Exercise and Tissue Valve

[manuel_Scotland]

Hi All,

I have a question for all. But first I´d like to state that I´m not very good with the search option on this Forum so if the question has been asnwered in another thread please point me in the right direction and accept my apologies for bothering you.

I´m a 44 years old healthy individual with an Asc. Aorta Anaurism (5.5 cm) and a fully functional bicuspid aortic valve. I´m scheduled to go under the knife in a month (aprox.). As I´m from Spain (I used to live in Scotland) and the procedure is done by the public health system is difficult to get the exact date. I have taken the decision of going for a Tissue Valve. The reason in my personal case are a history of anxiety and depression that would make really tough for me to get used to the ticking and my job and live stile. I frequentily travel to 3rd world countries for several weeks where access to healthe services may be a challenge.

I´m not posting this to get feedback regarding my decision, although if anybody wants to provide it you are more than welcome . I´m here to ask about exercise and tissue valves. I have seen plenty of information of exercise and mechanical valves. Really inspiting stories of people doing iron-men with it (you guys are amazing!), but not so much about the tissue ones. Can any of you share some light about it? How does it feel once everything is healed to run with a tissue valve. Also, is is true that their durantion depends on how much you use it (how much exercise) or that is a fase myth?

Massive thank you in advanced for your time. You are all heroes!

 

[70sdiver]

Well it is almost a given with a tissue valve you’ll have to have another surgery I would look into the inspiris resilia tissue valve. I’m still in cardiac rehab from my surgery but I’m going 3.8 mph on the tread mill for 30 minutes and feel good.

 

[tom in MO]

Your tissue valve should allow you do everything you do now. However, with time it will start to fail and this may degrade your physical performance, but for many it is not very noticeable.

 

[Gail in Ca]

After I got my tissue valve and recovered, I was back to step class on 2 risers.
I felt great as if I had never had surgery.
Of course I was 34 at the time.
It failed in 11 years. But I felt really good for those 11 years.

 

[manuel_Scotland]

After I got my tissue valve and recovered, I was back to step class on 2 risers.
I felt great as if I had never had surgery.
Of course I was 34 at the time.
It failed in 11 years. But I felt really good for those 11 years.

Thank you much for your feedback, it really gives me hope and a light at the end of the tunnel I’m about to enter. May I ask you a question, I assume you had the first tissue valve replaced already at 45, did you go for another tissue or mechanical this time?

Thanks!

 

[Gail in Ca]

I got a carbomedic mechanical aortic valve for 2nd surgery.

 

[pellicle]

Well it is almost a given with a tissue valve you’ll have to have another surgery

or two ...
my most fervent advice is "do not set yourself up for multiple surgeries"

run, do not walk out of any office where they tell you "its no problem"

 

[Gail in Ca]

I would say that in my case, I was very fit before and after my surgery. My surgeon said he’d seen my valve last 15 years so I thought for sure I’d get at least that! I exercised at the gym , walked my husky 2-3 miles 5 days a week, ate healthy, played music, was happily married with a 2 year old sweet, smart daughter.
BUT, I only got 11 years and apparently that was considered good. I was very disappointed because those 11 years went by very fast. I had issues before my subsequent 2nd & 3rd surgeries, so all was not wine and roses for repeat surgeries. Just fyi.

 

[pellicle]

because those 11 years went by very fast. I had issues before my subsequent 2nd & 3rd surgeries

I find it perplexing as to why so many are so unable to see out past 10 years as if it's some sort of statistically unlikely event.

I say again to younger members, don't plan for making future surgery a certainty.

 

[Mike1959]

I find it perplexing as to why so many are so unable to see out past 10 years as if it's some sort of statistically unlikely event.

I say again to younger members, don't plan for making future surgery a certainty.

 

[Mike1959]

Hey pellicle

I see you are still blind sided and being overly biased again - in favour of mechanical which isn't a fair representation

Surely a person of your supposed education can see that both types of valves offer different solutions for different diagnoses

I have always said both types of valve tissue v mechanical are excellent options versus the alternative of not having surgery

My offer of a one to one conversation to discuss is always open to you.

