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

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ElectLive

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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. :(
Great info, as always, thanks for sharing. Yeah, I know what you mean about the patient groupings. I think of the few relevant studies I found pre-surgery, they were 18-50 or something like that. I'm actually a little surprised my valve manufacturer has made zero requests to keep any sort of data on my future health. I guess every study has certain protocols, but even if they don't want me for a study, shouldn't they at least want in-house data on every single valve that's implanted? If it were my business, I sure would.

By the way, in a Cleveland Clinic valve disease webchat today, in reply to a relevant question to this thread, the following was said by a Dr. Edward Soltesz:

"How do currently used tissue vavle replacements compare to
those used 20 years ago? Is any significant progress being made in
improving overall longevity? Any predictions (no gurarantees obviously)
for the future, based on current studies?

Dr__Soltesz: Yes there is significant improvement in the tissue valves
we presently use - mainly in the anticalcification treatment that we use
- this results in a presumed longer longevity of the valves.
Dr__Soltesz: We will not have the data for another 25 years - but it
appears very promising."


So, good news, bad news. Hard not to laugh a little at that one.
 
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ElectLive

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PS I was doing several other things during that Cleveland webchat today, just went through the transcript again, and it appears I missed a very big point made repeatedly throughout:

They are now quoting less than 1% risk for AVR, including re-op. The phrase "far less than 1%" was even uttered at one time. I know those guys are good, but seriously? Now, they didn't really discuss complications or other issues, but I'm going to ignore that at least for today. Here I am kidding them about locking my tissue valve longevity data away for 25 years...little did I know they're just too darn busy chasing 0%
 

normofthenorth

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I know that many of the so-called "second generation" tissue valves (including the Hancock II) were very similar to the "first generation" except for being chemically pre-treated differently -- i.e., what Dr. Soltesz calls "the anticalcification treatment". (As I recall, there was a change from a more intense pressurized-soak treatment, to a less intense atmospheric-pressure treatment, which always puzzled me a bit.) I hadn't heard that the more recent "third generation" valves were also changed along the same lines. (Some of the third-gen tissue/pericardial valves are much more "designed" and "manufactured" and less "natural" than many earlier tissue valves -- including a few with a cylindrical shape and three support points, between which the cylinder "collapses" to close the valve.)

And ElectLive, nobody is "locking up" the data for 25 years -- it just takes 25 years to CREATE the data on 25-year longevity! Without a (proven and tested) mathematical or physical model for accelerated destruction, there's no short-cut for that.
 

ElectLive

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And ElectLive, nobody is "locking up" the data for 25 years -- it just takes 25 years to CREATE the data on 25-year longevity! Without a (proven and tested) mathematical or physical model for accelerated destruction, there's no short-cut for that.
Yeah, I know, I was overstating. Just was trying to emphasize that I'm so busy pursuing thoughts of greater valve longevity, I never stopped to consider they'd be making surgery easier too. Here's to the future, in both regards.
 

epstns

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The statement of risk being less than 1% is pretty much what I was told at Northwestern. That figure, I believe, is for otherwise healthy patients -- not for those who are at risk for other reasons in addition to the valve surgery.
 

ElectLive

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Yes, that's right. Forgot to mention, relative to my "easier" comment, minimally invasive is the standard for typical patients there now too.
 

67walkon

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A buddy of mine just had AVR and he was out of the hospital in 3 days-Cleveland Clinic in Weston.

I was told 4 years ago that it should be 15 to 20 on a treated bovine valve. Of course, when I had my last echo the tech made some comment about it being a "little small", which I immediately took to mean early failure. The doc said it is fine.

Does anyone know if activity level affects longevity? I was 57 at the time of surgery and I do things like ride a bicycle about 5,000 miles a year. Is that likely to shorten my valve's life span or increase it, I wonder.
 

ElectLive

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Does anyone know if activity level affects longevity? I was 57 at the time of surgery and I do things like ride a bicycle about 5,000 miles a year. Is that likely to shorten my valve's life span or increase it, I wonder.
I asked my surgeon that exact question and was told for the most part no effect either way. In his words, "don't bother sitting on the couch all day, won't help at all". Now, I do seem to remember an article where a Cleveland Clinic cardiologist said that "excessive" exercise (with tachycardia) might potentially shorten valve life, but no real studies to prove it. Consult with your doctor about your specific situation I guess.

