Any difference between tissue & mechanical in terms of taking advantage of advances?

[ks1490]

Any difference between tissue & mechanical in terms of taking advantage of advances?

Hi, I picked up on a sentence in someone's reply on another post. Is there any difference between a tissue vs. a mechanical valve in terms of taking advantage of future medical advances? For example, does getting a tissue valve leave you with more options in terms of future medical technological advances or is there no difference?

 

[geebee]

I guess you could say that a tissue valve does leave you open for taking advantage of future situations since you will more than likely need more surgeries. Therefore, if something better comes along you can get it when you need a replacement down the road.
However, I guess if something really outstanding came along even those with mechanicals could choose to have their valve replaced.

 

[Andyrdj]

A relevant question

A relevant question

How easy is it for a Tissue patient vs mech patient to have a second op?

 

[MarkU]

I guess you could say that a tissue valve does leave you open for taking advantage of future situations since you will more than likely need more surgeries. Therefore, if something better comes along you can get it when you need a replacement down the road.
However, I guess if something really outstanding came along even those with mechanicals could choose to have their valve replaced.

Approaching from a slightly different angle, would I have my perfectly functional St. Jude replaced with a more advanced valve just so I could give up Coumadin therapy? The answer would be probably not, unless there were other significant mitigating factors. I intend to keep dancing with the girl I brought to the dance.

I can say that because Coumadin therapy has not been a significant issue for me, and the inconvenience posed by it does not outweigh the increased risk and trauma of re-op, or the nearly year-long recovery I would likely need to undergo to return to my current level of activity.

From a pure economic standpoint, I am also entering what I hope to be my maximum earning period in the next few years and wouldn't want an additional heart surgery to throw that off track like it did the first time around.

I made a valve choice six years ago based on what was available at the time. I'm happy with that choice and have never second-guessed myself. And most fortunately for me, things have worked out well.

Now if they could develop a more "user-friendly" replacement for Coumadin, that would be okay with me, I suppose.

As I mentioned in another post, my decision would probably be more difficult for me today based on the advancement of tissue valves in the past six years (and if nothing else having six more years of historical data on which to base a decision).

Mark

 

[Mary]

How easy is it for a Tissue patient vs mech patient to have a second op?

I don't know if there are enough members who have had each type replaced, at least once, to give you a good answer.
However a tissue redo won't involve coumadin management during the replant, so that's easier.

 

[Andyrdj]

a question

a question

To Marku and other mech valvers:

Would any of you take the option of "the perfect valve" if it was replaced via robotic microsurgery?

How about percutanously (up the femoral artery)?

 

[RCB]

Hmmm

Hmmm

I don't know if there are enough members who have had each type replaced, at least once, to give you a good answer.
However a tissue redo won't involve coumadin management during the replant, so that's easier.

However, tissue valves need more reops and more reops mean more scar
tissue. More scar tissue means more problems.

 

[Mary]

However, tissue valves need more reops and more reops mean more scar
tissue. More scar tissue means more problems.

The questions asked by Andy was, "How easy is it for a tissue patient vs mechanical patient to have a second reop?"

That means a mechanical valver would also be having a reop, so they would deal with the same issue of scar tissue that the tissue valver would.

 

[RCB]

No need to wait for that!

No need to wait for that!

To Marku and other mech valvers:

Would any of you take the option of "the perfect valve" if it was replaced via robotic microsurgery?

How about percutanously (up the femoral artery)?

The valves we have are great, we are just in a different waiting line.
It is the one where they come up it with "the perfect ACT"! You know the one
where you put it on like a patch, that monitors INR so there is no need for testing and it keep you in range to +/- .01 all the time. And while we are at it, a lifetime supply come with all mech. valves.

 

[Andyrdj]

Perfect ACT

Perfect ACT

Well,that wouldn't be the perfect ACT would it - although it would be a big step forward.

Surely "perfect" would be something that could selectively prevent clots forming in the heart whilst not affecting normal clotting when you cut yourself. Otherwise there's still bleeding risk internally and externally.

i can't for the life of me think how you'd do that - unless you could permanantly implant some sort of enzyme receptors around the valve to cause some drug carrier - e.g. nanoparticles in the drug you take- to break open and release the ant-clotting agent within in that place, and that place only.

