Does an active lifestyle decrease the longevity of a bovine aortic valve?

[rosalia]

Hi all,

I am wondering if anyone knows where to find the answer to this question, if, indeed, there even is one. Does a more active lifestyle decrease the longevity of an aortic tissue valve? I am not an elite athlete by any means, but do like to jog, walk, and go to the gym. I work full time, but it's an office job, and do the usual household stuff. I was 51 when I had my aortic valve replaced, and feel great.

I don't know where I heard this, but it has stuck in my mind. I am not asking the correct question on Google, or I would have found it! Thanks in advance, as I know if there is an answer, someone on this forum will know it.

Have a great day all

 

[Kelly2632]

Rosalia, I don't have a specific Google answer for you. But, have you asked your doctor what your exercise limits are? You and I are about the same age (I'm 54), and I had my AVR on 05/26/17 with the exact same valve as you received - only I received the 23mm model!

I found it incredibly frustrating right after my surgery to even get my doctors to tell me what my allowable max heart rate should be while exercising (I was taking Metoprolol at the time). I do not jog, thanks to a bad knee. Basically, the only clear answer I COULD get from my doctor is that he wanted me to walk at least 5,000 steps each day. The healthier the circulatory system - the easier the heart beats, right?

 

[Duffey]

Hi all,

I am wondering if anyone knows where to find the answer to this question, if, indeed, there even is one. Does a more active lifestyle decrease the longevity of an aortic tissue valve? I am not an elite athlete by any means, but do like to jog, walk, and go to the gym. I work full time, but it's an office job, and do the usual household stuff. I was 51 when I had my aortic valve replaced, and feel great.

I don't know where I heard this, but it has stuck in my mind. I am not asking the correct question on Google, or I would have found it! Thanks in advance, as I know if there is an answer, someone on this forum will know it.

Have a great day all

I wonder if you’re confusing “active lifestyle “ with a higher metabolic rate? A higher metabolic rate is associated with younger age, and age is a determining factor in the number of years a tissue valve is expected to last. I had a bovine valve implanted when I was 52. I have always led an active lifestyle, swimming a mile each day, five days a week, and fourteen years later my valve is still working fine. I no longer swim, but I do ride a stationary bike for 40-45 minutes a day.

 

[JTTwo]

Rosalia,

There are lots of posts about this in previous years. Unfortunately there isn't a definitive answer since there are so many variables. Doctors have different opinions about this as you can imagine.

I'm a very active road and mountain biker 7 years post op with a Medtronics Freestyle Valve, 29 mm
After a lot of careful research, I settled on a reasonable amount of caution with intensity and duration. Basically, I try to keep my HR below 160 as my self imposed "redline", because I have a valve and a connective tissue disorder (trying to keep my blood pressure reasonably low). I do several 65 to 100 mile bike rides a year, along with riding 3-4 days a week.

I think Duffey has it right above and it's great to see people still living how they want to. My advice is similar: stay active, do what you love, be reasonable and don't overdo it.

 

[ottagal]

I echo Duffey and JTTwo's comments. I haven't found a study (yet) that proves that more exercise accelerates tissue valve degeneration. However, I was told the younger the person, the higher the metabolism etc. and possibly that is a contributing factor to tissue valves not lasting as long. However, a friend (who smokes) was told that smoking can contribute to valve degeneration. I exercise regularly i.e. cardio class, bike, yoga, strength classes etc. I figure moderation is the key for me.

 

[pellicle]

Does a more active lifestyle decrease the longevity of an aortic tissue valve? I am not an elite athlete by any means, but do like to jog, walk, and go to the gym. I work full time, but it's an office job, and do the usual household stuff. I was 51 when I had my aortic valve replaced, and feel great.

as mentioned its not been (to my knowledge) demonstrated in a proper study, however anecdotally I seem to see a lot more of that Structural Valve Degradation (SVD) in the more active, which tend to be the younger (the highly active semi sporting over 60's we have here have mechanical valves and the younger ones have faced SVD earlier than 10 years).

