Anyone had 3 valve replacement surgeries?

Gail in Ca said:

I had my wires removed after the 2nd and 3rd surgeries, within a year of the surgeries because they protruded and bugged me, and my surgeon was fine with my removal request.

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I had the top two sets taken out from OHS 2 because of the same, but the reason for removal for OHS 3 was different (but they are gone none the less)

pellicle said:

Morning



for whatever reason I read this article about the ATS some time back (I have the full text, because some time back I worked in a University Library).

https://pubmed.ncbi.nlm.nih.gov/16928497/

now bear in mind that it is not related to your situation (nor mine) because it is specifically about the 19mm valve size.

Before going further I want to make clear the following points:

• I am not any expert in the haemodynamics of how blood flows around a mechanical valve leaflet and all of the many aspects which must be traded off against one another to make a valve "ideal" (note: none are)
• an important part of this opening and closing jet pressures (to my understanding is turbulence is less so) for these produce pressure sufficient to begin to trigger platelets which will then lead to their aggregation and the formation of floating emboli (aka clots)
• to restate the first point in a different way I can not make any conclusions about the difference between opening and closing angles and their pros and cons in the body

So having said that I found the article interesting for the following things (which are not restricted to the 19mm valve issue in question):

Leaflet opening angles of ATS valves in vivo tend to be less than those reported by the manufacturer, and there is a wide variation in opening angles even among valves of the same size.


ATS valves 21 mm or larger (72.2° ± 3.8° in 21-mm, 72.4° ± 2.8° in 23-mm, and 72.8° ± 2.9° in 25-mm valves). {pellicle: note this variation is different from the figures obtained by the study I mentioned above. This is something to keep in mind; not all studies give the same measurements}

This image helps one to understand the geometry of the opening and closing measurements and how they are obtained.

View attachment 890282

worthy of note is the difference in trimming of the wire ties in the above image.

lastly, this is my own X-Ray of my wire state post sugery (and pre my debridement from infection surgeries).
View attachment 890283
Yellow circles give examples of various metal junk left lying around from god only knows which of my 3 surgeries (I suspect #1 more than #3)
Note also the traces of old wires which remain "trapped in the bone" as leftovers from the two prior surgeries. 20 years of being there means "staying there".

A point to consider (which I did) is: what happens if an infection in the chest finds those place to hide in ... answer = "they remove the whole bone. We have had members here undergo this (and one of my friends fathers underwent this exact solution to an infection issue.

This is part of the risks of why you don't want to plan for multiple OHS.


HTH

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Good info! Thanks!
I saw my wires during my angiogram yesterday. (which came out clear and free of any vein or artery narrowings or obstructions!)
I have 10! Seems like a lot. No?

Earthsciencerocks said:

I have 10! Seems like a lot. No?

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you have 10 sternal wires?

wow ... xray? (cos, like wow)

pellicle said:

you have 10 sternal wires?

wow ... xray? (cos, like wow)

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I know! Right?
All showed up on my angiogram on Tuesday.

Hey All,
So survived 3rd AVR! I’m post op day 4 now. We chose St. Jude HP mechanical valve with partial Dacron root section replacement. I’m still in hospital getting INR stabilized. I requested and got a double surgeon team that did a good job. I’m praying to be released today. I can’t hear clicking, and my nurse listened with a stethoscope and had a hard time hearing it as well. I’m pleased with our valve choice and am looking forward to the future again!
Recovery time is here, and I’m all in!
God bless you all!

Congratulations and wrlcome to the other side. Very happy for you that you cant hear it ticking

Welcome to the other side!!

Really glad that all went well.

Earthsciencerocks said:

I can’t hear clicking,

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That is great news. I also have a St Jude and rarely hear mine unless I'm exercising hard.

pellicle said:

a good article and I just wanted to say that the genes you inherit are usually going to express themselves (especially mitochondrial ones) pretty much consistently after you've passsed from embryo to born. There are a few exceptions and we are of course still learning.

