of 12. For a 70 year old, the average went up to 20 years. I do not know the lifespan difference for a 26 year old, but would guess it to be slightly lower. I think the obvious key, though, is to realize how indeterminate all these numbers really are. Literally anything could happen. It's almost like the average shouldn't be the goal, but somewhere within the range should be instead, just could be anywhere. And no guarantees on even 6 years obviously, but no guarantees on the mechanical alternative either.

I certainly support the future optimism, but maybe with a touch of caution. I'm not so much worried about what will actually be possible in 10 or 20 years, but for any new tissue valver out there, you know the options will be better next time. How much so remains to be seen.
 

tobagotwo

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Here are some interesting edwards valve life sites:

http://www.edwards.com/products/heartvalves/Pages/theonaorticdurability.aspx

http://asianannals.ctsnetjournals.org/cgi/content/full/19/1/14


An interesting anouncement about general valve longevity study results, fromThe Journal of Heart Valve Disease and Journal of Thoracic and Cardiovascular Surgery :

http://www.ctsnet.org/file/vendors/978/pdf/163.pdf


Here are a series of graphs that show relational data about different brands at 20 years and similar. (Note- This is a St. Jude document. There are some age differences between some results within some graphs, which can affect outcomes greatly, and which may not be appropriate to show within the same graph. A mean age of 65 is going to have a significantly shorter outcome than a mean age of 70 - look for very similar age groups to match apples to apples [such as pages 12 and 14]):

http://www.google.com/url?sa=t&source=web&cd=18&ved=0CEoQFjAHOAo&url=http://www.sjmprofessional.com/Media/DownloadResource.aspx?id=%7B6CDA843F-C153-407F-B2E7-DD02B60C557B%7D&rct=j&q=Carpentier-Edwards PERIMOUNT Pericardial Bioprosthesis 25 Year Results&ei=430KTt6cAoXMgQewpsWIAg&usg=AFQjCNHK78TbndZr4op5ZFCMJ_dzeyJEIQ

Best wishes,
 

ALCapshaw2

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I am 26 years old, so maybe it won't last as long due to increased calcification rate in younger people?

I shouldn't say I don't drink. I have a glass of red wine with dinner a few days a week. But I don't go out and have a 6-pack on my birthday or anything. Heck, I was just at a wedding this weekend on only had 1 glass of red wine. So... haha.

Ultimately, I guess it seems like it will be hard to say how long my valve lasts, but I was just curious how long some of the bovine valves were lasting. My CV surgeon (Dr. Koshal) figured i'd be up for re-operation at around 40 or 45.
A couple of our Female members chose to receive Bovine Pericardial Tissue Valves in their 20's in order to have Children without being on Coumadin. They had their babies and then had their valves replaced after about 10 years when their performance deteriorated.

'AL'
 

tobagotwo

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Drinking won't affect the useful life of a tissue valve. If you are proscribed from drinking, it's going to be due to some prescription drug that you're taking, not the valve. Of course, if you get drunk and walk into the street in front of a truck, the valve is likely to suddenly fail moments later.

If you're 26, the valve's lifespan is up to the whimsy of your internal chemistry. However, I certainly wouldn't be looking for a lot of time from a tissue valve at that age. If you get ten years, that would be a lot in my opinion. Youth generally makes the surgery easier to recover from, but the body's very active chemistry starts to work on the valve much sooner, and goes at calcifying it much more relentlessly.

Best wishes,
 

ElectLive

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I assume next generation tissue valves are always in the works...all trying to deal with the calcifying issue, particularly for younger adults. Whenever the next great "future of tissue valves" is unveiled, I'm curious, can any reliable data be gathered from the initial few years of trials, or do you literally have to wait 20 years (or at least 10), for example, to find out if a breakthrough tissue valve will in fact last 20 years (in a young adult)? I guess this gets to how linear is the failure rate?
 