Dr Schaff has his views on this in his video presentation. I suggest its worth your time.

 

[Gordo60]

I think I saw that when younger it’s not only higher metabolic rate but also a more active immune system that can cause faster degeneration of tissue valves compared to older valve recipients.

 

[pellicle]

I think I saw that when younger it’s not only higher metabolic rate but also a more active immune system that can cause faster degeneration of tissue valves compared to older valve recipients.

I seem to recall similarly ... although one does wonder if the activity of other metabolisms (like : Increased blood plasma activity of Lp‐PLA2 is associated with higher prevalence of SVD … contributes to the failure of these valve substitutes...) is related to activity or not. Each of these silos of medical knowledge seems to cease at their own interest boundaries.

As (written elsewhere) us valvers who are under 60 are in such a minority as to barely warrant proper study. (not that valvers in general warrant any more study than "did surgery kill you" or "what is the issues at 10 years" ... ) when someone like me had their 2nd surgery 27 years ago.

 

[Gordo60]

Dr Schaff has his views on this in his video presentation. I suggest its worth your time.

Interesting video thanks.

That was around 10 years ago. I wonder what Dr Schaff’s views would be now a decade later?

During recent research I came across a number of question and answer sessions etc with some prominent surgeons who said that if they were around 60 now and needed a valve they would choose tissue. Of course that was only a small sample and provides no evidence of what the majority of surgeons would choose.

 

[pellicle]

That was around 10 years ago. I wonder what Dr Schaff’s views would be now a decade later?

reasonably unchanged I think based on this:
https://www.ahajournals.org/doi/full/10.1161/CIRCULATIONAHA.113.002584

Rakesh M. Suri, MD, DPhil; Hartzell V. Schaff, MD

We have several comments in response to the manuscript by Kaneko et al. The authors contend that survival is equivalent after mechanical versus biological aortic valve replacement (AVR) in nonelderly patients. The weight of available evidence does not support this conclusion. The large retrospective series described in our review, along with contemporary reports from Weber, Badhwar, and Brown, reproducibly suggest a risk-adjusted survival advantage associated with mechanical AVR. Second, Badhwar and colleagues recently documented the very low risk of bleeding complications (0%) and, perhaps consequently, a survival benefit conferred as early as 7.5 years after mechanical AVR using carefully managed anticoagulation and home monitoring (target international normalized ratio 2.0). Third, separate studies by Vicchio and de Vincentiis have both demonstrated equivalent and excellent quality of life outcomes regardless of prosthesis choice and anticoagulant use. Fourth, the cumulative physiological burden of senescent biological devices is rarely discussed. Microcalculi associated with bioprosthetic structural deterioration presumably expose patients to embolism risk before reoperation while progressive hemodynamic obstruction causes persistent left ventricular hypertrophy and diastolic dysfunction. Finally, although valve-in-valve therapies to treat bioprosthetic valve failure have been shown to be life-saving options in very high-risk patients, offering such a strategy to younger patients who may in fact continue to be standard surgical risk candidates when reoperation is required, is not supported by currently available evidence. Full individualized discussion of the risks, benefits, and alternatives of available heart valves substitutes, including a balanced review of clinical outcome data, empowers patients to make responsible decisions and is an important ethical responsibility of the surgeon.

after all ... not much has really changed

Of course that was only a small sample and provides no evidence of what the majority of surgeons would choose.

or what in the actual face of the decision they would do. I have observed many times in my life people say "I'd never ... if I had to ---", but observed when they were actually faced with it they chose differently to their assurances.