If anything, exercise is a plus for overall heart health. It may not extend (or shorten) the life of your valve directly, but good for all of us to exercise and keep a healthy heart, for whatever else might happen further down the road.
 

normofthenorth

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I wonder if there would be a way to construct a randomized trial, or any other kind of statistical data to try to show an effect, either way. I'm sure LOTS of us athletic AVR types would love to know.

Here's a related question that might be much simpler to answer: It's widely understood (=~widely believed to be true) that being fit and active slows down your resting heart rate. And of course, getting CV exercise raises your heart rate while you're doing it. Simple Question: If I play a bunch of high-intensity sports a few times a week, will my heart beat MORE times or LESS by the end of the week??

I'm not convinced or assuming that the answer is relevant to the ultimate question about valve longevity -- i.e., that increasing total (average) heart rate would decrease the longevity of a tissue valve -- but it might, and I'm not sure if being active increases or decreases total (average) heart rate. It's possible that the answer is different for various frequencies of CV exercise -- e.g., if you exercise a few hours a day, every day, maybe there isn't enough non-exercise (low-HR) time to compensate for the high-HR times.
 

ElectLive

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Here's a related question that might be much simpler to answer: It's widely understood (=~widely believed to be true) that being fit and active slows down your resting heart rate. And of course, getting CV exercise raises your heart rate while you're doing it. Simple Question: If I play a bunch of high-intensity sports a few times a week, will my heart beat MORE times or LESS by the end of the week??.
Norm - This makes a lot of sense. There was an implied point from the doctors in my previous post: regular exercise may slightly reduce valve longevity, but the benefits of regular exercise outweigh it. Maybe it's a few weeks, maybe a few months, who knows. I don't need a surgeon or cardiologist to tell me that, but I do think it would be great to offer patients some sort of general guidance on a "golden mean" of CV exercise intensity and duration, in the spirit of your overall heart rate scenario.

Fortunately for me, my exercise is now, and always was, moderate in time and effort. I know I'm staying pretty heart healthy, but shouldn't be reducing longevity much at all, I would guess. But if I were a marathoner, for example, I sure would want to know a lot more about this.

Now, I just wonder...

I'm pretty sure they download every beat of my heart when I go in for pacemaker check-ups. You'd think they'd be able to click a few buttons and tell me beats per week, right? So, I could watch tv all day one week, do my usual exercise the next week, then... Ok, we're going to need another pacemaker patient for that last one, a serious runner for example, definitely not me. Also, we'll have to space the weeks out to get the effect of overall lowering of heart rate with increased exercise. But anyway, you get my point, with a friendly arrythmia clinic, a pacemaker patient just might be able to test out your scenario.

[Edit] Well, after a certain # of posts, there's a pretty high likelihood that there will be one (at least) that is pretty stupid:

Upon further discussion with my arrythmia center, the pacemaker downloads do not actually show them every beat. They only see what's outside the programmed "normal" range. Now, in my defense, they did say that theoretically it was possible to track everything, if they really wanted to. But they of course didn't. Oh well...
 

normofthenorth

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Sounds like an assignment for epstns to me!

Don't forget that lots of heart doctors (including all of mine, AFAIK) say that there's NO valve-life-shortening effect of exercise, and there's some logic to that, despite the direct correlation between patient age and valve longevity. Specifically, the mechanisms of failure seem to be biochemical calcification and not mechanical wear. If the leaflets gradually got frayed or tattered or otherwise "beaten up", like an old flag or an old sailboat sail, it would require some strong proof to convince anybody that we WEREN'T talking about a gizmo with X beats in it before it got used up. But AFAIK that's not at all what happens when a tissue valve deteriorates (either our native ones or a replacement), so the oft-repeated understanding -- young people experience shorter valve life than older ones, but it's NOT because of the young'uns greater activity level -- has caught on, without much convincing evidence either way.

Another related question: RCT studies are usually done or funded by "interests", e.g., medical teams whose funding comes from somebody who might benefit significantly from a (not-surprising) significant result. (Take On-X and reduced-INR ACT, e.g.) Does anybody have a (financial) interest in proving that tissue valves deteriorate faster (or slower, or neither) in a group of athletes, vs. a group of same-age healthy "couch potatoes"? Maybe some health-insurance providers (incl. governments like the Canadian provinces) could save some money if they could substitute more cheap cardio rehab and sports programs for more expensive OHS/HVR, but the link may be too fuzzy to motivate them. It's not easy for OUR needs/wants to translate directly into medical research, when those needs/wants don't coincide with a strong commercial interest. I don't see the international association of personal trainers (or of cardio-rehab clinics) funding a big fancy study.
 

