2nd surgery to replace mechanical valve with bovine valve

[virginian777]

i had a edwards mechanical valve put in 4-26-12 stiches cut tissue causeing a leak,dr said it would be best to replace than repair but this time i requested a bovine valve. i hate taking warfarin getting blood checked every month watching what i eat. not to mention the fear of getting cut as my hobby is woodworking i have 1000 tools that can cut.i'm not knocking the mechanical valve i just don,t like all that goes with it.had i done my research before first surgery i would have not picked the mechanical valve.

 

[Shamrocknj]

Good for you....I hope you have peace of mind now. I too have the bovine valve as of 6 weeks ago!

 

[virginian777]

how is it going?

 

[Jkm7]

Sorry you have to go through another surgery, Virginian, but happy you will get the valve of your choice.

I chose bovine at my second surgery which was coming up on five years ago. I am so grateful I made that choice and know, for me, that was the right valve. Hope you have an easy time of it. If it helps........ my second surgery was very much easier on me than my first, four years earlier.

 

[Shamrocknj]

Great.....I feel really good .....not back to work yet but should be in2 weeks!

 

[pellicle]

If it helps........ my second surgery was very much easier on me than my first, four years earlier.

I had a similar experience, but my third surgery was not so easy. It lead me to be certain I didn't want a fourth

 

[virginian777]

ya JKM7 it does help doc said i would only be in hospital about 3 days,can't wait to get off warfarin and eat some collard greens and its funny i never really like them before.

 

[Gail in Ca]

Everyone's opinion is different. You are choosing to have a 3rd surgery. I have already had 3 surgeries and have made a pact with my surgeon not to have any more! I, personally, would never have chosen a 3rd surgery. My advice would be to stay in the hospital at least 4 days, I was sent home after 3 days for my 2nd surgery, and I felt it was too soon. I was so exhausted, and people call and want to talk. I made sure with my 3rd surgery to ask for 1 more day in the hospital. I do understand your need to woodwork and of course being on coumadin gives that extra risk of bleeding. However, I would sure research the risk of multiple surgeries over cutting yourself. I test with my own machine weekly, it really isn't so bad. I know you will enjoy your tissue valve. We all do that have had them, for the 11 or so yrs we get with them.

 

[Jkm7]

<snip>

However, I would sure research the risk of multiple surgeries over cutting yourself. I test with my own machine weekly, it really isn't so bad. I know you will enjoy your tissue valve. We all do that have had them, for the 11 or so yrs we get with them.

Gail, Don't you think that a highly charged thing to say........ 11 or so years? So biased and unfair a statement to make for people who are deciding which valve to choose. That kind of comment is of no useful service to anyone IMO
It could be accurate for a patient 20 years old, maybe ..... but you fully know that is not the full story.

The newest generation of tissue valves we are getting have an excellent expectation to last 20+ years depending upon the age of the patient. A person sixty years and more is not thinking foolishly to imagine their valve could serve them well for more than 20 years.

 

[Gail in Ca]

Hmm..biased and unfair? My surgeon, one of the world's best, told me to expect 10 yrs from a tissue valve, just 4 yrs ago and I was 54. I believe he is being realistic, and didn't want me to think this would've been my last surgery.
It seems that those of us that have been given mechanical valves are not supposed to have an opinion on this site. I just know what I've been told by the experts. Maybe things have changed dramatically in 4 yrs.
I think I'm entitled to express my opinion on multiple surgeries. I've been through them. I have the experience. I think it is a useful comment, to state that a tissue valve may not go for as long as many are lead to believe.
I hope for your sake that they do last 20 yrs. But, it is only 20 yrs and then you are looking at another surgery on your vital organ. After my 3rd surgery, which took many hours on the table, I have had problems with lung collapse,
irregular heart beats, and A-fib. I am a healthy individual. But, I think many surgeries take their toll on our hearts. Now, THAT is my personal opinion, not that of my doctors. I haven't asked them about what multiple surgeries do to the heart. As long as I belong to this site, I will have an opinion. I think I try to be positive in my replies. I'm alive, and that's what counts. Having recently visited with my surgeon, I found that they think differently than I do. He said that I have had my life extended now, for 23 years. I always feel that I'm fixed, and I will live a normal life as I would've without the surgeries. But, his thoughts really made me think about this.

 

[katm]

I am almost three weeks post surgery, I received a cows valve and I am already frightened just thinking that this valve might not last me as long as expected. I pretty much left the decision up to my surgeon to make once he got in there and with his expertise decide which valve would best serve me. I understand and respect everyones opinion on what valve they decide on and why. The problem is, I feel myself shying away from this site and others (at this stage of my recovery) it disturbs me so much to hear the stories from others when their mechanical or bovine valve doesnt work as expected. One of the things I feared most once given this damm diagnosis was that my life would never be the same as it was before my diagnosis. Gail to be honest your history scares me, its exactly what I dont want to have happen. I am glad that you are doing well now. I am confused as to why you have had three surgeries. Was it three surgeries over the last 23 years? Did you receive two bovine and the last one mechanical? Did you start off 23 yrs ago with just your run of the mill BAV? lol I am kind of new to this site, so I am not that familiar with everyone. I think total honesty is important but we have to keep it in perspective as the same time. My sister is a ultra sound tech who just recently was scanning a woman who has had a bovine for the last 23 yrs. There are success and failure stories on both sides. I get so tired thinking about it sometimes.