Mentu

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Adam, as you read studies, remember that they are descriptive not proscriptive. Statistical studies apply to groups but not to individuals. Also, the difficulty with projections about the new generation of tissue valves that have come into use in the past few years is there is not a long enough track record for good durability studies to have been conducted yet. It is only normal that those with tissue valves wonder about valve durability but it isn't something to worry about since it isn't something you can control. Even with good statistical studies, doctors can't predict the outcome for any individual patient's valve mechanical or tissue. Further, since it is not yet known what causes calcification of heart valves, I think it is unwise to modify one's diet. If it is learned one day that diet does effect valve calcification, the very foods that one might choose to avoid today may later prove to be helpful or unrelated to calcification. It is best to live your life and stay as healthy as possible. Few people who have received heart valves die because of their valves. Remember Mr Amundson; after experiencing the first successful heart valve replacement, he died after falling from a ladder but in the mean time, he had almost two decades of life that no one expected him to have.

Larry

Larry
 

Natina13

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I was told by my Surgeon... the one he choose for me ( 11 wks ago)... an Edwards "Magna" Bovine Tissue Valve...has an average life span, for people in my age group(59)....of 18-20 years. He said they have seen it last longer too. Now....he didn't have to tell me........accidents happen, infections happen, etc. Those numbers are good enough for me...as I will have to have my triple bypass,repeated around 10 yrs out. Dang my grandpa,he loved me so much...he passed down his CAD to me.. He had a triple bypass around 55, died from a massive heart attack at age 63....BUT, that was like 40 yrs ago.........he would have lived a lot longer today, we have advanced quickly in this area. I know they will continue to , as it seems to me....more and more people are having to have these surgeries done. Must be sumpin in da water :)
Renee
 

normofthenorth

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I assume next generation tissue valves are always in the works...all trying to deal with the calcifying issue, particularly for younger adults. Whenever the next great "future of tissue valves" is unveiled, I'm curious, can any reliable data be gathered from the initial few years of trials, or do you literally have to wait 20 years (or at least 10), for example, to find out if a breakthrough tissue valve will in fact last 20 years (in a young adult)? I guess this gets to how linear is the failure rate?
I don't think ANYTHING in this field is linear! Heck, even failure rates for mechanical and electronic equipment aren't usually linear. With mech valves, there's a reasonable hope that accelerated "torture tests" can simulate long periods of normal wear in a short period, though even that won't indicate all the OTHER reasons a patient might need a re-op or have other problems. With tissue valves, I don't think we even have that hope, until the mechanisms of degradation and failure are better understood.

In short, there is, and maybe always will be, a choice between a "proven" valve that's actually been around for a long time and has held up well, and a "new and improved" model that promises to work even better and last even longer -- a promise that may or may not be kept. And the stats will eventually show how the average (mean) patient, or the median, did, and may or may not apply to you. There are indications, expectations, hopes, etc., but no guarantees at all -- not completely unlike all the OTHER aspects of this existence of ours. I think the sanest thing to do is to examine the options in advance (or defer to your health professionals, if that's your style), make a choice, then live your life.
 

ElectLive

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I don't think ANYTHING in this field is linear!
Yeah, I'm with you on the general lack of linearity as well as the uselessness of expecting even averages to pan out. Anything can and will happen to any given individual. But let me rephrase my question, slightly:

I noticed a post of yours in a separate thread about the lifespan of your pig valve, as compared to the more common cow valve. I believe you said it was a 25 year study, and there was at least a few years difference in longevity according to the study/paper you cited. I've read a lot of posts recently and may have a foggy memory, though, so by all means, correct me if I'm misstating anything. Anyway, for purposes here, I don't care if the data is correct or not, let's assume it is. In this instance, I'm curious if evidence of the same conclusions would have been seen at the 20 year mark, or even at 15.

I guess the age of implant and the broader longetivy of the group is an important factor affecting this, in other words, a 15 year study on young patients might be more meaningful than a 15 year study on the elderly.

