Exercise and Tissue Valve

[newarrior]

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.

Interesting...I am getting more anal about BP--I have had systolic reading in the 123 to 130 range lately. Just a little over 120 but enough where I am back on Losartan 50m mg twice a day, Working on diet in regards to sodium and my goal is losing 24 lbs...Down 6 as of late 18 to go..

 

[newarrior]

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.

Sad as it's like you are being penalized for being active/healthy. And yes more profit for tissue valves and the 2nd and 3rd surgeries they entail. Regardless most of the data indicates a longer lifespan and better outcomes with a mechanical valve for those under 71 years of age.

 

[nobog]

Sad as it's like you are being penalized for being active/healthy. And yes more profit for tissue valves and the 2nd and 3rd surgeries they entail. Regardless most of the data indicates a longer lifespan and better outcomes with a mechanical valve for those under 71 years of age.

Well, that's not how it works. The manufactures make what is considered "state of the art". The problem is the "state of of art" has a huge standard deviation (i.e. 6 months to 20 years) when it comes to how long they last. People choose that. People also bought Yugo cars.

 

[Gkeraney]

Hi


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

I randomly chose this post to respond on the issue of bio valves wearing out from lots of exercise. The articles you posted are good. I ran much more after my second valve, much more and a dozen half marathons, and it failed about 20% faster. I'm also sure I had clots on that valve and probably not on the first one. I also think that stentless valves are less likely to develop leaflet thrombosis than stented valves and my second valve was stented, with the plan to put a tavi inside it in 10-12 years and another tavi inside that 10-12 years after that one. I'm pretty sure I have not mentioned that part of the plan circa 2010.

Increased activity causes our neutrophils to increase. This may be the key takeaway. I'm less sure that mechanical wear and tear is the problem, ie, the number of beats. It may be some problem but I'm 100% convinced that increase neutrophil attacks on our artificial parts is a problem.

I think we will soon see lots of tavi patients on warfarin, as it becomes obvious it allows the valves to last longer.

It took me too long to realize that the consensus opinions about valve durability were wrong. Or at least the opinions given to me. In 2011 I should have gotten a mechanical valve which would probably have gotten me into my 90's. Oh well.

 

[QuincyRunner]

Thanks for your post, Gkeraney. I’ve always wondered about people here that say that they were getting a tissue valve because they wanted to stay active, as if avoiding warfarin was more important than their valve wearing out prematurely precisely because of that active lifestyle. Like others here my surgeon highly recommended a mechanical valve for me in 2011 because he knew that I was a runner and wanted to return to that active lifestyle. I have always been grateful for that because at the time I wouldn’t have known any better.

 

[V__]

Well, that's not how it works. The manufactures make what is considered "state of the art". The problem is the "state of of art" has a huge standard deviation (i.e. 6 months to 20 years) when it comes to how long they last. People choose that. People also bought Yugo cars.

Thanks for pointing this out. I would imagine that the manufacturers may want record various valve parameters they test, in order to correlate them with the longevity data, and eventually to figure out which parameters are important. Have you happened to know if such investigations are happening?

 

[nobog]

Thanks for pointing this out. I would imagine that the manufacturers may want record various valve parameters they test, in order to correlate them with the longevity data, and eventually to figure out which parameters are important. Have you happened to know if such investigations are happening?

Its what they have been doing for 40 years, The FDA requires it. Many detailed tests, it can take 10 years from concept to market.

 

[pellicle]

Hi
pardon me, but:

I would imagine that the manufacturers may want record various valve parameters they test, in order to correlate them with the longevity data, and eventually to figure out which parameters are important.

I would wonder if they do have longevity goals greater than what is produced now. I mean once upon a time (in the 1960's) these things weren't lasting long at all, numbers measured in something more like year or years not decades.

Now we don't even see follow-ups of actual implanted valves go beyond 10 years. When one considers the average age of a heart valve patient they are already usually quite advanced in years, so why would they be looking towards getting the valves to last as long as a mechanical (when the market seems content with the existing situation). I'd say (and its been said here) that most people are unaware of the durability and its always said as something like "fifteen or twenty years" (if reports here are anything to go by).

 

[pellicle]

The FDA requires it

I don't know if you know, but it would be interesting to know how long after a valve is placed on the market to the FDA require detailed reports on valves in-vivo performance for?

 

[pellicle]

People choose that.

a phrase I like to use to summarise what I call sanity is "minimal distortion of reality".

I've found people not only reach for, but cling like a barnacle to ideas which are pure fiction. I feel that's a kind of indicator for madness or insanity (at the very least being delusional).

 

[V__]

I would wonder if they do have longevity goals greater than what is produced now. ...

I'd hope that the market competition between the different valve vendors forces them to compete and improve the product. "Once and done" would seem like a good marketing slogan
But it's just hope, I don't know this industry. Hence the question.

Now we don't even see follow-ups of actual implanted valves go beyond 10 years.

Yep, noticed this trend. There seem to be exceptions when an advanced surgical center publishes their long-term statistics.

 

[nobog]

I'd hope that the market competition between the different valve vendors forces them to compete and improve the product. "Once and done" would seem like a good marketing slogan
But it's just hope, I don't know this industry. Hence the question.

Many years ago (20+) SJM actually had a marketing slogan "Not New, Not Improved".

The valve is exactly the same as it was 40 years ago - and there's (many) reasons for that.

 

[pellicle]

There seem to be exceptions when an advanced surgical center publishes their long-term statistics.

I've dug into some of those, mean follow up is seldom over 11 years (usually less than 10.9)

Can you name one that does better?

