A Good Rumor

[Guest]

Last week I was at a meeting of anticoagulation specilaists. A person "in the know" but who would not want to be quoted told me that the new tissue valves are working so well and lasting so long that the companies that make mechanical valves are being forced to re-examine their product lines and marketing strategy. That is really all that I can say. The person knows that I am very involved with people on anticoagulation and would add this to the mix of information for people making their decisions. I believe this to be true because it does not go against anything that we already know, it just takes it a step further.

 

[Ross]

I don't think it's surprising. I've even rethought my thinking since they do seem to last way longer then what people are told. Sort of like my hip replacement. They told me 12 years is all I'd get, well I'm on 8 now and it's still doing very well.

 

[PJmomrunner]

Al, that IS a good rumor

Al, that IS a good rumor

did this person intimate that there were studies coming out or anything to back this up? (Please say "yes, a huge very long-term study", okay? ) I really want to believe that the tissue valves are lasting longer than predicted, since my surgeon is recommending a tissue valve. Did this person happen to mention which tissue valves (stented or stentless porcine, bovine pericardial, homograft, something I'm leaving out?)?

 

[Guest]

This is all that the person said. Remember that studies are just that - studies. Many times they have little resemblance to real-life because of exclusions of certain people from the studies.

With what has been written here already, I think it is safe to conclude that any edge that mechanical valves had in the area of durability is decreasing.

This person would have nothing to gain by not being honest.

 

[PJmomrunner]

Thanks for sharing, Al.

 

[Dave S]

Not a good thing to be reading after making what I think was the right decision
in choosing a mechanical valve .

I think they are lasting longer, but no where as logn as a mechanical valves.
I argued the point with my doctor, he said the tissue valve will not last a lifetime for anyone in their 40's, but if you are in your mid 50-60's he said it might be the way to go.

 

[LUVMyBirman]

I was 30 at the time of my mechanical MVR. That being said...and six years later. My card informed that this valve should last another 15-20. If you do the math....on the long end, that's 26 years. Which seems correct if you gage the repeats we know of from a few members. At yr. 29. When they say "lifetime"...that reference is for folks whom are 55+ at time of surgery.

 

[Guest]

Dave, my first wife died of cancer at age 34, so I know how 20/20 hindsight works. You cannot look back and make retroactive decisions. If you do that, you will be haunted by your choice forever. All you can say is that you made the best decision for yourself with the information that was available at the time.

We tend to see choices as yes or no but in reality they are mostly shades of maybe. If you read what I wrote closely, I did not say that mechanical valves were obsolete. I said that there seemed to be a trend. If there ever is a final answer it will not be relevant to your choice. You needed the valve last *** a trend didn't mean anything for you.

 

[gijanet]

Oh, yeah, Al, thanks............

Oh, yeah, Al, thanks............

for throwing me into an even greater quandary about this valve issue. I did e-mail Katie's surgeon, and he said that a tissue valve in the mitral position was an option - just not a good one for us..............in a four year old, we would be lucky to get five years out of it.............sigh! So, mechanical it is! Since this will be Katie's fourth heart surgery, I hardly think that we want to risk a fifth in the next five years.............or EVER, for that matter!

Seriously, though, thank you so much for keeping us "in the know." (Although I am still waiting for my "know's" to outweigh my "dunno's"! Hugs. Janet

 

[ar bee]

to the forum owners/managers

to the forum owners/managers

may I humbly suggest that we, on a periodical basis, vote for the most useless and the most useful post on this forum?

guess which post I would vote for!

regards and well2allofu
ar bee

 

[Phyllis]

Thanks for sharing, Al. That's good news for all those that moo and oink.

 

[epstns]

Not only is it good news for all who moo and oink, it is also good information for all of us who have yet to make a valve choice -- especially for those of us nearing the traditional middle-age decision points for mech versus tissue.

Al - Thank you for keeping us posted!

 

[Mary]

Al,

I wondered if you were hinting that a new mechanical or the On-X will be developed/approved for aspirin anticoagulation.

 

[mmarshall]

Well I'm 31 and going in for a AVR in the next month. I was advised by my surgeon that we are going to do the Ross but my back up will be the latest stentless valve. I forgot the specifics of it...I will get that this week. Basically they have been using this stentless tissue valve for the last 12 years and 98% of the patients are showing no signs of calcifying or wear out. So of course he could not give an exact time line as to how long it will last but realistically I would say that 15 to 20 years would be a good estimate. And like some of the people have said on here....mechanical lasting a lifetime works for someone that is 45 to 50....but the younger 25-35 need to consider that the function of a mechanical lasts a lifetime but that does not mean it is going to be in our heart for a lifetime. So if we go in at our age thinking that this is the only heart surgery we will be facing in our lifetime...the odds don't look good...no matter what type of replacement we decide to go with. At 31...I would rather face another OHS in my 40s or 50s...then deal with it in my late 50s or 60s....recovery just seems better...and the hope that within the next 15 to 20 years...or longer..hopefully...they will have advancements to where OHS is not needed...or if it is....tissue and/or mechanicals have made great advancements.

 

[Guest]

There was no mention of a specific product.

 

[Superbob]

Al,

Thanks for your candor in passing along this information. Hopefully technological improvements will continue to give us all a variety of excellent choices whether they are mechanical or tissue.

Bob

 

[Dave S]

Thanks
AL..

 

[tobagotwo]

I'm glad that the competition is all in the name of improvement, but the proof of the pudding for tissue valves in the young just isn't there yet. As far as I know, they are still at hazard for a short valve life, due to their bodies' swift mineralization response. It has improved, I would hope, but the real questions have to be how much and how reliably.

I'm a great believer in tissue valves where feasible, or with proper understanding of the likely valve lifespan. However, I am still waiting for some good studies that indicate they have really overcome this critical issue before I would even think about recommendation for the young without strong warnings. I will remain skeptical on this issue until I am convinced. Unfortunately, time-in-use is required to get the answer.

For us geezers over 50, it's a simpler issue. With the young is where tissue valves could offer the most value, but where they are the most susceptible to early calcification.

Thanks for the hot stock tip, Al!

Best wishes,

 

[Guest]

The trouble with waiting for good studies is that the study may have been financed by a mechanical valve manufacturer. If it turned out that the tissue valve did better, then it might never get written up to be published. The mechanical valve maker would know to be worried but they wouldn't necessarily tell anyone else.

Something similar seems to have happened with Exanta. The SPORTIF IV trial was the one that had the bad results. So far it has never been published. Even at last week's big anticoagulation meeting, some of the speakers seemed to not know of the unpublished results. SPORTIF III and SPORTIF V were all that they could refer to.

 

[epstns]

Question for Bob H. . .

Question for Bob H. . .

Say, Bob,

What is the current cut-off point for us "geezers" in our mid to late 50's for mech versus tissue valves? I'm now 57, and looking at AVR within probably 2-4 years.The last time I discussed valve choice with my cardio, we were leaning toward mechanical to reduce the odds of needing re-op. Has the common wisdom shifted to tissue valves in the 50's rather than in the 60's? This could re-open an interesting dilemma. . .