Does pre-emptive surgery make any sense ?

[dick0236]

I am not looking for advice but only your thoughts as to whether or not a "thought" that has occured to me makes any sense.

In 1967, at age 31, I had my aortic valve replaced because the docs told me I would not live to be 40 and had a high risk of sudden death without corrective surgery. One of their selling points was that the replacement valve had a desigh life of 50 years. At that time Life Expectancy was 73 so a 50 year valve life would take me to 81, well beyond normal life expectancy.

Like many of you I wondered if I would make age 40, then 50, then 60, then 70. We all know that those thoughts are common amoung us. In hindsite, those worries were a "total waste of time". In a few months I will be 73 (my 1967 Life Expectancy) and the valve is now 41 years old (nine years under its design life). The valve continues to operate properly and if my math is correct, it has gone thru 1,300,000,000 cycles. My doctors are all amazed that I have gone this long on that valve. My PCP, during my annual checkup last week told me the valve MAY operate beyond age 81 since it has not shown signs of failing.

Now my question . Any intelligent person would accept that my valve will not last indefinately. While I am not particularly concerned about another OHS, I do not relish the idea of going thru the rigors of surgery at an age of 80 or beyond. I have begun to think about have the valve replaced before ???

My reasons are:
1. The current valve is functioning properly (as far as I know) and surgery could be planned, rather than done on an emergency basis.
2. I am currently healthy and physically fit.
3. I am a young 72 and active.
4. There now is a high likleyhood that I will outlive this valve.
5. The new generation of valves have a lot of advantages over this old valve.
6. A new valve implanted now would almost certainly last the duration.

This is "new ground I'm plowing". While it has occured to me that I might need a reop if the valve failed, it has never occured to me to have the surgery before the valve failed. Am I NUTS

Sorry this is so long. I personally don't like to read posts this long, but.....

 

[Bina]

Your post surprises me and gets me thinking.....but I always thought that you were going for the world record with your current valve!!

 

[Superbob]

Wow, Dick, that is amazing -- and inspiring!

I guess my personal philosophy tends to be, "If it ain't broke, don't fix it."

However, I see your point about a pre-emptive replacement with a new-generation valve. I wouldn't presume to advise you. But you've given us some great food for thought.

I wish you well as you think this through.

 

[cp172]

What an inspiration you are. My thoughts are to stay the course until you have reason to make a decision. I Ditto SuperBobs thoughts.

And I think you deserve to write as long a post as you want.

 

[dick0236]

Bina......That's one record I will certainly forego

Oaktree....I did talk to Dr. Starr via Email about a year ago. He told me there are quite a few old "ball-in-cage" still in use. A number of the Starr-Edwards valvers are here on VR.com. A few months ago, I spoke by phone with Dr. Richard Wood, Chief of Cardio Surgery at Baylor Univ (he did my surgery as a chief resident at UofK). He was not surprised that I was still around, but having the same valve did surprise him. I got his name when I asked for some old hospital records that I needed to get a Valve ID Card. I think I made his day !

I am a long way from ANY decisions but I do appreciate the input of my "peers".

 

[dick0236]

Oaktree, No, I didn't ask Dr. Starr to address any questions regarding valve life. I contacted Edwards a few months ago when I applied for a Valve ID wallet card. Apparently, the valve I have never had the model or serial number recorded by the hospital, surgeon or Edwards. Therefore, while Edwards has been very helpful and did provide me an ID card, they are not entirely sure what I have.

As I said, I am a long way from making any kind of decision. I have had a bad habit of "jumping the gun" over my career.....but this AIN'T GONNA BE ONE OF THOSE TIMES.

 

[CThrock]

I think your right we all think about the same thing with our valves.
But, wow your story is amazing!! Do you know of any other people that have had there valves that long? You would be a great interview on a medical show.
Man what ever your doing keep up the good work.
I would'nt worry about it to much unless a problem comes up.

 

[Dina]

This IS a difficult one as there are so many ways to look at this with
all the 'ifs' and 'buts' that it entails. You could look at this as an older
technology, but then again if you compare some of the workmanship of
machines done in the 60's in comparison with today's, I am sometimes
ashamed. The 'skillmanship' of today( not the technology) goes in want
when we compare it to the past -at times.Also ,like S.B said "If its not
broke..."
Since I have a tissue valve ,I am not too sure of procedure; you said that
the valve was functioning well and gone beyond expectation --is there any
more definitive way to diagnose the valve itself, to test its likelihood of
an even longer life? I know that most cardios go by the patient's symptoms,
but is there another way to test mechanical valves?
As I am a high anxiety worrier, I can see how this has you thinking .
Just don't do a "Dina" and think of nothing else-since you seem healthier
than me and I'm not even 43 yet

My best to you as a native Louisvillian

 

[Leah]

Your track record is awesome and inspiring! Thank you for being here and posting.

I have no expertise or ability to make recommendations (and that's not what you were asking for anyway) but have a couple of thoughts:

1. Even though you now have an old valve, it's working well. You know that for a fact. How does the risk of this valve's failing weigh against the reality that any surgery and any new valve could potentially generate its own problems?

