Bio valve - how/what can the patient do to get the most mileage from valve

[Lily]

Gil, years ago I asked my cardio how I could get a longer life out of my valve too. He told me I should take good care of my teeth and gums.

I don't know that it's working for me, necessarily, but just thought I'd share what he told me.

 

[ottagal]

Gil, years ago I asked my cardio how I could get a longer life out of my valve too. He told me I should take good care of my teeth and gums.

I don't know that it's working for me, necessarily, but just thought I'd share what he told me.

Good point LIly! If we can prevent/avoid Bacterial Endocarditis, it will certainly increase our chances of getting more mileage out of our bio. valves.

 

[Luckyguy17]

Gil, years ago I asked my cardio how I could get a longer life out of my valve too. He told me I should take good care of my teeth and gums.

I don't know that it's working for me, necessarily, but just thought I'd share what he told me.

Lile and Ottawagal,

That does seem very confirmed by a local professional.

Did hear our chief of cardiology, the respected Dr. Devarennes, on releasing another patient, state "That bacterial infection was a very high risk for bio AVR patients and should be prevented/addressed as it is dangerous".
The surgeon also recommended continued use of mild antiobiotics (apo-Amoxi class), by AVR patients on every doctor visit, contradicting a damous report in 2008, that said anti biotics were not required.

So maintaining dental/mouth health may be a big one, thanks

Gil

 

[Lynlw]

Lile and Ottawagal,

That does seem very confirmed by a local professional.

Did hear our chief of cardiology, the respected Dr. Devarennes, on releasing another patient, state "That bacterial infection was a very high risk for bio AVR patients and should be prevented/addressed as it is dangerous".
The surgeon also recommended continued use of mild antiobiotics (apo-Amoxi class), by AVR patients on every doctor visit, contradicting a damous report in 2008, that said anti biotics were not required.

So maintaining dental/mouth health may be a big one, thanks

Gil

Any replaced valve is at risk for BE, NOT just bio ones. (homografts are the best for BE prevention) There have been numerous discussions and different Countries go by different guidelines but many follow the AHA recs. Or are close to their guidelines.
I don't know if Canada's Guidelines are the same as the American Heart Associations, But if so, even when they changed the guidelines and stopped recomending prophylaxis antibiotics for MOST of the people who were supposed to get them before the change, a small group of people STILL were recomended to continue getting them.
The previous list was all people who were at an increased risk of getting BE, now it is jusT recomended for the groups who IF they got BE could have the worst outcomes. you can read the full guidelines online but this link is to the Wallet card and gives the basic list that is still supposed to pre medicate (again this is the US, I don't know who makes the Canadian rules)
http://www.americanheart.org/presenter.jhtml?identifier=11086
You received this wallet card because you are at increased risk for developing adverse outcomes from infective endocarditis, also known as bacterial endocarditis (BE). The guidelines for prevention of BE shown in this card are substantially different from previously published guidelines. This card replaces the previous card that was based on guidelines published in 1997......
..The current practice of giving patients antibiotics prior to a dental procedure is no longer recommended EXCEPT for patients with the highest risk of adverse outcomes resulting from BE (see below on this card). The committee cannot exclude the possibility that an exceedingly small number of cases, if any, of BE may be prevented by antibiotic prophylaxis prior to a dental procedure. If such benefit from prophylaxis exists, it should be reserved ONLY for those patients listed below. The Committee recognizes the importance of good oral and dental health and regular visits to the dentist for patients at risk of BE....

.....Changes in these guidelines do not change the fact that your cardiac condition puts you at increased risk for developing endocarditis. If you develop signs or symptoms of endocarditis – such as unexplained fever – see your doctor right away. If blood cultures are necessary (to determine if endocarditis is present), it is important for your doctor to obtain these cultures and other relevant tests BEFORE antibiotics are started.

Antibiotic prophylaxis with dental procedures is recommended only for patients with cardiac conditions associated with the highest risk of adverse outcomes from endocarditis, including:

Prosthetic cardiac valve
Previous endocarditis
Congenital heart disease only in the following categories:
–Unrepaired cyanotic congenital heart disease, including those with palliative shunts and conduits

–Completely repaired congenital heart disease with prosthetic material or device, whether placed by surgery or catheter intervention, during the first six months after the procedure*

–Repaired congenital heart disease with residual defects at the site or adjacent to the site of a prosthetic patch or prosthetic device (which inhibit endothelialization)

Cardiac transplantation recipients with cardiac valvular disease

Prophylaxis is recommended because endothelialization of prosthetic material occurs within six months after the procedure.......