Or some sort of coating that could be applied to the leaflets of the valve and surrounding heart region which would make any clotting impossible.

Now both the options I've thought of require getting into the heart to deliver something extra - conceivably it could be done percutaneously.

Can you think of any other way a selective clotting agent might work? It sounds like a very difficult challenge to me.

 

[Karlynn]

The point of getting a mechanical valve is to avoid further surgery due to the risk of further operations. If there was not risk involved in reoperations, then I doubt mechanical valves would be as widely used. Knowing that there are times when a mechanical may need to be replaced, I doubt that if the risk of replacing a mechanical was much greater than replacing a tissue valve that, once again, mechanicals would not be used as much.

It is my understanding that scar tissue presents the greatest problem. In 4 years on this forum, I don't recall seeing anyone make any comments about scar tissue being any worse for a particular valve type during re-ops.

 

[MarkU]

To Marku and other mech valvers:

Would any of you take the option of "the perfect valve" if it was replaced via robotic microsurgery?

How about percutanously (up the femoral artery)?

You never say never, but that would just be speculating on something that doesn't exist, and probably won't any time in the near future.

And again, why would I want to mess with something that is working well so far? Have to balance the risk versus the reward. Any invasive procedure is going to have some level of risk associated with it. I would have to have some compelling reason to upset the status quo.

I absolutely believe that medical technology will continue to progress, but what that new technology will look like is anybody's guess. That's the neat thing about creativity and innovation - its specific manifestation is unpredictable. It may well be that someone has an inspiration and develops something completely out of the box that makes all of our mech v tissue debates moot.

Mark

 

[geebee]

If it ain't broke..............

 

[MikeHeim]

Taking it back to the original question, I don't think there's a clear answer. If we could predict where future technology would go, there really wouldn't be too much to debate on this site.

Bio-valvers are hoping for anti-calcification treatments that could make a tissue valve last a lifetime, but I don't believe this is a near-term reality. On another front, there is the near-term (since it is already happening in clinical trials) possibility of changing out tissue valves via cathader, which certainly reduces cutting, which reduces scar tissue formation, which reduces much of the risk of repeat surgeries. At least that is my understanding...

Those considering mech valves can hope for the aspirin trials (I believe these are currently taking place in both Germany and South Africa) with the ON-X valves to show that rigorous ACT therapy can become a thing of the past. This is especially true with ON-X valves in the Aortic position. I also have little doubt that there is a mech valve that is even better than the ON-X as far as increased turbulance and better anti-clotting that is being developed as we speak.

My personal answer to your question is: Who knows? None of the above advancements are a certainty. If you choose a biological valve at this time, you know it will have to be replaced at some unspecified date, and you may be able to take advantage of one of the above advancements with the next go-around. Of course, if you get a biological valve, none of the advancements may be ready by time you are ready to get it replaced, and you will be faced with the exact same decision that you have today. It all comes down to the level of risk that each person is comfortable with...

 

[temp69]

To paraphrase a surgeon...

To paraphrase a surgeon...

When I met with Dr. Laks at UCLA I asked him if I could, at age 55, get a tissue valve now, with the hope that it would last 15-20 years, at which time they would be able to replace it with non-invasive surgery.

He said that it was unlikely that one could go in and replace one tissue valve with another without doing OHS. I can't quote him, don't remember exactly what he said, but he really discouraged it, saying coumadin's not that big of a deal and go ahead and get the new On-X which should last...well let's just say I didn't buy the extended warranty.

I hope this is of some help. I wanted a tissue valve and hoped they'd be able to just replace it with a non-invase technique, but apparantly not yet.

The good news for everyone -- is that if they DO come up with a snazzy new valve which can be swapped out with non-invasive, everyone will benefit, whether you currently have a mechanical or a tissue valve. Who knows?

 

[mntbiker]

Gina hit the nail on the head. Those of us that have gone with tissue valves have no choice but to take advantage of future technology. If you had gotten a mechanical valve (theoretically) there is no reason to worry about future technology since you have already been taken care of for life.

 

[Natanni]

My husband has the mechanical valve, and I can't speak for him (at the moment anyway) but speaking from my conservative nursing side, I can't help but wonder if having a perfectly functioning mechanical valve replaced with the dream valve would outway the risk infection, which can do permanent damage...