2. You are interested in avoiding emergency surgery and the loss of choice that go along with that. Can you get a better idea how this valve would be likely to fail if it fails? I have asked more than one doctor this question about the current tissue valves (I realize yours is mechanical) and have been told that they would not be likely to fail suddenly and that the progression (or decline) would be watched the way my native valve is being watched now. Is it the same way with mechanical valves? It would make a big difference to know that.

Good luck as you reflect on this! (Sorry, you just said you don't like long posts!)
Leah

 

[ALCapshaw2]

That's an interesting dilema you have Dick !

I think I would compile a list of Questions for Dr. Starr and whoever manufactured your valve.

1 - What is the longest time a Starr-Edwards valve has continued to perform in a patient? (it may be YOU)
Or in a controlled test environment?

2 - What Failure Mechanisms have they seen?
At how many cycles of operation were these failures observed?

Then I suggest you ask your Cardiologist about performing a 'baseline' TEE which gives a better view of the valve, especially looking for possible mechanical defects in the valve (especially the struts).

Also look for 'cracks' in the Ball. I remember seeing a picture of a failed Ball in Cage Valve a LONG time ago on VR.com where there was a long open crack in the Ball, causing Clots to be formed, which lead to it's replacement.

I'm inclined to agree with the others,
"If it ain't broke, don't fix it."

BUT, I would also want to have regular TEE's to examine the valve for signs of deterioration.

'AL Capshaw'

 

[Donald]

Hi Dick,

I'm a little late coming into this thread, but wanted you to know that you are not alone with regard to how you felt about how long you would live, in those early years. Dr. Starr installed my valve in 1981! As time went on I finally accepted the fact that I could live a long life. I'm glad you took the time to share your life experiences for anyone that recently had surgery, and doubts their future.

-Don

 

[Duff Man]

Another axiom might be "don't trouble trouble until trouble troubles you."

 

[ponygirlmom]

I agree with, I think, everyone. Keep your old valve as long as you can.

 

[Jkm7]

Very thought provoking.

A few practical questions come to mind. I wonder if a surgeon would agree to do it and would insurance pay?

 

[skeptic49]

Wow, Dick...I've been thinking about your dilemma. I guess if you were a scientist you could use all kinds of sophisticated formulas and do numbers crunching (regression analysis?) to try to figure out the odds of everything - your new longer life expectancy, the valves's LE, how long will you remain healthy enough to have the surgery if you wait, etc. Where's the tipping point? It's another one of those pesky deals where there might be no wrong strategy or answer, but several good ones. The age old adages come to mind - "Dont fix it..." and "at least do no harm."

Jim

 

[Ross]

I say use the old adage, "Don't fix it if it ain't broke."

If we had crystal balls and could see into what the next surgery holds for us, then maybe, but I can't see placing your life on the line preemptively.

 

[Alistair]

Hello Dick,

First, let me just say that you are by far the most inspirational member here at VR.COM. You ARE the light at the end of the tunnel for many of us new to this scenario of Valve Replacement (esp. Mechanical).

You seeking advice from us is kind of like Dr. Starr looking to an Intern for advice. Yet, new perspective can be enlightening; I suppose.

I have lived life thus far with the previous mentioned philosophy of "if it ain't broke, don't fix it". At 17, I was told a replacement would be necessary by age 30, yet I never had symptoms and ran from any Cardiologist who was ready to cut me. This year (at age 46); I began to have subtle symptoms to which I quickly responded.

What is the lifespan of a human valve? Only God knows these things with absolution, the rest of us including Doctors are exempt of such knowledge.

One responder wrote of past 'craftsmanship' vs. today's mass produced junk. I would certainly agree with that. I prefer antiques over today's "stuff" any day, not that I'm referring to you as an Antique, mind you.

The questions you ponder have validity; the answer? I'm sure you will make the right decision for you. Advancements in Medicine change and improve almost daily.

Best regards and I thank you with my "new" St. Jude heart valve for being such an inspirational pioneer.

-Alistair

 

[sue943]

If it were me, and I know that it isn't, then I would just leave it be.

Saying that it should last fifty years was probably vague even then, it could be forty, could be sixty, could be twenty or less if it had a fault. Since many people seem to have a re-operation way before the fifty years then I wouldn't even give any credence to fifty, it might well have been a figure plucked from the air. It were today they would probably just have said it would outlast you without giving a number of years. You seem to have a good one, and as others have said, if it ain't broke don't fix it.

What would concern me greatly is that even being as fit as you are, and relatively young, an operation to replace this working valve could actually kill you thus shortening your life to under the fifty years post replacement.

 

[Cooker]

Dick ? Thanks for the post. Thought provoking to say the least ? I will not presume to give advice but I will say that I understand your thought process here ? Another thing to consider is that ?all? has advanced leaps and bounds since your surgery ? Not only have the valves changed and improved but the techniques, equipment, drugs etc? I don?t know if that would cause me to pull the trigger but it was just a though. ? Tom

 

[marie]

Wow what a great thought process. I'm less than seven months post op so it's hard for me to imagine going through it again. So for me if nothing is wrong with it then I'd leave it alone.

Thanks for sharing your thoughts.