 

[V__]

I've dug into some of those, mean follow up is seldom over 11 years (usually less than 10.9)

Can you name one that does better?

Will find them on the weekend. Which is "as soon as tomorrow"

 

[V__]

I've dug into some of those, mean follow up is seldom over 11 years (usually less than 10.9)

​

Can you name one that does better?

Unfortunately, I didn't save the ones I thought I remember. So looked again. Here are a few. They seem to be overviews, rather than single-center experience reports.

• Controversy pro: Mechanical AVR for better long-term survival of 50–70 years old . It quotes 3 studies, with survival curves going to 10 years, 15 years, and ~18 years.
  • Mechanical or Biologic Prostheses for Aortic-Valve and Mitral-Valve Replacement. This is the study with longest follow-up, quoted above.
• Survival and long-term outcomes after mitral valve replacement in patients aged 18 to 50 years . Follow-up of up to 15 years. (*)
• Survival and Long-term Outcomes Following Bioprosthetic vs Mechanical Aortic Valve Replacement in Patients Aged 50 to 69 Years . Also a follow-u of up to 15 years. (**)

However, you mention that "mean follow up is seldom over 11 years". The one marked with (*) has median follow-up of 12.4 years. For (**) it's 10.8 years. They are the longest in this list, so this would be consistent with your statement.

 

[David Robbins]

Thanks for your post, Gkeraney. I’ve always wondered about people here that say that they were getting a tissue valve because they wanted to stay active, as if avoiding warfarin was more important than their valve wearing out prematurely precisely because of that active lifestyle. Like others here my surgeon highly recommended a mechanical valve for me in 2011 because he knew that I was a runner and wanted to return to that active lifestyle. I have always been grateful for that because at the time I wouldn’t have known any better.

Tissue valve to stay active? Afraid of a bleeding problem due to blood thinners? I had a St Jude mechanical in 2008 and have been active in heavy strength training and long distance hikes ever since. I test my INR at home and make immediate adjustments in warfarin dosage if necessary. If you are athletic my cardiologists recommend mechanical valves. I had my 2nd AVR as a redo at Stanford so I trust their advice. I was 53 at implant. I also have valve related afib untreatable with ablation. My recommendation is to live the life you were living and put your fears aside. If you have other health limitations, listen to your doctor.
We’re all different. I was an athlete in high school and 50 years later, I still am.

 

[V__]

I've dug into some of those, mean follow up is seldom over 11 years (usually less than 10.9)

The one marked with (*) has median follow-up of 12.4 years. For (**) it's 10.8 years. They are the longest in this list, so this would be consistent with your statement.

Come to think of this, a typical patient is about 65 at the time of the surgery. And has about 18 years of life expectancy left. Which sets an upper limit of the typical survey's mean duration followup. Which limit is only achievable if everybody is followed up to the end of life.

Of course, the maximum follow-up time by itself may not so helpful (if it was a single outlier). Perhaps a better information is amount of sampling in the upper range of the survey. Statistical error bars would help. I don't see them often, but there exceptions. As just an example of what I'd prefer to see, the plots in this paper are much more indicative of the accuracy. One plot is below.

 

[pellicle]

Morning

Thanks for doing due diligence on the reply above.

Come to think of this, a typical patient is about 65 at the time of the surgery. And has about 18 years of life expectancy left. Which sets an upper limit of the typical survey's mean duration followup

Yes, you may have seen I raise that point a bit (but it's likely buried in the haystack of posts I mske).

I discuss this further in my blog post, and Dr Schaff of the Mayo makes these points in his presentation too

http://cjeastwd.blogspot.com/2014/01/heart-valve-information-for-choices.html
Best wishes

 

[V__]

Yes, you may have seen I raise that point a bit (but it's likely buried in the haystack of posts I mske).

Thanks for the patient reply - I'm sure the same topics resurface once in a while. Maybe there should be a FAQ list somewhere?

I discuss this further in my blog post, and Dr Schaff of the Mayo makes these points in his presentation too

http://cjeastwd.blogspot.com/2014/01/heart-valve-information-for-choices.html

Thanks! It's a great post. And the plots with error bars are balm for my soul

 

[Gkeraney]

Morning

Thanks for doing due diligence on the reply above.

Yes, you may have seen I raise that point a bit (but it's likely buried in the haystack of posts I mske).

I discuss this further in my blog post, and Dr Schaff of the Mayo makes these points in his presentation too

http://cjeastwd.blogspot.com/2014/01/heart-valve-information-for-choices.html
Best wishes

It boggles the mind that a large study has yet to be done that shows average time to reoperation for mechanical aortic valves placed in patients under 40. It would be useful to use patients with no comorbidities. It would be useful if only patients compliant on anti coagulants were included. Is it 40 years? 30? I'd bet a lot of money it's over twenty, and probably 25, and maybe 30, but there are folks here who would bet more money on it being well over 40. They could be right. If they are, it's something like insanity that everyone isn't getting a mechanical valve. Or at least everyone who is very interested in being compliant.

Meanwhile the trend is more bio-valves. I'm an odd messenger to rail against this. Right now I think if I make it to 70 I would ask for a mechanical valve then, which would continue my trend of going against the grain.

I wonder if part of what has gone on with many of the docs is pure stupidity, ie, they only now realize these bio-valves are developing thrombus formation, because of wnl ( we never looked). Would an anti-coagulated toronto spv bio valve have lasted 17 years on average vs 10? I wonder. Are the patients with aortic bio valves who have afib, and therefore anti coagulated, are those valves lasting longer? Is there a desire from the medical community to not know these things?