 

[pellicle]

Hi

some data:

Gail, Don't you think that a highly charged thing to say........ 11 or so years? So biased and unfair a statement to make for people who are deciding which valve to choose. That kind of comment is of no useful service to anyone IMO ...
A person sixty years and more is not thinking foolishly to imagine their valve could serve them well for more than 20 years.

http://ats.ctsnetjournals.org/cgi/content/abstract/90/3/775

Methods: From 1982 to 2004, 1134 patients underwent aortic valve replacement (AVR) with Hancock II bioprosthesis and were prospectively monitored. Mean patient age was 67 ± 11 years;
202 patients were younger than 60,
402 were 60 to 70, and
526 were older than 70.
Median follow-up was 12.2 years and 99.2% complete.
[my note: this follow up date is important in projecting data out to 20 years]

Results: Survival at 20 and 25 years was 19.2% ± 2% and 6.7% ± 2.8%, respectively, with only 34 and 3 patients at risk.

Survival at 20 years was 54.9% ± 6.4% in patients younger than 60 years, 22.7% ± 3.3% in those 60 to 70, and 2.4% ± 1.9% in those older than 70 (p = 0.01).

Structural valve deterioration developed in 67 patients aged younger than 60, in 18 patients aged 60 to 70, and in 2 patients older than 70.

The freedom from structural valve deterioration at 20 years was 63.4% ± 4.2% in the entire cohort, 29.2% ± 5.7% in patients younger than 60 years, 85.2% ± 3.7% in patients aged 60 to 70, and 99.8% ± 0.2% in patients older than 70 (truncated at 18 years).

Repeat AVR was performed in 104 patients (74 for structural valve failure, 16 for endocarditis, and 14 for other reasons). At 20 years, the overall freedom from AVR was 65.1% ± 4% for any reason, 29.8% ± 5.4% in patients younger than 60 years, 86.8% ± 3.3% in patients 60 to 70, and 98.3% ± 0.6% in patients older than 70.

http://www.heart-valve-surgery.com/.../cow-valve-replacement-surgery-bovine-valves/

Reports suggest that the average lifetime of a cow valve replacement is about 10 to 15 years. Although some research suggests that cow valve replacements may last over 20 years. Therefore, younger patients opting to have cow valve replacement surgery may need to have a re-operation at a future time.

lastly:
Journal of Thoracic and Cardiovascular Surgery. Vol. 131.No.1 2006: 1-3
http://www.ctsnet.org/file/vendors/978/pdf/163.pdf

“All so-called ‘actual freedom’ results
published in the medical literature
or in commercial files should be
completely disregarded as invalid
descriptions of valve performance”
[note: emphasis mine]

lastly, please refer to this post http://www.valvereplacement.org/for...e-aortic-valve-has-lasted&p=498750#post498750
on this server ... follow up the links. note the St Jude document is actuarial not actual

 

[pellicle]

I am almost three weeks post surgery

good to hear you're doing well ... keep up the good work

I received a cows valve and I am already frightened just thinking that this valve might not last me as long as expected.

in all seriousness, my advice is stop thinking about it.

the world is strange and unexpected, so live every minute as if you don't know what will happen next.

truly

I get so tired thinking about it sometimes.

so don't

I've had 3 OH surgeries now, and still having ongoing small annoying complications from my last OH surgery in 2011. Who knows what will happen? Really only the fools or the gods "know".

I see little point in backing up my statements of life philosophy with my experience again, but you can find them here (or I can tell you if you want to know).

relax ... try to enjoy

 

[ramjet]

yes indeed katm, there are successs and failure stories with all valves.

A couple of things to keep in mind. The tissue valves may not last as long as the mechanical valve, and statistically that is the case...but I am not worried about cutting myself with warfarin, I can stop that bleeding eventually with good direct pressure and elevation usually...I am more worried about falling off a ladder or having a car accident when on warfarin...because you can't usually control bleeding into your brain. If, for some reason yoru warfarin levels go a bit high, and you have a bad whack to the head, you can have a haemorrhagic event into the skull. I was warfarin for a month of so until my tissue valve had settled down. Well, only a few months after I was taken off warfarin I had a car accident...and the first thing my doctor said was...good thing you chose a tissue valve and you were off warfarin. But its defiantly not that simple either.