In the meantime I wish you and your family a very happy Christmas and holiday season

Best
Mike

 

[dornole]

I think pellicle is "biased toward mechanical" due to the scars all over him and his lived trauma of multiple OHS, without the choice of avoiding it. You also posted this:

"I´m not posting this to get feedback regarding my decision, although if anybody wants to provide it you are more than welcome ."

If you are confident tissue is that best for you, then get tissue! And don't explicitly invite feedback on your valve choice when you don't want it. To demand that everyone on a forum present "unbiased" views divorced from their own experiences isn't realistic or reasonable.

 

[pellicle]

Hi

I think pellicle is "biased toward mechanical" due to the scars all over him and his lived trauma of multiple OHS, without the choice of avoiding it.

I'm not sure that I am biased towards mechanical as I most certainly have and do suggest tissue valve is a good option in a many cases. I usually will suggest the resilia these days if the person is over 65 and amenable to TAVR for later work. I'll also always caution that you must be amenable to and keen on managing INR if you do choose a mechanical.

So just boxing me into "biased" is a simplification.

As to scar tissue, I'm almost never talking about what's on the surface and mainly talking about what's underneath (the stuff that's critical not just visible at the beach in a swimsuit). This is perhaps missed by many who may not understand what the significance of this is for a surgeon and for a redo. Few people have any experience in "preparing" an animal for food anymore and so have little to no idea (or worse, totally wrong ideas) about what scar tissue looks like in and around the organs.

Scar tissue in and around the heart forms a binding clag which makes it impossible to simply lift something aside and look. It forces surgeons to do much more imaging before the surgery and to know where things are which are now obscured by scar tissue.

https://www.bouldercentre.com/news/surgical-scar-tissue-less-talked-about-side-effect
also alluded to here:
https://www.sciencedirect.com/science/article/pii/S1522294215000252

In addition to the typical challenges of redo sternotomy, special attention must be paid to the bypass grafts, especially internal mammary grafts as they are not controlled by aortic cross-clamping and serve to decrease long-term mortality. Fortunately, with modern imaging techniques, it is possible to minimize the risk of injury and subsequent complications before entering the operating room.​

This is why redo surgery is regarded as more difficult. All of this is common knowledge to the actual experts (surgeons) but seems entirely absent from most discussions from most patients.

Surgically this is often referred to as adhesions

https://www.tandfonline.com/doi/abs/10.1080/00015458.2003.11679470
Best Wishes

 

[Chuck C]

Surely a person of your supposed education can see that both types of valves offer different solutions for different diagnoses

The OP invited opinions on valve choice. He is 44 years old. Pellicle gave sound advice that a person his age should consider the reality of reoperations. What about this offends you?

Do you believe that it is incorrect that a 44 year old will face reoperations?

Do you beieve that scar tissue is not really something to be concerned about in future redo operations?

I have always said both types of valve tissue v mechanical are excellent options versus the alternative of not having surgery

And I have seen Pellicle suggest several times that individuals consider a tissue valve. The guidelines suggest that age is the biggest factor in this decision, but there are several other factors which could steer a person to tissue, even if a person is young, which have been been stated numerous times by Pellicle.

Perhaps you have a different view as to valve choice for the OP? He has invited commentary, so please comment and give your thoughts. Or is your position is that there is no wrong choice, regardless of age, and folks on the forum should not express views, even when asked to do so?

 

[pellicle]

Pellicle gave sound advice that a person his age should consider the reality of reoperations. What about this offends you?

here's the interesting thing ... I didn't reply to the OP ... nor Mike (because he's on my ignore list but after you quoted him I could see that chain)

I replied to 70sdiver and Gail in Ca and left the OP alone because he said he wasn't interested.

Still someone has to have a go at me because apparently they know so much more than me and its important to shout me down without presenting a shred of evidence (there is a name or two for that).

I think what offends Mike the most is having people have different opinions to his own. Which is weird because many surgeons would echo exactly my opinions. Perhaps the issue is that his own choice bothers him.

