Durability of tissue valves in younger patients

[alan_delac]

Hi,

I have seen my cardiac surgeon yesterday. I'm not going for an operation yet but we discussed various valve types that would be suitable for me (43 years, bicuspid aortic valve, 38mm aorta). I'm more inclined toward tissue valves at present.
He didn't seem to be too interested in bovine pericardial valve and was bit sceptical of the available data (statistics can be presented in various ways and so on). He mentioned Freestyle Medtronic as a possibly good option as it comes with the aortic root replacement and my root may need to be replaced sooner or later although it has been stable for at least 15 years.
I have searched Internet for data on durability of the latest generation tissue valves in younger patients but couldn't find much. The Freestyle Medtronic valve has been in use since 1992 so 10-12 year performance should be available.
Would anyone know bit more about durability of the best available tissue valves in younger patients - say <55 years group? Any info or links would be appreciated.
Another question is if you had any idea why would some surgeons avoid bovine pericardial valves? Difficult to handle? Is there some controversy?

Regards

Alan

 

[Bryan B]

I don't have any statistics or links, but generally the younger you are the less durable the tissue valve is. You are at the same age as me and depending on how active you are I would consider you borderline. I got a Ross Procedure because durability and age didn't seem to be a factor, but my backup plan was a pericardial bovine valve.

 

[Kevin M]

I've never heard anything but positive things about the bovine valves on this site. There has been a ton of discussion on this matter in the past. Do a couple of searches and I think you will find enough reading material to keep you going for a long while.

There isn't much long term data on any of the stentless porcine valves, of which the Medtronic Freestyle belongs. Some doc's believe they'll last a very long time - others don't like them. Same thing goes for the Ross procedure. There are a lot of medical journals that suggest it should not be used in mid-life adults and a lot that suggest it should.

I've never heard or read anything negative about the Carpentier Pericardial Bovine valve in the context of someone your age, although admitedly, I haven't read any of the medical journal stuff on the net in a couple of years.

The one thing that is proven and almost certain is that a typical stented porcine valve of old, will certainly be burned out in 5-10 years in younger individuals such as yourself.

It seems that each surgeon has their favourite and they tend to push that direction. You have to be comfortable that you are getting a product/procedure that you are comfortable with - that is all that really matters.

In my opinion, I wouldn't trust anyone that says any tissue valve replacement in someone your age will last more than 15 years. There just isn't anything out there that suggests this is true. We are often living guinea pigs.

Back when I needed my first operation, I was assured that my homograft would last 25 years plus. Nowadays, it is a known fact that homografts and 20 year olds do not mix. They tend to be used up within 12 years or less.

Do some searches using various valve types as keywords. There are a lot of studies out there that are published and can be accessed by the public. It is true that studies can be confusing because of their seemingly contridictory methodologies and results, but I've found them to be a good resource for learning about the generalities of each valve type. It also educates you just enough to figure out what questions you should be asking your surgeon. The more you talk to them, the more comfortable you should ultimately be with your final choice.

Some of us are never entirely sure if we made the right choice for us or not. I'm not entirely sure. I often second guess my decision. Others are totally confident that they made a choice that is the right one for them.

Ultimately, if you go with a tissue valve, you should expect to have a second replacement procedure between 53 and 60 years of age. If what they say about the bovine and stentless valves is true - then maybe we'll do better than that, but personally, I am skeptical based on my highly biased personal experience.

If you went with a mechanical valve, your odds of requiring a second valve replacement would be quite low, however, your odds of having some form of thrombotic episode will be about 1% per year.

There are no easy answers with this stuff, but please take comfort in knowing that you will return to a very normal, active and satisfying lifestyle no matter which procedure you end up with.

I know there will be many others that will offer their opinions shortly because this is always a hot topic.

Keep well and keep asking questions.
Kev

 

[Tom F.]

From what I have read tissue valves do burn out quicker the younger you are. At your age perhaps you should at least look into a Ross Procedure. Your doc may not be able to perform this surgery, so you may need to find another surgeon. I am also a little concerned that you may be looking at an aortic root replacement at another time, and its not being done now. I would want to know why the aorta is not being done at the same time of the valve surgery.

 

[spillo]

Hello,
I am 48 and packing tonight to head for Cleveland and get a Edwards Perimount Bovine Pericardial aortic valve job.
The younger you are the shorter they last because of calcification and lifestyle. Just like anything, the more you use it the quicker it will break. If the heart pumps faster, as would the valves, because your swimming and unning alot the valve would be expected to last less than a couch Potato
( does potato have an e ? ) who is otherwise healthy. And the younger the more calcium deposits.
The nurse for Dr. Cosgrove at Cleve. Clinic said these valves are treated with zenologic to lesson calcification. I don't know what zenologic. There is a new valve by edwards (www.edwards.com) that is 98% free from places calcium can deposit ( I think this % is right ).
I was told that being on coumadin for 15 yrs run the same risk as OHS. The second OHS has the same risks as 30 yrs. of coumadin. If I can get 12 or 15 out of the first valve I will only need one more. I'm betting the one in 12 yrs will last the rest of my life for the above reasons and simple progress in medicine.
Many people will not agree with my decision "asking for a second OHS" but all have repected it. Thats what is best on this site, besides the info. and caring.
I also think you should have the aorta and valve done at the same time. Many doctors don't like the ross procedure because you are replacing a bad valve with another one plus your doing another valve procedure to fix the procedure you just did. Alot of work for one valve.
Either way, the best to you. Look up the edwards web site and CCF.org
spillo

 

[Bryan B]

If you are going to need an aortic root replacement, The Ross Procedure then becomes a viable alternative again. They would remove your pulmonary valve and root and replace your old aortic valve and root with it. Then they would replace your pulmonary valve and root with a homograft (donor) pulmonary valve and root.

