2nd AVR on my horizon : (

[CarolM]

Some exercise exertion problems led to a stress test where my BP dropped, so the test was curtailed. I had a heart cath 2 days ago that shows my 2012 Edwards bovine 21mm valve is now showing severe stenosis. I follow the "rules" and exercise 6 days, eat well, etc., and this news is distressing to say the least. Have other members had such a short valve lifespan?

 

[ottagal]

So sorry to hear this, CarolM. I am sure it felt like a punch in the gut. I am coming up to 10 years since my Edwards Bovine 21 mm valve was installed. I have had higher than normal pressure gradients (almost from the get go post surgery). They have been monitoring it since and so far (touch wood), I have avoided a repeat. I know there are a number of members who have had a 2 AVR in a shorter than anticipated lifespan for the valve. Hang in there...hopefully, others will chime in soon. You will get through this. Perhaps, a second opinion will help or not? Thinking of you...

 

[pellicle]

Hi

Very sorry to read this.

...Have other members had such a short valve lifespan?

One or two, but mostly they no longer seem active.

Smaller diameter valves seem more susceptible to calcification stenosis and panus.

All one can do is roll with the punches and adjust ones outlook to see the positives.

 

[DebbyA]

I got my Medtronic Mosaic porcine valve in Jan 2008 and it lasted 6 years--replaced in Feb 2014. In addition to stenosis, I had regurgitation due to a cusp that was partially torn. I never expected lifestyle to influence valve longevity.

 

[Enigmalady777]

I understand the feelings of frustration when you're following all the lifestyle recommendations but still end up having a problem. While I don't also expect lifestyle to affect my valve, per se, I do hope that eating right and exercising will contribute to a healthier heart, and when that doesn't happen it's very depressing (at least for me it is).

I never expected that I would need a defibrillator/pacemaker a year after my mitral valve surgery, and yet here I am. I'm at a point where I am afraid to "rock the boat" so to speak, in changing anything about my regimen since I feel very good physically now and my heart problems seem have calmed down.

 

[Protimenow]

Yes, as Pellicle noted, we've had a few on this site who have reported short lifespans for their animal valves. Valves usually don't last as long in younger valve recipients.

It's been speculated that, because the younger people who receive valves are more active than the older recipients, the valves are put through more stress (and more use), so they fail more quickly.

A short while ago, I'd have been very critical of young people who chose tissue valves just so they can avoid warfarin. I still, mostly, feel that way. Having a mechanical valve that will probably last the lifetime of its recipient, and having to go through the really almost insignificant task of warfarin dosing and monitoring, made the decision to go mechanical almost a no-brainer.

BUT -- research seems to be getting closer to alternatives to mechanical valves (they aren't there yet) (TAVI/TAVR), they're at the very beginning stages of testing a valve with a bioengineered material, and I'm sure there are other approaches being taken. It's still a gamble for anyone getting TAVI/TAVR or more traditional tissue valves whether or not a repair or acceptable alternative will become available before the current repair fails -- and second or third (or fourth?) surgeries are always more difficult than prior surgeries. So - the concept of avoiding a mechanical because there's something just as permanent (or easy to repair), may not be that unreasonable.

For myself, if I had to choose again, I would probably still opt for mechanical. Their track records are exceptional. And, some time in the future, an alternative anticoagulant will probably become available. It'll probably cost 50 or more times as much as warfarin, cost thousands of times what a shot of Vitamin K costs to reverse the effects of too much anticoagulant, but it will reduce or eliminate the need for self-testing. So - if the choice of tissue is made just to avoid the 'horrors of warfarin,' these 'horrors' may become avoidable (if not any better than warfarin at reducing the risk of clots forming on the valve).

 

[CarolM]

I appreciate all of the positive thoughts.
I felt very comfortable with my decision 7 years ago for a bovine valve. I am far less decisive now, with the prospect of doing OHS multiple times with a short valve lifespan.

 

[CarolM]

I got my Medtronic Mosaic porcine valve in Jan 2008 and it lasted 6 years--replaced in Feb 2014. In addition to stenosis, I had regurgitation due to a cusp that was partially torn. I never expected lifestyle to influence valve longevity.