 

[pellicle]

another few points on the dangers of reoperation due to scar tissue (and a related issue "adhesions")

https://www.sciencedirect.com/science/article/pii/S0022522307017424

Patients with multiple previous operations or chest radiation have more severe adhesions, accounting for increased risk of injury seen in the current study.​

​

Immobility of the heart on catheterization is a sign that graft or other structures are embedded in scar tissue, fixed to the chest wall, and in danger of injury. Identifying such a perilous situation should trigger preventive strategies to minimize risk.​

​

Coronaries and grafts normally move with the heart during the cardiac cycle, but if segments are immobile, that means they are restricted by dense scar tissue. Peeling them off the anterior chest wall is challenging, requiring manipulation, and risk of injury is high. ​

​

If grafts embedded in scar tissue are encountered while performing the aortic dissection, extrathoracic arterial cannulation is an excellent alternative, preferably using the axillary artery.​

​

Once the pericardial reflection is identified, further dissection in the correct plane is facilitated. Lifting the pericardial border stretches the adhesions, improves exposure, and opens the plane of dissection. Cutting with scissors should be synchronous with heart rhythm. ​

I'd say that most people aren't aware of these things ... and why would they be if they haven't had a redo yet?

There is a reason why in Japanese language the characters meaning alive before [implied you] are said as Sensei and loosely translated as teacher. Of course it wouldn't occur to someone like @Mike1959 that I may actually know something about what I talk about.

 

[Mike1959]

another few points on the dangers of reoperation due to scar tissue (and a related issue "adhesions")

https://www.sciencedirect.com/science/article/pii/S0022522307017424

Patients with multiple previous operations or chest radiation have more severe adhesions, accounting for increased risk of injury seen in the current study.​

​

Immobility of the heart on catheterization is a sign that graft or other structures are embedded in scar tissue, fixed to the chest wall, and in danger of injury. Identifying such a perilous situation should trigger preventive strategies to minimize risk.​

​

Coronaries and grafts normally move with the heart during the cardiac cycle, but if segments are immobile, that means they are restricted by dense scar tissue. Peeling them off the anterior chest wall is challenging, requiring manipulation, and risk of injury is high. ​

​

If grafts embedded in scar tissue are encountered while performing the aortic dissection, extrathoracic arterial cannulation is an excellent alternative, preferably using the axillary artery.​

​

Once the pericardial reflection is identified, further dissection in the correct plane is facilitated. Lifting the pericardial border stretches the adhesions, improves exposure, and opens the plane of dissection. Cutting with scissors should be synchronous with heart rhythm. ​

I'd say that most people aren't aware of these things ... and why would they be if they haven't had a redo yet?

There is a reason why in Japanese language the characters meaning alive before [implied you] are said as Sensei and loosely translated as teacher. Of course it wouldn't occur to someone like @Mike1959 that I may actually know something about what I talk about.

Interesting line of defence Pellicle

I have followed a similar line of ops as you, with my first surgery in 1979 so speak with experience like yourself!

I am extremely happy with my choices made as they are all life extending and health enhancing.

Question- would you have made any different decisions with the knowledge you had at the time?

Great forum and interesting debates

 

[Timmay]

Kudos to you for knowing your choice.

You’re definitely not taking the recommended medical path. You’re under 50 - so the medical recommendation is a mechanical valve. I’m sure you know that already . Just making sure that I state it here for future readers.

So why do I give you kudos? Because YOU know YOU. That is actually pretty huge. You have prioritized your mental health over your physical health … and you’re willing to sacrifice a potentially longer life for what is a potentially happier life (mentally/emotionally). I think this is great so long as you are truly being honest with yourself about sacrificing that longer life and accepting more open heart surgeries in the future … because that will be an undeniable fact for you.

I don’t have to agree with your choice (and I don’t), but I also don’t have to live YOUR life with YOUR challenges. You need to live that life - not me, not anyone on this forum, and not anyone around you. Just make sure you really are being honest with your choice of accepting more surgeries in the future and accepting a statistically shorter life span.

And DEFINITELY look into the Inspiris Resilia tissue valve. If I felt that I needed to choose a tissue valve then I would pick the Resilia because, for me, it appears to have the potential for the longest life.

 

[Gail in Ca]

My surgeon informed me, after my 3rd surgery, that it took 3 hours to cut through the scar tissue from my previous surgeries. This is before they could start the replacements and repairs I needed. That’s not something to take lightly. I was thankful to be at a top hospital and my surgeon one of the world’s best.

 

[guybaxy]

wow, I just had my third surgery, haven't seen the surgeon's report as yet, but it would have been long. i think the ,most important thing is how longe you are on the cross clamp, when they clamp the aorta and go to by pass. i.e --how long the heart is stopped for