Lynlw

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Many doctors, at least the ones who mainly take care of children and young adults who have various parts replaced and they knw how active they ar or aren't believe the reason younger people go thru tissue valves, or conduits, grafts etc has NOTHING to do with exercise, either very much or none, but is related more to the body ability to grow and heal bones. Young people who are growing and if their bones break usually heal relatively quickly compared to over 40 and definately over 60 also tend to build apatite quicker which causes the "calcification" of tissue valves, conduits. This would also make sense that people who are the age of post menopausal when bone density becomes a concen would have the best chance of tissue valves lasting the longest.

Of course another thing that would make valve longevity in an under 20 or even under 30 group less is the fact that many childs/young adults need their parts replaced mainly because they outgrow them, and i'm pretty sure that gets counted as stenosis, etc.

They have been testing diferent typs of tissue valve in vitro and vivro for decades now seeing what the "calcification" is made of and things like that.
Also since we aren't not doctors,with years of school and experience, there are probably so many other things to take into consideration that we haven't thought about.

BUt to answer the origonal question, I know several people (even relatively young) whose tissue valves lasted over 20 years, most are on the right side. But one of the newer member Rib homograft was in the aortic position and lasted 25 years..he was a teen when he got it http://www.valvereplacement.org/forums/showthread.php?36295-new-aortic-valve-loomin.....choices&highlight=
 
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hevishot

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Adam,
I am sorry no one actually answered your question. I believe you wanted to know the longest a tissue valve has ever lasted. The answer to your question is 30 years 197 days. It was a pig valve (not bovine) implanted in 1979-2010. The patient died from natural causes. It is listed the Guiness book of world records.
 

Mentu

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My surgery was performed at Oklahoma Heart Institu
Do realize that a single report is not statistically meaningful. That said, my bovine pericardial valve is now failing at 9 years post surgery. As my cardiologist has pointed out, our prosthesis does not exist by itself. Failure is a function of the valve as it works inside our bodies. Something about my body causes calcification of tissue heart valves. This was also true of my Uncle and Grandfather so there is almost certainly a genetic component. I will say, that living with my bio-prosthesis has been easy. So, nine years may be my time frame till failure but the same valve in another body should last could last twice that long.
 

epstns

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Mentu;n886738 said:
So, nine years may be my time frame till failure but the same valve in another body should last could last twice that long.
I hope it does, Mentu. My Edwards pericardial valve recently celebrated its eighth birthday, and it is still doing just fine for me.
 

ExC.Andrew

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Thanks all for your inputs. One point I was told by an attending doc after my aortic valve replacement: it is not clear what causes calcification, but there are indications that the blood flows near the surface of the valve are a contributing factor. Sort of makes sense if you get the physics of it.

The only practical thing I figured I could do was to ensure my blood is as thin as possible (besides keeping in best phys condition as possible). I do not take coumadin or other anti-coagulants anymore, but I figured anything, eg foods that promote thinner blood are good.

And conversely, with the caveat that vit K is essential to good health (and in fact helps prevent calcium deposits in arteries according to some research). Also I believe taking K with D3 or cod liver oil is best (see Weston A Price foundation on this - google used to be good about being open to non mainstream medical information, but it is unfortunately changing - I will quote more specific info later).

Diagnosed BAVD w/ AFIB 2014 @ age 68, bio (porcine) aortic valve replacement 2017 w/maze procedure etc. All good so far, EF normal, no AFIB - knock on wood
 

Duffey

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Thanks all for your inputs. One point I was told by an attending doc after my aortic valve replacement: it is not clear what causes calcification, but there are indications that the blood flows near the surface of the valve are a contributing factor. Sort of makes sense if you get the physics of it.

The only practical thing I figured I could do was to ensure my blood is as thin as possible (besides keeping in best phys condition as possible). I do not take coumadin or other anti-coagulants anymore, but I figured anything, eg foods that promote thinner blood are good.

And conversely, with the caveat that vit K is essential to good health (and in fact helps prevent calcium deposits in arteries according to some research). Also I believe taking K with D3 or cod liver oil is best (see Weston A Price foundation on this - google used to be good about being open to non mainstream medical information, but it is unfortunately changing - I will quote more specific info later).

Diagnosed BAVD w/ AFIB 2014 @ age 68, bio (porcine) aortic valve replacement 2017 w/maze procedure etc. All good so far, EF normal, no AFIB - knock on wood
I guess you realize that this thread was started, and mainly contributed to, in 2011. Lots of changes in valves since then. However, I have a 14 year old bovine, implanted when I was 52, that’s still going strong.
 

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