But anyway, to your broader points, all well said, I don't disagree. Obviously, though, for any of us in the tissue valve group, particularly younger patients, we are just buying time, so to speak. Any "early" evidence of new valve performance might make the difference between pre-surgery news for some, and post-surgery news for others. I'm not holding my breath waiting for it, but curiosity about "breakthroughs" seem to come with the territory too.
 

normofthenorth

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Yeah, I'm with you on the general lack of linearity as well as the uselessness of expecting even averages to pan out. Anything can and will happen to any given individual. But let me rephrase my question, slightly:

I noticed a post of yours in a separate thread about the lifespan of your pig valve, as compared to the more common cow valve. I believe you said it was a 25 year study, and there was at least a few years difference in longevity according to the study/paper you cited. I've read a lot of posts recently and may have a foggy memory, though, so by all means, correct me if I'm misstating anything. Anyway, for purposes here, I don't care if the data is correct or not, let's assume it is. In this instance, I'm curious if evidence of the same conclusions would have been seen at the 20 year mark, or even at 15.

I guess the age of implant and the broader longetivy of the group is an important factor affecting this, in other words, a 15 year study on young patients might be more meaningful than a 15 year study on the elderly.

But anyway, to your broader points, all well said, I don't disagree. Obviously, though, for any of us in the tissue valve group, particularly younger patients, we are just buying time, so to speak. Any "early" evidence of new valve performance might make the difference between pre-surgery news for some, and post-surgery news for others. I'm not holding my breath waiting for it, but curiosity about "breakthroughs" seem to come with the territory too.
It was a 25-year study -- maybe even 27 or so -- but the (stat-sig) data they reported on longevity was all at shorter intervals, esp. 15 and 20 years. (There are several comparable 15-year studies of tissue valve longevity, and very few 20-year studies, so far.) The article says there were (in 2010) only 3 patients/valves still "at risk" (i.e., alive and beating) at 25 years, out of 1100-odd total -- not as surprising or depressing as it initially sounds, considering that (1) not many of the 1100-odd patients got their pig valves 25 years ago, (2) the average age was >60, and (3) short-term and longer-term survival rates were probably worse back then than now.

The main reported variable in these tissue-valve longevity studies is NOT overall survival, but (in this one) freedom from Structural Valve Deterioration (SVD) or (in too many other studies) freedom from re-ops. Basically, a patient who gets run over by a truck 16 years post-AVR (or dies of cancer or emphysema or. . .) shows up as a "win" in the 15-year column, and as "no data" in the 20-year and 25-year columns.

So, yes, the Hancock II pig valves in the study all showed lower rates of SVD at 10, 15, and 20 years than the CEP cow valves in comparable studies, in each patient-age tranche, IIRC. The abstract is free and easy to see, the full-text free and ~$30 unless you're "special".
It's entitled "Hancock II Bioprosthesis for Aortic Valve Replacement: The Gold Standard of Bioprosthetic Valves Durability?" by Tirone E. David, MD, Susan Armstrong, MS, Manjula Maganti, MS, in Ann Thorac Surg 2010;90:775-781, abstract at ats.ctsnetjournals.org/cgi/content/abstract/90/3/775? .
It's a 1-center study, so it's conceivable that Ontario's universal health-insurance system, or the University Health Network, or Drs. David and Feindel, etc., . . . are so brilliant that their results are misleadingly brilliant and they're attributing that brilliance to their chosen valve. I don't know if the various center-rating agencies even consider Canadian centers (or where UHN gets rated, if they do), but it isn't obvious to me that UHN is heads and shoulders above CC and Mayo etc. The study also cites some other studies on Hancock II longevity (in OTHER centers) whose results are comparable to UHN's. I can certainly believe that UHN is better than the average cardiac center, in any country, but most published studies don't come from average centers.

I've expressed frustration before about the way patient age figures into the statistics, in this article and all the others -- only in broad tranches, like "under 60", 60-70, and >70. If you are ~35, it's very difficult to translate the "under 60" results into numbers that are directly relevant to your choices (e.g., mech vs. tissue). Some day, I hope the authors of these important and impressive studies get sufficiently "patient-friendly" to include a chart that answers the most obvious question of us patients. :(

BTW, pem introduced me (and us all?) to a brilliant and highly relevant article on statistics by Stephen Jay Gould, "The Median Isn't the Message", at http://www.cancerguide.org/median_not_msg.html .
 
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Just ASK

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