The reason why none of that has found its way into clinical practice are (in my view)

1. ethical issues surrounding genetic testing
2. we could just measure and know

however all of that Cytochrome P450 stuff is why you don't drink grapefruit juice on any medication.
https://cjeastwd.blogspot.com/2021/05/grapefruit-and-warfarin.html

Best wishes

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This is probably not a question I should ask but.... Does the Cytochrome stuff have anything to do with why, back in the late 80s, they used to say taking ecstasy with citrus juice makes it stronger? Just curious.

Happy to hear you're in recovery!

Congratulations. Enjoy your newer life. I have two St. Jude’s valves, and I hardly hear them myself.

Eva said:

I have two St. Jude’s valves, and I hardly hear them myself.

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interestingly just the other day, I was in getting an Echo done and the technician (woman) asked me "do you have a bio" ... I paused and said something about isn't that on the file?

She replied yes, but said "its very quiet".

I replied I'm lying on the quiet side, wait till I roll over.

After I had to do the other side, she then said "I had a woman in here who had two mechanical valves" and that was much louder than you, and with really different sounds"

I remarked (in a questioning tone) ; what, like some kid practicing the castanets?

We had to have a small break as her 5yo kids just started playing some percussion instrument...

So apparently yes, like castanets

pellicle said:

interestingly just the other day, I was in getting an Echo done and the technician (woman) asked me "do you have a bio" ... I paused and said something about isn't that on the file?

She replied yes, but said "its very quiet".

I replied I'm lying on the quiet side, wait till I roll over.

After I had to do the other side, she then said "I had a woman in here who had two mechanical valves" and that was much louder than you, and with really different sounds"

I remarked (in a questioning tone) ; what, like some kid practicing the castanets?

We had to have a small break as her 5yo kids just started playing some percussion instrument...

So apparently yes, like castanets

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I don’t think mine sound like *castanets*! but they sound fun enough for my grand nephews and nieces to put their heads and listen to the ticking!

Earthsciencerocks said:

Hey All,
So survived 3rd AVR! I’m post op day 4 now. We chose St. Jude HP mechanical valve with partial Dacron root section replacement. I’m still in hospital getting INR stabilized. I requested and got a double surgeon team that did a good job. I’m praying to be released today. I can’t hear clicking, and my nurse listened with a stethoscope and had a hard time hearing it as well. I’m pleased with our valve choice and am looking forward to the future again!
Recovery time is here, and I’m all in!
God bless you all!

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I looked at your profile, I am glad this went well for you ? Just curious was mechanical not your first choice , early on ? What was your reasoning on choosing bioprosthetic twice

ashadds said:

I looked at your profile, I am glad this went well for you ? Just curious was mechanical not your first choice , early on ? What was your reasoning on choosing bioprosthetic twice

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ashadds said:

I looked at your profile, I am glad this went well for you ? Just curious was mechanical not your first choice , early on ? What was your reasoning on choosing bioprosthetic twice

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I didn’t want anticoagulants. I was very active and chose to go bio valve first two. I’m older now and my kids are out of the house (almost). Plus mechanical valves have a life as well. They don’t last forever, and have their issues as well.

Earthsciencerocks said:

Plus mechanical valves have a life as well. They don’t last forever, and have their issues as well.

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What sort of life do you see in the literature on them?
What sort of issues do you see on the valves themselved?

I understood they are rated in the billions of activations, I think more than one billion. So even assuming

from the best expert on the forum

https://www.valvereplacement.org/threads/32-years-since-my-first.888810/post-921924

pellicle said:

What sort of life do you see in the literature on them?
What sort of issues do you see on the valves themselved?

I understood they are rated in the billions of activations, I think more than one billion. So even assuming

Average HR​	90​
Beats / hour​	5400​
per day​	129600​
per year​	47336400​
Per 30 years​	1.42E+09​

from the best expert on the forum

https://www.valvereplacement.org/threads/32-years-since-my-first.888810/post-921924

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{underline mine}

Replacement of the aortic valve in patients under 50 years of age: long-term follow-up of the St. Jude Medical prosthesis​

(link)

Twenty-year experience with the St Jude Medical mechanical valve prosthesis​

(link)

pellicle said:

What sort of life do you see in the literature on them?
What sort of issues do you see on the valves themselved?