 

[Gordo60]

reasonably unchanged I think based on this:
https://www.ahajournals.org/doi/full/10.1161/CIRCULATIONAHA.113.002584

Rakesh M. Suri, MD, DPhil; Hartzell V. Schaff, MD

We have several comments in response to the manuscript by Kaneko et al. The authors contend that survival is equivalent after mechanical versus biological aortic valve replacement (AVR) in nonelderly patients. The weight of available evidence does not support this conclusion. The large retrospective series described in our review, along with contemporary reports from Weber, Badhwar, and Brown, reproducibly suggest a risk-adjusted survival advantage associated with mechanical AVR. Second, Badhwar and colleagues recently documented the very low risk of bleeding complications (0%) and, perhaps consequently, a survival benefit conferred as early as 7.5 years after mechanical AVR using carefully managed anticoagulation and home monitoring (target international normalized ratio 2.0). Third, separate studies by Vicchio and de Vincentiis have both demonstrated equivalent and excellent quality of life outcomes regardless of prosthesis choice and anticoagulant use. Fourth, the cumulative physiological burden of senescent biological devices is rarely discussed. Microcalculi associated with bioprosthetic structural deterioration presumably expose patients to embolism risk before reoperation while progressive hemodynamic obstruction causes persistent left ventricular hypertrophy and diastolic dysfunction. Finally, although valve-in-valve therapies to treat bioprosthetic valve failure have been shown to be life-saving options in very high-risk patients, offering such a strategy to younger patients who may in fact continue to be standard surgical risk candidates when reoperation is required, is not supported by currently available evidence. Full individualized discussion of the risks, benefits, and alternatives of available heart valves substitutes, including a balanced review of clinical outcome data, empowers patients to make responsible decisions and is an important ethical responsibility of the surgeon.

after all ... not much has really changed

Talk about coincidence. Literally just finished reading that.. That publication was back in 2013 so still a little dated.

There’s been so many recent advances in this area but the trouble is the long term data isn’t there yet to validate the expectations.

Unfortunately for me around age 60 is still very much a grey area based on existing longer term data.

 

[pellicle]

Unfortunately for me around age 60 is still very much a grey area based on existing longer term data.

agreed ... and if your surgery is not slated yet then there is still plenty of time to:

• gather data
• observe the landscape for improvements

Ultimately if this is your first OHS surgery then its a complex thing or a simple thing. Heaps of analysis of associated issues or flip a coin.

Best Wishes

 

[Gordo60]

Another interesting study with a large sample size:
https://medicalxpress.com/news/2017-11-mechanical-heart-valve-safest-choice.html

To compare the long-term risks and benefits of mechanical versus biological heart valves, researchers examined rates of mortality, stroke, bleeding and reoperation in patients who underwent heart-valve surgery at 142 hospitals in California between 1996 and 2013. Patient records were obtained from the California Office of Statewide Health Planning and Development databases.

Researchers examined the records of 9,942 patients who underwent aortic-valve replacement and 15,503 patients who underwent mitral-valve replacement during the study period.

"Our research likely contains the largest number of patients ever studied to examine this issue," Woo said.

The study also found that unlike what's recommended in the national guidelines, which say patients ages 50 to 70 undergoing aortic or mitral valve replacement should be given a choice of either a mechanical or biological valve, the best choice in fact can hinge on whether the aortic or mitral valve is being replaced.

The study shows that for patients undergoing mitral valve replacement, a mechanical valve is actually beneficial until the age of 70. On the other hand, for patients undergoing aortic valve replacement, the benefit of implanting mechanical valves ceased after the age of 55.

 

[Savymom]

Not sure about a specific study, but others have already commented on that.

My tissue valve lasted 13 years. I was 25 when it was implanted. During those 13 years I had another baby, ran hundreds of miles and lifted very heavy weights. My tissue valve was ready to be replaced at 13 years but it was not a critical situation and I probably could have waited a little longer if I wanted to become symptomatic.

My dr had always said younger patients will need a new valve sooner due to their own immune response. However, mine lasting 13 years seemed pretty normal, and didn’t seem like it was much faster than most who need repeat surgery’s.

Being active even if it does effect the longevity of the valve is more beneficial than not being active, and all the consequences that come with sedentary lifestyle.

