Exercise and Tissue Valve

[manuel_Scotland]

Hi Manuel
Not much of a runner however I do treadmill work with no problems. My expertise is in powerlifting. I had my aortic valve replaced with an Edwards tissue valve 18 years ago. My last echo showed only minor calcification and my EF was 65. I am currently the Pennsylvania state bench press record holder in the 163 lb. (74 kg) over 65 age class with a bench press of 226 lbs (102.5kg). I expect to get 30 years out of my valve. The notion that the more you exercise the faster your valve will wear out is a lie. In fact in my case it is just the opposite. Working out lowers your heart rate which translates into less beats per minuite which means your valve will last longer. You must be careful what you read here. You asked about exercise and I am telling you what I do not what you should do.

Oh WOW! Man! you should be proud! thank you so so much for sharing! Fortunatelly they managed to save my valve, it was transform from a "monocuspid" (yeah, I had never heart that one before) to a perfect "bicuspid". So I guess for me it will be getting use to train as a "almost" normal person. So looking forward to it.

 

[pellicle]

I had a huge 5.5 aneurysm in the ascending aorta that needed repair.

#metoo

wear the scar with pride, cost (someone) more than any tatts you'll get

 

[pellicle]

alternatively you could live a very normal life - without blood thinners and background ticking noise of the valve.

I actually live a very normal life *with* blood thinners. Its the myth that is propagated that blood thinners is something that prevents living a normal life which is sad to me. Usually a myth propagated by those in a position of no experience and outdated (meaning no longer applicable) arguments.

I put my faith in statistics not hope.
I'm glad it worked out for you. Actually I'm glad it worked out for everyone.

As I have said many times both valves offer great outcomes - (although both have positives and negatives)

agreed ... and all are well documented.

 

[d333gs]

Hi Manuel
Not much of a runner however I do treadmill work with no problems. My expertise is in powerlifting. I had my aortic valve replaced with an Edwards tissue valve 18 years ago. My last echo showed only minor calcification and my EF was 65. I am currently the Pennsylvania state bench press record holder in the 163 lb. (74 kg) over 65 age class with a bench press of 226 lbs (102.5kg). I expect to get 30 years out of my valve. The notion that the more you exercise the faster your valve will wear out is a lie. In fact in my case it is just the opposite. Working out lowers your heart rate which translates into less beats per minuite which means your valve will last longer. You must be careful what you read here. You asked about exercise and I am telling you what I do not what you should do.

Good stuff Sam!

 

[d333gs]

Re heartbeat; Mine is getting back to where it was before the opp 13 months ago, 59 as I type now , low 50s as I sleep

 

[skier]

The notion that the more you exercise the faster your valve will wear out is a lie.

My surgeon told me that the more active you are, the faster a tissue valve will wear out. This was in the context of endurance exercise. I trust he knows what he's talking about. I just checked, and he an author on 197 publications.

 

[tom in MO]

My surgeon told me that the more active you are, the faster a tissue valve will wear out. This was in the context of endurance exercise. I trust he knows what he's talking about. I just checked, and he an author on 197 publications.

From what I read, no one really knows what makes a tissue valve fail in 2 years for Joe and last 15 years for Harry. The only correlation is with age, the younger the recipient the shorter the usable life of the tissue valve. Maybe your surgeon was using data for causation by activity that wasn't adjusted for age (e.g. young people are more active.)

 

[skier]

The only correlation is with age, the younger the recipient the shorter the usable life of the tissue valve. Maybe your surgeon was using data for causation by activity that wasn't adjusted for age (e.g. young people are more active.)

Yes, I think that's the case. IIRC, the studies are around age. Tissue valves have been shown to last longer in older folks, and the presumption is that's because they are more sedentary.

 

[nobog]

From what I read, no one really knows what makes a tissue valve fail in 2 years for Joe and last 15 years for Harry. The only correlation is with age, the younger the recipient the shorter the usable life of the tissue valve. Maybe your surgeon was using data for causation by activity that wasn't adjusted for age (e.g. young people are more active.)

I do. The manufactures simply have no way to validate the tissue. Here's an example:

Porcine leaflets: You can have variation from paper thin to 5x that thickness on one leaflet - you would think the tissue that is 5x thicker would last longer - well, there is no correlation between leaflet thickness and durability. Then there is the basic valve design - and then there is the "assembly" and then ... what does the body do to this thing (calcification, blood pressure)?

Pericardial: Looks like a smooth sheet but is full of veins with a grain - that can be random.

Some valves go 200 million cycles (5 years) on an accelerated life tester, the same exact valve (different serial number) might go billions. The only thing a manufacturer can do is to make a robust valve design - where "most" last a "long" time.

So... thats the nature of tissue and until the state-of-the-art can figure out all the variables, a tissue valve will last 2 years - or 15 years. That's why I cringe as people younger and younger are opting for tissue valves.

I have personally seen a tissue valve last 6 months - and I have personally seen a tissue valve last 20 years - which one will you get?

For you statisticians out there, it's called +/- 3 standard deviation.

 

[Chuck C]

So... thats the nature of tissue and until the state-of-the-art can figure out all the variables, a tissue valve will last 2 years - or 15 years. That's why I cringe as people younger and younger are opting for tissue valves.