What type of valve is #2?

 

[CarolM]

So sorry to hear this, CarolM. I am sure it felt like a punch in the gut. I am coming up to 10 years since my Edwards Bovine 21 mm valve was installed. I have had higher than normal pressure gradients (almost from the get go post surgery). They have been monitoring it since and so far (touch wood), I have avoided a repeat. I know there are a number of members who have had a 2 AVR in a shorter than anticipated lifespan for the valve. Hang in there...hopefully, others will chime in soon. You will get through this. Perhaps, a second opinion will help or not? Thinking of you...

Thank you. The heart cath was conclusive, so I am not in need of a second opinion. I think I simply feel stunned, and need to wrap my head around the reality (again). I feel the mental piece is sometimes as hard as the physical.

 

[DebbyA]

#2 is Medtronic Open Pivot mechanical valve. I tried vey hard to convince myself that another tissue valve was a good idea, but failed.
BTW, I was 60 when I got the first valve, which seems 'young' from the 72 I have now achieved, so the popular wisdom that tissue valves wear out faster for young people doesn't apply to me.
I apologize for not expressing sympathy in my first post--it IS something hard to wrap your mind around for a second go-round.
Your saying "I followed the rules..." is almost an exact echo of someone I met at a cancer support group 3 years after my 2d valve. Sometimes life hands us some shockers.

 

[pellicle]

I appreciate all of the positive thoughts.
I felt very comfortable with my decision 7 years ago for a bovine valve. I am far less decisive now, with the prospect of doing OHS multiple times with a short valve lifespan.

my advice to you is to dispassionately consider the +ve and -ve of each, write that each on a piece of paper

Then with the negatives that you have written there research them yourself and see what you find.

For instance a negative most people list of mechanical is the need for lifelong AntiCoagulation Therapy. The analysis of this is interesting and I would include the following observations

• you may find yourself on ACT anyway after an additional surgery due to AFib
• most of the data you read which suggests problems with ACT are related to old practices and the elderly cohort who are on ACT (and is not related to valvers in particular)
• self management is possible (less so in the restrictive environment of the USA, but there are examples of those folk here) and gives better outcomes than "usual care" (which I believe should be called "usual disregard"
• just like diabetics modern electronics has given us a revolution of lab work in a thing the size of a remote control
• additional surgical procedures when on ACT do require some management, but once you understand what that is its no more a panic situation than spending a little time planning for a trip

So yes its true that a mechanical valve will NOT be a certainty of no re-operation, but that's actually a weird way to look at it because few people regard a tissue prosthetic as the certainty of having a reoperation , which I suspect is the same psychology that leads us to believe that we can avoid dying (rather than just delay it).

My view is that a mechanical (with no clear contra-indications) is the best bet you can have at avoiding a re-operation, for (to the best of my knowledge) any even which drives a reoperation of a mechanical will also drive the reoperation of a tissue valve. Its just that "calcification" and Structural Valve Degradation will not drive reoperation in a mechanical but will a tissue.

I have not covered any issues which are of a personal preference nature for you ... they're for your paper sheets.

Best Wishes

 

[ottagal]

Thank you. The heart cath was conclusive, so I am not in need of a second opinion. I think I simply feel stunned, and need to wrap my head around the reality (again). I feel the mental piece is sometimes as hard as the physical.

I understand. Glad you know the results were conclusive and don't have to second guess. Wrapping our heads around these situations is half the battle. I wish you peace and acceptance moving forward. You will get through this.

 

[Protimenow]

Pellicle indicated a 'restrictive' environment for self-management of ACT in the United States. In many cases, he's absolutely right.

If you're on Medicare, some plans will allow you to self-test (but not self-manage - you'll get a meter and strips from a provider, who will forward your weekly result to a doctor -- and charge a LOT of money for the service and the 'medical' advice -- and you may still get stuck with co-pays. If you're not on Medicare, who knows what kind of service you'll get -- this can be a barely competent 'clinic' that's happy with monthly testing, hates to hear that you self-test, and prescribes from an outdated 'protocol').

