avr for young with blood desease

[avshalom]

hello,
my name is avshalom.i am 33 years I have bicuspid aortic valve with severe aortic regurgitation,
{mild lv dilatation(60 mm), mild of aortic root-sinuses (42 mm),very mild of ascending aorta(37 mm) Lvesd=37 mm , and good lv function .}

I suffer from shortness of breath very frequently.

my cardiologist suggests me to delay my AVR because i have , in addition, mild von willbrand (VWD) - factor 8 deficiency - and taking blood thinners isn't the best solution in my situation.

my surgen think i should take a tissue valve or pass aortic valve repair
But I am not calm because his short durability in younger person like me.

I want your advise.
what do you think?

avshalom

 

[Ross]

Hello and welcome avshalom

Given your condition, the only thing I see is tissue valve despite the longevity issues. It will last a good while for you before needing another. You really don't have a lot of choices. Kind of have to pick the best possible one and see how it goes. If you do nothing, you know your in trouble and won't be around to worry about it much longer.

 

[ALCapshaw2]

For starters, I would suggest learning all you can about the various tissue valve options including Porcine, Stentless Porcine, Bovine Pericardial, Homograft, and even the Ross Procedure.

Someone posted a link to www.edwards.com Edwards manufactures Bovine Pericardial valves which are very popular at some of the major hospitals. Generally, Bovine Valves last longer than (standard) porcine valves. There are 'improved' types of porcine valves that supposedly have greater longevity but I am not familiar with them.

The Ross Procedure takes YOUR own pulmonary valve and uses it to replace your defective valve. Then another (usually tissue) valve is placed in the low pressure pulmonary position. You will need to find a surgeon who specializes in this procedure which is more complicated than standard valve replacement surgery. Most surgeons do NOT perform this procedure.

IF you must go with a mechanical, the newer generation of valves are designed to create less turbulence and therefore less likely to cause clot formation. These include the valves from On-X and the St. Jude Regent. There are currently studies underway in Europe to determine if Aspirin therapy alone is sufficient for recipients of the On-X valve.

Best wishes,

'AL Capshaw'

 

[hensylee]

Welcome avshalom. I think the others above have given you good advice. You probably must have your valve replaced in order to prolong your life. When there are other secondary issues, it is hard to decide what to do. But we have some pretty knowledgable members and they will have more to add here. Hang in there, we will stay with you right on til and after surgery. But you stay with us, too. Blessins........

 

[Guest]

Von Willibrand's disease is a lack of clotting via the platelet mechanism. Factor VIII deficiency is a type of hemophilia. Therefore, you would have a problem taking even aspirin. You obviously already have a hematologist who be involved in the surgery decisions. I do think that things point toward a tissue valve for you - probably without any anticoagulation.

 

[avshalom]

Thank all.
I want to ask more few questions:
What do you think about taking medicine from ARB to postpone the operation?
How many years in average a tissue valve can hold on younger male below 40?
avshalom

 

[Guest]

What is ARB?

Nobody knows how long the valve will last. They are improving all the time but the question has never been answered as far as I know.

 

[PJmomrunner]

Avshalom:

Just wondering...is the notion of using a porcine (pig) valve acceptable to you?

P. J.

 

[avshalom]

Avshalom:

Just wondering...is the notion of using a porcine (pig) valve acceptable to you?

P. J.

yes. I have no problem with the valve source. my problem is that tissue valves (porcine or bovine) don't last for long years.

avshalom

 

[coryp]

yes. I have no problem with the valve source. my problem is that tissue valves (porcine or bovine) don't last for long years.

avshalom

AVSHALOM,

I am in your situation. 34 yom getting a valve replacement and aneurysm removal june7th. I do not have the blood issues that you do so it may cause additionan issues that I am not aware of.

Let's discuss something I am a little more knowledgable on (valve selection). I am getting a Edwards Bovine Magna 3000fx, unlike you (it seems) I have the choice but going through 4 different surgeons I opted to go with my final surgeon and his choice for thE Bovine. There are many reasons really and I can go into them if you like. Here was the my reasoning, If I went Mechanical I could possibly get 25-30 yrs from the valve (in all likeyhood) and then that would put me at 59-65 for my next surgery. My surgeon told me that I could expect to get 15-20 yrs from the Bovine (putting me 10yrs ahead on the 2nd surgery). I would opt to have the 2nd surgery (hopefully last) at a younger age giving me a better chance of quick recovery and survival and believe that by the time I need my 2nd (given 15 yrs) common practice for valve replacement will be through cath (no OHS). I get to forego all the coumadin and lifestyle changes that go along with it as well as the clicking of the mechanical valve (not that these are terrible).

That is my reasoning.

Where are you located?