Have we thouroughly confused you yet?

Before making any decisions on a valve talk it over more with your surgeon and find out exactly what they are planning to do while they are in there. And many surgeons have their specialty, so one surgeon may prefer a mechanical while another may prefer a tissue. Very few surgeons do the Ross Procedure, so if you decide that is the best option for you, you will probably have to search for one that is well known for performing that procedure. It is more technically difficult and takes longer to do.

 

[RCB]

Spillo- can you help me with stat

Spillo- can you help me with stat

Next time someone quotes you a stat. on warfarin for 15 years same risk as OHS......etc., can you please ask for a source?
I plan to have the same talk with my cardiologist and I want to be able to name a study. My search of the internet
didn't help, but you know how that goes sometimes.
thanks

 

[Bryan B]

RCB,

I found a site talking about the Ross Procedure that quoted that patients on Coumadin for mechanical valves had a 2% per patient year higher risk of embolism and a 2% per patient year higher risk for serious bleeding event, but finding the link may be difficult. When I get some time I'll see if I can dig it up.

 

[spillo]

RCB,
My wife and I both worked at the Cleve. Clinic from 1980 to 1990. They have a great library. I have spent a million hrs. there. I will ask her ( or maybe I can walk over there myself ) to look up stats like this and whatever else she/we can find. You used to be able to make copies for free. I will try to copy, scan and post some articles when I get back. My surgery there is 4/14 or so. Spillo

 

[RCB]

Spillo-Thanks

Spillo-Thanks

I will be looking forward to the information.
Take care.

 

[Turkey Hunter]

Spillo,,

You may want to talk to yet another cardio or surgeon at CCF. There are more options. But, if YOU are compfortable with your choice........go for it !!

Dr. Grimm is a fantastic cardiologist and Dr. Pettersen is fantastic at any procedure put in front of him.....even with my Ross.

Petersen "perfected" his skills on children in Europe. My thoughts were if he can operate on an infants heart........then mine should be easy.

Obviously I am bias.....he is the reason I am here, as far as I am concerned. !!

Ben

 

[Bryan B]

Ben,

Just curious, how long is your scar? I had a pediatric surgeon for my Ross Procedure and it's barely 6" long. I didn't think about the benefit of my surgeon being accustomed to working in small spaces and I might get a smaller scar out of the deal.

 

[johnbelloh]

surgeon

surgeon

Spillo

I agree with Ben. Dr. Pettersson replaced my aortic valve with a homograft along with my aortic root. This is a technically difficult procedure and requires a highly skilled surgeon with much experience for a good outcome. In addition I was a re-do which adds to the complexity. The other reason I chose him as my surgeaon is because he has the most success at the Clinic with the Ross Procedure which is the most demanding of all valve surgeries.

I am completely satisfied with my outcome and feel like a new person. The valve is working perfectly with no leaks and a presure gradient of 5mm HG.

I take no meds other than an 81mg aspirin and now have a resting heart rate in the low 50s. I am now running 3 days a week and completed a 1/2 marathon last Sunday.

John

 

[Turkey Hunter]

Bryan,

My scar is every bit of 13 to 14 inches long, and very ugly. I had an allergic reaction to the 'dissolvable" stitches. Which by the way are still not completely dissolved and a knot works its way out once in a while.

Ben

 

[RCB]

All CC alumni

All CC alumni

Drs. Pettersson(remember two ts and two ss-very Swedish)and Grimm are on my team too. Could you all send me a PM with your name and procedure, so I can mention your name. I did that with Xalg and Dr. Grimm only smiled came when I mentioned his Xalg real name- he is a very serious man.
I think my fourth redo, double valve, Maze and
bypasses will challenges them. I hope not too much!

 

[Granbonny]

Bob

Bob

I did not realize you were going to have that much surgery done..When will you know your date?...Bonnie

 

[RCB]

Date?

Date?

Dr. Grimm said he didn't want to wait any longer than two
month. He said he would meet with the other drs. and
try to do it mid-May. He said he would call in two weeks-
that was about three weeks ago. I will give him a call this
week. Hope they are not getting cold feet because my creatine was 2.6 last it was checked.

 

[Turkey Hunter]

Rcb

Rcb

Two points,
One......I sent you a PM.

Two........ Dr. Grim also made me wait longer than the time frame he told me I would get a call. It was Hell, but I now trust Him completely. He is fantastic !

I can't say enough about my respect and admiration for him. Trust him....yet still question him. He likes answering those questions. He wants a patient that is educated !!

Ben

 

[Granbonny]

Bob

Bob

My dumb..but what is a Creatine? First time I've heard it. Bonnie

 

[Bryan B]

Bonnie,

Here are some definitions of creatine:

http://www.google.com/search?q=define:creatine+(Cr)

Ben,

I'm wondering if your scar is longer because you had the aneurysm. I was expecting an 8-10" scar. Sorry to hear about your problem with the stitches. Everything on mine look good except I got the little hump going at the top.