I understood they are rated in the billions of activations, I think more than one billion. So even assuming

Average HR​	90​
Beats / hour​	5400​
per day​	129600​
per year​	47336400​
Per 30 years​	1.42E+09​

from the best expert on the forum

https://www.valvereplacement.org/threads/32-years-since-my-first.888810/post-921924

Click to expand...

Using your HR estimate of 90 beats/min. my valve, after 57 years, has completed 2,698,174,800 beats. Rounded off that is 2.7 billion beats with a B......and with NO issues with the valve itself. My only issue has been a stroke a few years after the valve was implanted......and several years before the INR system was introduced. Anticoagulation management, back then(1974), was pretty primitive by today's standards.

I asked my Cardio, at my last yearly checkup, how long he thought the valve would last. He said it would likely outlast me at my age of 88+.

My surgeon and cardiologists have said my mechanical valve would last my lifetime. The only reason my first mechanical (2nd surgery) had to be replaced was due to bacterial endocarditis. The bacteria caused issues with the tissue around the valve but the valve itself had not been affected.

pellicle said:

{underline mine}

Replacement of the aortic valve in patients under 50 years of age: long-term follow-up of the St. Jude Medical prosthesis​

(link)

Results: From October 1977 through October 1997, 271 patients less than 50 years of age had isolated aortic valve replacement. Follow-up was 1957 patient years. Thirty-day operative mortality was 1.1% with 18 late deaths, 4 of which were valve related. Ninety percent of survivor INR responses indicated a frequency of monthly INR checks or less. Valve-related events including percent per patient year and mortality related to these events included thromboembolism, 6 episodes (0.3% per patient year, no deaths); anticoagulant-related bleeding, 6 events (0.3% per patient year, 2 deaths); paravalvular leak, 6 events (0.3% per patient year, 2 deaths); valve thrombosis, 2 events (0.1% per patient year, no deaths); and endocarditis, 3 events (0.15% per patient year, no deaths). There was no incidence of structural valve failure.​

Twenty-year experience with the St Jude Medical mechanical valve prosthesis​

(link)

In our previous reports,1, 2, 7 we have observed, as have others,8, 9, 10 that the St Jude Medical mechanical prosthesis has superior durability (we have observed no structural failures), excellent hemodynamics, and a low incidence of thromboembolism.​

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Well, I have had my Mechanical St. Jude's leaflet Aortic valve since 2001, that makes it 23 years I have had this thing in me and still going strong. There are other who have had theirs a lot longer.

I was 36 when my St. Jude's mitral was implanted and I'm 62 now, so that means it's 26 years old. I've had zero issues with the valve.

My brother has a mechanical aortic, not sure which brand, but it's not St. Jude's, that was implanted in 1993 so he's 5 years ahead of me. He is a difficult patient, as in going for years without Warfarin (2 mild strokes), when he did take Warfarin he never tested and just assumed it was right, and not really understanding how the valve and Warfarin work together or caring to learn. He has been a marathon runner for many years, actually pretty much an addiction. Last year he had a major internal bleed, probably caused from a lung irritation, but didn't know it. He was feeling kind of bad and having a hard time taking deep breaths for a couple of weeks, thought he had congestion, so he decided to run 12 miles on the treadmill in his basement (December in Illinois) to try to clear it up, but couldn't make it up the stairs afterwards. His wife forced him to go to the hospital where it took a few days to determine that the collapsed lung and what they originally thought was lung cancer, was actually a huge clot in his chest cavity. Before they knew what it was, they tried to do a thoracentesis, but all they got was a small amount of thick bloody jelly. Since he was now oxygen dependent and the blood tests were not showing cancer, they did surgery and were able to identify and remove the clot and his lung began to re-inflate. A few weeks later an echo showed pannus on the valve so they admitted him to the hospital about two weeks after that for a second valve replacement. Repeated the echo and the pannus was gone so they sent him home. They now think that it was residual clot left from the larger one. Now he's back to running, he gets an INR regularly, and his valve is performing exactly as it should.