 

[Arlyss]

Fom Mechanical to Tissue....

Fom Mechanical to Tissue....

I have edited this to bring it more to the point of this thread. It is very difficult to anticipate what future advancements might mean for an individual. However, percutaneous valve replacements involve slipping the valve in via catheter and having it expand in place inside the existing valve - the leaflets of the existing valve are just pressed out of the way, to the sides. That would only be possible with a tissue valve... no doubt the intent is to replace both native and prosthetic tissue valves this way if possible.... I wonder about the ones that are heavily calcified, like my husband's, and the risk of stroke from particles breaking away during such a procedure....

This is not a new idea (percutaneous valve replacement), but there appears to be much more enthusiasm now - so perhaps some of the past technical challenges have been overcome. However, the valve is not sewn in place, as is currently done in open chest surgery. I wonder how securely anchored the new valve is, and how tight the seal around it is? Even now it is possible to have what is called "perivalvular leaks" - where blood leaks around the suture line.... I also wonder about the hemodynamics across the valve where one valve is sitting inside of another.

My husband has had three "open heart" surgeries now - one actually for the ascending aorta, technically not the heart at all. Reality has been very different from what we were told by the cardiologist at the time of his first valve surgery - that he was all fixed, all he needed to do was take coumadin the rest of his life! No one wants to have more surgery than needed, and the mechanical valve was given to him with that intent. It has turned out very differently. Actually, he has handled his surgeries well. Injury to the brain is a very different matter, and I will put some of the text I wrote here into a different thread in hopes of helping others avoid the type of stroke he had.

So, what does the future hold from the place where someone starts their journey? What will future advances mean to them? It depends so much on what is inside that individual, the state of the art technology at the time, and the knowledge and skill of the surgeon. Time tests it all....

Best wishes to everyone as you search for information today, where ever you are in your journey....

Arlyss

 

[Andyrdj]

Percutaneous replacement

Percutaneous replacement

He said that it was unlikely that one could go in and replace one tissue valve with another without doing OHS.

He's mistaken to some degree - it's already be done this year by Corvalve (see press releases for Corevalve Europe at www.corevalve.com). Most of their percutaneous replacements have been over native valves, but one was to replace an ailing bioprosthetic valve in a 79 year old man - one who would have been too weak for conventional surgery.

They seem to be having a pretty good sucess rate so far - Edwards had a similar trial which was halted, but theirs seems to be saving lives at a prodigious rate of knots - lives which would have been doomed due to being unfit for surgery.

I don't know the details of how they did this, or indeed what sort of tissue valve they can do this with. But going back to the question

Any difference between tissue & mechanical in terms of taking advantage of advances?

My hunch is that they might not be able to remove a mech valve this way, If the method was to leave the old tissue vavle in and implant the new one "inside" it, then you clearly can't do this with a bileaflet mech valve. Similarly if they removed just the valve leaflets and left the stent in (which seems a little better) you couldn't do this with a mech.

If they're really dextrous and can unstitch an artificial valve and put a new one in (VERY TRICKY) then perhaps they could replace a mech.

Now, the key point of corevalve's approach is that it's designed to be anchored into the aorta, but also to be removed and replaced multiple times. So once the first replacement of a conventional valve is made, they can remove theirs before putting in the next one (so you don't get a valve within a valve within a valve......... ad infinitum).

They key with these will be how long they last, how easy they are to replace, and how safe they are between replacements.

If they fail gradually and predictably and last e.g. 15 years, then perhaps 4 or 5 such replacements in a lifetime would be considerably less traumatic than even a single operation.

 

[Karlynn]

Arlyss, your husband has had quite the journey. If the time comes that my mechanical mitral valve needs replacing, I too would go with a tissue if it looked like it would last me as long as I needed it too. I'm praying the need for that surgery doesn't arise, grateful for the 14+ good, surgery-free years my mitral valve has given me so far and would not opt to replace it if it is unnecessary (relating to a question in a prior post). But depending on my age, should the need arise, I would go with a tissue valve.

Your husband did what needed to be done to keep living, and that is the bottom line for all of us, isn't it?

Do they know if the surgery to repair the aneurysm had anything to do with the strands of tissue found on the aortic valve causing his 3rd surgery?