I would call it good marketing. Get the customer to focus on the bright shiny object and not pay any attention to the statistics.

 

[pellicle]

Morning

I have personally seen a tissue valve last 6 months - and I have personally seen a tissue valve last 20 years - which one will you get?

Long termers here have seen that too. Tom included.

The chemistry of failure is well described too

https://www.ahajournals.org/doi/10.1161/JAHA.120.018506

That's why I cringe as people younger and younger are opting for tissue valves.

me too, having had a replacement valve at 28 the subject is close to my heart.

However many of the most vociferous opposers of me saying to someone under 50 the actual facts (and delivering a lot of hate my way for daring to go against their chosen saviour) are over 60yo. Pure irony.

For you statisticians out there, it's called +/- 3 standard deviation.

That's normal, but personally if the SD is small enough that's the key, but the SD should be very tight or that's just sloppy manufacturing. To my mind bioprosthetic valves are something like handicrafts or leather working, and while I've had my leather wallet for a long time now I expect it to fail and I'll buy a new one. I've still however got the same ceramic plates we got when I got married (and indeed I have a few from my parents for various reasons).

Leather gloves are comfortable, but they do wear out faster than my wood chopping axe's steel.

Another reason for the difference in durability is that leather is dead (and bioprosthetic valves are a type of leather) but native valves are living tissue, which (when healthy) grows and repairs over time
https://www.ncbi.nlm.nih.gov/pmc/articles/PMC4485434/
Accordingly my hands still look the same (few more wrinkles) but I can't tell you how many pairs of leather gloves I've gone through.

Ultimately all the trade-offs are well understood, make your understanding equally well and pick the trade-off you prefer (warfarin or reoperation).

 

[pellicle]

Hi

My surgeon told me that the more active you are, the faster a tissue valve will wear out. This was in the context of endurance exercise. I trust he knows what he's talking about. I just checked, and he an author on 197 publications.

I haven't got any current citations for that, but I understood it to be correct and have read such in the past.

Further if @hevishot wants to call someone a liar he should understand that being incorrect or being misinformed is not the same as being a liar. A lie is when someone deliberately speaks something thats false and knows that to be false. Its a deliberate act. Calling someone a liar is offensive and unacceptable.

I request you rephrase that

 

[newarrior]

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

Sounds like you did the right thing and I'm sorry to hear about your first valve.

 

[newarrior]

I do. The manufactures simply have no way to validate the tissue. Here's an example:

Porcine leaflets: You can have variation from paper thin to 5x that thickness on one leaflet - you would think the tissue that is 5x thicker would last longer - well, there is no correlation between leaflet thickness and durability. Then there is the basic valve design - and then there is the "assembly" and then ... what does the body do to this thing (calcification, blood pressure)?

Pericardial: Looks like a smooth sheet but is full of veins with a grain - that can be random.

Some valves go 200 million cycles (5 years) on an accelerated life tester, the same exact valve (different serial number) might go billions. The only thing a manufacturer can do is to make a robust valve design - where "most" last a "long" time.

So... thats the nature of tissue and until the state-of-the-art can figure out all the variables, a tissue valve will last 2 years - or 15 years. That's why I cringe as people younger and younger are opting for tissue valves.

I have personally seen a tissue valve last 6 months - and I have personally seen a tissue valve last 20 years - which one will you get?

For you statisticians out there, it's called +/- 3 standard deviation.

Thanks for a brilliant summary regarding tissue valves. I think I can safely say we're all praying for the day where we can get one valve that will last us the rest of our lifetime without having to be on blood thinners or deal with the ticking. It seems like all the scientific evidence is pointing towards a mechanical even when you're older it appears 71 is the cutoff date when you could start thinking about going to tissue or trans aortic

 

[newarrior]

Yes, I think that's the case. IIRC, the studies are around age. Tissue valves have been shown to last longer in older folks, and the presumption is that's because they are more sedentary.

Interesting but if we are still super active as we age then I suppose age is irrelevant as far as valve life ?

 

[skier]

Interesting but if we are still super active as we age then I suppose age is irrelevant as far as valve life ?

No, I believe a tissue valve in someone super active won't last as long as in someone sedentary. I'm not sure if any studies prove that, but that's what my surgeon told me is the presumption when I chose a mechanical valve.

 

[nobog]

No, I believe a tissue valve in someone super active won't last as long as in someone sedentary. I'm not sure if any studies prove that, but that's what my surgeon told me is the presumption when I chose a mechanical valve.

There is truth to that. What wears a tissue valve out? cycle count (active person to have elevated heart rate at some point) and pressure - so do just that - watch your blood pressure.

 

[pellicle]

There is truth to that. What wears a tissue valve out? cycle count (active person to have elevated heart rate at some point) and pressure - so do just that - watch your blood pressure.

Reminds me of a discussion with hevishot where I argued exactly those things but also added body biochemistry to the mix of things that attacks the valve (SVD)

 

[pellicle]

Interesting but if we are still super active as we age then I suppose age is irrelevant as far as valve life ?

Correct
Like this woman

https://www.newsweek.com/my-turn-climbing-everest-bionic-heart-99749

 

[newarrior]

I would call it good marketing. Get the customer to focus on the bright shiny object and not pay any attention to the statistics.

Well stated sadly