Fortunately, meters can be acquired from distributors (often with a doctor's prescription required) or can be purchased on eBay. The same applies to strips. (Personally, I prefer Coag-Sense, but CoaguChek XS is also a well tested meter with a lot better market presence).

Having your own meter and strips gives you control of the timing and frequency of your testing -- weekly testing is recommended. If you have any questions about changes in diet, changes in medications, or other changes, you would be able to test more frequently. Clinics and services probably won't give you that degree of freedom.

As far as self-management, there are guides on this forum, and people on this forum who have been self-managing for years. You can get good advice here.

Like many others, I've been self-testing and self-managing for years. Although it's more difficult to get meter and supplies (and prescription for warfarin) in the United States than it may be in much of the rest of the world, don't be discouraged -- you CAN do it.

 

[jcgtok17]

Carol, The Edwards valve is the most popular in Japan. The avg. size is 21mm. I had my 27mm Trifecta GT St. Jude device "installed" May 2017. Hoping for > 10 year and that TAVI procedures advance. If mine were to need replacement < 10 year I'd would consider the mechanical options I think (50 at time of AVR). Fingers and toes crossed for a successful procedure.

 

[tom in MO]

Some exercise exertion problems led to a stress test where my BP dropped, so the test was curtailed. I had a heart cath 2 days ago that shows my 2012 Edwards bovine 21mm valve is now showing severe stenosis. I follow the "rules" and exercise 6 days, eat well, etc., and this news is distressing to say the least. Have other members had such a short valve lifespan?

Don't think of this as a failure, but as a successful 7 years of being able to live life to its fullest. Rest easy in that there is no "rule" to follow that will let your tissue valve last long. One thing about valve failure and stenosis, it's not caused by lifestyle. It's caused by genetics, chemistry and physics. You can't exercise or eat your way out of a valve problem.

Good luck with your new journey. As you know from the first surgery, it gets easier as you make the hard choices.

 

[rich01]

Nothing wrong with getting upset or even mad about it. I think for many of us, we need to go through that stage before we can get to acceptance.

It's hard to figure out what is the best way to keep our new valves functioning. I think much of the information cardiologists give us is to keep us from having a heart attack, not to prevent stenosis. Is taking K2 good, bad, or makes no difference? Same with fish oil, and vitamin d, and magnesium, and on and on. Is red meat good or bad? What about saturated fat?

I still lean towards a vegetarian or at least a primarily vegetarian diet with some fish and occasionally some meat, but what do I know?

It would be interesting to see if tests like CIMT (carotid intima-media thickness) test and coronary calcium scan would tell us if we are on the right track. I had a CIMT a few months ago and plan on following up with another to see if I have improved the health of my arteries. No guaranty that calcification of arteries and calcification of aortic valve have the same cause.

 

[pellicle]

Don't think of this as a failure, but as a successful 7 years of being able to live life to its fullest. Rest easy in that there is no "rule" to follow that will let your tissue valve last long. ...

well said

 

[CarolM]

#2 is Medtronic Open Pivot mechanical valve. I tried vey hard to convince myself that another tissue valve was a good idea, but failed.
BTW, I was 60 when I got the first valve, which seems 'young' from the 72 I have now achieved, so the popular wisdom that tissue valves wear out faster for young people doesn't apply to me.
I apologize for not expressing sympathy in my first post--it IS something hard to wrap your mind around for a second go-round.
Your saying "I followed the rules..." is almost an exact echo of someone I met at a cancer support group 3 years after my 2d valve. Sometimes life hands us some shockers.

Indeed it does. I was almost 58, and now 65 shortly. I would say my scale is tipping towards the mechanical also.

 

[rich01]

Indeed it does. I was almost 58, and now 65 shortly. I would say my scale is tipping towards the mechanical also.

You should at least discuss TAVR.

 

[jcgtok17]

TAVR is worth checking out for certain. I'm not sure in the USA, but TAVR are covered under universal healthcare plans in both Japan and Canada.