I will need another heart procedure in about 10 years, unrelated to my valve, so my valve will be replaced in about 10-15 years no matter what happens to my valve. There is a very real chance that the new tissue valves might last quite a lot longer than 10 years...my valve is reportedly lasting much better than predictions initially indicated, and remember, everyone is different, even if we have the same brand of tissue valve, there are a range of sizes to suit your particular aorta, and different sizes have different haemodynamic properties and hence different lifetime expectations....don't stress. Have cardiac echos every year or two, and as Doris Day sang..."Que sera sera"

 

[Gail in Ca]

Dear Katm, glad to hear you are recovering well. When recovered, you will feel so much like your normal self! I know, because I loved my porcine valve, given to me the 1st time I had surgery for an ascending aortic aneurysm that was already at 6cm when discovered. My surgeon at that time said he had seen them last 15 yrs, so, of course, I knew mine would last 15 yrs! He gave it to me, I let him make the decision on what valve to have. I was 34. (89)
I did really well, and felt great, doing step on 2 risers 3 times a week, walking the dog, and just got back to my normal living. You will too. I did take a break from this site for a few years. Don't feel bad if you need to, also.
We all have had different experiences. But, we are blessed to be alive and enjoying life. I actually get a kick, now, at some of the posts and replies. It is sort of addicting. Anyway, you can read the abreviated version of my surgeries on my profile. I've had 1 porcine, and 2 mechanical aortic valves placed in 20 yrs. It has been almost 4 yrs since my 3rd, and hopefully, final, surgery. I feel good. I walk the dog 3 miles. Our surgeons give us life!

 

[katm]

Thanks Pellicle, I do remember reading of what you have experienced in your life. I remember thinking how inspirational you were to me. I do have to stop thinking and just live my life and be grateful for it. Thank you for the reminder. Sometimes I just feel sorry for myself. Your words are very uplifting to me considering all that you have experienced. Hope this doesnt offend you but I find your words very spiritual to me. Thanks again.

 

[katm]

Thanks Gail, so happy to hear that you feel well. Yes, I love/hate my surgeon, lol.

 

[katm]

I laughed out loud to the Doris Day reference. lol Loved her! Thanks

 

[pellicle]

Thanks Pellicle,
...
Hope this doesnt offend you but I find your words very spiritual to me. Thanks again.

Glad to offer something which helps. I'm totally not offended and actually do consider myself a spiritual person if not a religious one.

There may be some transferability of my current blog rambling to you too

http://cjeastwd.blogspot.com.au/2013/01/perhaps-not-everything.html

Assuming that grief can be abstracted to loss, people can grieve at the loss of their health.
So my above rambling is that while I felt I had lost much, the thing which I can't have taken from me is my spirit. That I can only bury and ignore if I choose to.

Perhaps your spirit is as strong as before and perhaps when some of the hurting stops you too may just be stronger

 

[Bryan B]

These stats are for the Carpentier Edwards pericardial valve.

By 10 years, the freedom from explantation was 58% for patients 21 to 49 years of age, compared with 68% for patients 50 to 64 years, 93% for patients 65 to 74 years, and 99% for patients 75 years of age and older.

http://www.ncbi.nlm.nih.gov/pubmed/21676681

A lot of it depends on your age as to how long a Carpentier Edwards pericardial bovine valve will last (along with other mitigating factors). I have one of these valves and I am in the 50-64 age range so I have a 68% chance of freedom of explantation at 10 years. My surgeon told me to expect to get 12-15 years out of my valve.

My surgeon at Duke is the leading surgeon of the CoreValve trials at Duke. He told me that in his opinion if I get the average number of years out of my bovine valve that catheter based aortic valve replacement would be a viable alternative to OHS for me. He based his judgement on how he felt the FDA would approve the valve in stages as the studies continue and advancements are made. He said that at first the catheter valves will be approved for patients that are high risk for traditional surgery. The next step would be approval for patients like me who have had multiple surgeries (medium risk).

For the record, for my 2nd surgery I had initially chosen a On-X mechanical valve but after discussions with him the day before surgery we decided to switch to the bovine valve. I had no problem with Coumadin as I was on it for 3 months when I had A-Flutter and developed a clot in one of my atrium (don't remember which side now). I had no issues with Coumadin and had no problems staying in range...kind of lol. They had my range at 2-3 and i tended to hang around 3.5 which they said was fine.

I took a chance at the Ross Procedure and it didn't work out (but I have no regrets). Now I am taking a chance that my valve will last until I am a candidate for catheter based valve replacement. If it doesn't work out I will have no regrets. If I need to get a traditional OHS in my early 60's I will make that decision when the time comes, but I plan on that being my last OHS. I'm betting on the catheter based replacement and my surgeon was VERY CONFIDENT that if I make it to my early to mid 60's it will be an option for me. BTW I was 50 when I had my last surgery and next month my valve will be 2 years old...just a toddler.