 

[zelic]

as mentioned its not been (to my knowledge) demonstrated in a proper study, however anecdotally I seem to see a lot more of that Structural Valve Degradation (SVD) in the more active, which tend to be the younger (the highly active semi sporting over 60's we have here have mechanical valves and the younger ones have faced SVD earlier than 10 years).

Dr Schaff has his views on this in his video presentation. I suggest its worth your time.

Great review. Dr Schaff did my surgery. Out of the 12 cardiac surgeons I talked to before my surgery ( i was 57 at the time of my procedure 2/18) He was the only one that recommended a mechanical one. I agreed with him at my age. However, with the newer

reasonably unchanged I think based on this:
https://www.ahajournals.org/doi/full/10.1161/CIRCULATIONAHA.113.002584

Rakesh M. Suri, MD, DPhil; Hartzell V. Schaff, MD

We have several comments in response to the manuscript by Kaneko et al. The authors contend that survival is equivalent after mechanical versus biological aortic valve replacement (AVR) in nonelderly patients. The weight of available evidence does not support this conclusion. The large retrospective series described in our review, along with contemporary reports from Weber, Badhwar, and Brown, reproducibly suggest a risk-adjusted survival advantage associated with mechanical AVR. Second, Badhwar and colleagues recently documented the very low risk of bleeding complications (0%) and, perhaps consequently, a survival benefit conferred as early as 7.5 years after mechanical AVR using carefully managed anticoagulation and home monitoring (target international normalized ratio 2.0). Third, separate studies by Vicchio and de Vincentiis have both demonstrated equivalent and excellent quality of life outcomes regardless of prosthesis choice and anticoagulant use. Fourth, the cumulative physiological burden of senescent biological devices is rarely discussed. Microcalculi associated with bioprosthetic structural deterioration presumably expose patients to embolism risk before reoperation while progressive hemodynamic obstruction causes persistent left ventricular hypertrophy and diastolic dysfunction. Finally, although valve-in-valve therapies to treat bioprosthetic valve failure have been shown to be life-saving options in very high-risk patients, offering such a strategy to younger patients who may in fact continue to be standard surgical risk candidates when reoperation is required, is not supported by currently available evidence. Full individualized discussion of the risks, benefits, and alternatives of available heart valves substitutes, including a balanced review of clinical outcome data, empowers patients to make responsible decisions and is an important ethical responsibility of the surgeon.

after all ... not much has really changed



or what in the actual face of the decision they would do. I have observed many times in my life people say "I'd never ... if I had to ---", but observed when they were actually faced with it they chose differently to their assurances.

Good point - In fact Dr Schaff was my surgeon (had AVR 2/18 at age 57) I talked to 12 surgeons across the country all but one suggested I get a tissue valve. Dr Schaff recommened a mechanical one. I agree with his logic unless you have some other medical reasons not to go with a mechanical valve below 60-65 years of age. While improvements such as tissue fixation for longer durability and TAVR are options the jury is still out as the long term data is sparse.

 

[ottagal]

I think I saw that when younger it’s not only higher metabolic rate but also a more active immune system that can cause faster degeneration of tissue valves compared to older valve recipients.

Yes, I forgot that piece. My cardiologist also mentioned about a more active immune system as well. Thanks for the added info.

 

[ottagal]

Not sure about a specific study, but others have already commented on that.

Being active even if it does effect the longevity of the valve is more beneficial than not being active, and all the consequences that come with sedentary lifestyle.

Excellent point!

 

[user 16827]

as mentioned its not been (to my knowledge) demonstrated in a proper study, however anecdotally I seem to see a lot more of that Structural Valve Degradation (SVD) in the more active, which tend to be the younger (the highly active semi sporting over 60's we have here have mechanical valves and the younger ones have faced SVD earlier than 10 years).

Dr Schaff has his views on this in his video presentation. I suggest its worth your time.

Very interesting video

It endorses the idea on weekly testing, those statistics are impressive.

I declare my Bias for mechanical as i chose that but the stats all seem favourable.

I was surprised by the amount of warfarin therapy in the Bio valves if you give it enough time