 

[Lynlw]

OK the Canadian Dental Association guidelines say to follow the American Heart Association's http://www.nsdental.org/media_uploads/pdf/37.pdf
...Patients with cardiac deformities should receive antibiotic prophylaxis according to the current
guidelines of the American Heart Association (see Table 2). Consultation with the patient’s
physician may be required.
Patients with artificial devices in the circulatory system should receive antibiotic prophylaxis
using the current protocols of the American Heart Association. Such patients would include, but
not be limited to, those with heart valve replacement including bioprosthetic and homograft
valves, recent surgical repairs of cardiovascular defects within the past six months, and
indwelling shunts or conduits (such as patients with indwelling central lines or vascular access
catheters, such as Port-a-caths, for cancer chemotherapy, ventriculoarterial or ventriculovenus
shunts for hydrocephalus and arteriovenus shunts for hemodialysis). Consultation with the
patient’s physician may be required...

 

[Shobu]

I have a human valve as my replacement AVR for a BAV, which I received 8 years ago. Now in my mid 30's and it needs to be replaced. Will be having the ON-X valve done, since the human one calcified and went stenotic pretty badly over the last twelve months. Glad I went with the human valve, despite the short lifespan, as I am very active and at that time coumadin therapy wasn't the best idea for me. Did everything they recommended lifestyle-wise while staying active, so am in good shape for the new surgery. Going with mechanical now so a) don't (hopefully) need another OHS for a LOONG time, as well as b) the human valve degenerated fast. Also the fact there are mechanical valves like the ON-X that may be quieter and more forgiving on the INR levels. Maybe even ASA and Plavix therapy in the future! So my limited advice would be to enjoy life with the human valve and not to worry too much if you need a replacement in the future, as the technology is more and more impressive every year. Also, try not to second guess your initial valve selection, as they all have their pros and cons, and you really aren't going to be very limited by any of the options that are out there these days. No matter the valve choice, I am always seeing people with every type of valve surf, swim, scuba, triathlon, marathon, climb Everest etc, these days on the forums. Anyway, just my 2c.

 

[ottagal]

OK the Canadian Dental Association guidelines say to follow the American Heart Association's http://www.nsdental.org/media_uploads/pdf/37.pdf
...Patients with cardiac deformities should receive antibiotic prophylaxis according to the current
guidelines of the American Heart Association (see Table 2). Consultation with the patient’s
physician may be required.
Patients with artificial devices in the circulatory system should receive antibiotic prophylaxis
using the current protocols of the American Heart Association. Such patients would include, but
not be limited to, those with heart valve replacement including bioprosthetic and homograft
valves, recent surgical repairs of cardiovascular defects within the past six months, and
indwelling shunts or conduits (such as patients with indwelling central lines or vascular access
catheters, such as Port-a-caths, for cancer chemotherapy, ventriculoarterial or ventriculovenus
shunts for hydrocephalus and arteriovenus shunts for hemodialysis). Consultation with the
patient’s physician may be required...

Lyn,
Thanks for the detailed explanation (and including the guidlines for all cases that still require prophylactic antibiotics). You are bang on! When I typed my response to Gil, I was a little lazy and
failed to mention Antibiotic prophylaxis for ALL artificial valves. Sorry about the oversight.

 

[ks1490]

My surgeon said there's nothing I could do to extend it's life, other than to live a healthy lifestyle which, as someone mentioned before, will also help recovery at the time of a future surgery. He said that the valves are tested on machines simulating multiple years at high heart rates so excercising and getting the heart rate up is not going to even touch what these valves are tested at.

 

[Fiddler's Green]

When I was initially deciding which valve I wanted, I asked the surgeon this question. My surgeon, Dr. Lamelas, is involved in cutting edge work and he said there was some preliminary results that suggested that statins might help with the lifespan of the valve.

I replied that my cholesterol levels were perfect and he said that the statins would probably not help me then.

I really don't think anyone has a definitive answer to your question though.