From the Adirondacks

[Innovativebrain]

Hi Gang, and thanks for this forum. Like all of us, I'm interested in enhancing my quality of life and longevity. Had AVR for calcified bicuspid valve in 2019, doing great. No other cardiac or circulatory issues other than well managed high BP.
In my work life, I'm the CEO and Health-care practice Lead at an innovation consultancy, so I'm interested in the bleeding edge of valve replacement methods and practices. (pun intended). Since I have a valve with a predicted useful life of 12-15 years on the short end, I'm interested in 2 things:

1. How to increase the useful life of the valve I have (Edwards Perimount Magna Ease)
2. Advances in replacement of artificial valves such that stroke-risk is lessened. (TAVR Valve in valve is the current standard, but high stroke risk)

Guidance and expertise appreciated!
And, If there is interest in having a creative problem solving/design thinking session in this space, I'm your guy. Find out more at www.newandimproved.com
Bob

 

[treichert0312]

Hello innovative - love the Adirondacks- daughter is going to school in Burlington. My AVR from 2014 lasted 8 years - I was counting in the 12-15 then TAVR. However, the pig valve did not calcify so that ruled out TAVR. Mechanical was what I needed, so went with that in spite of the rat poison requirement. The warfarin misinformation is one thing to consider.
Another one - I think Abbott may have a patent - but some INR testing on mobile device would be super cool. The weekly stick on the finger is not a big deal but the patch would be very interesting.

 

[Innovativebrain]

Thanks for that update. And how is your recovery from the second surgery going?

 

[pellicle]

Hi and welcome

you don't have an indication of age in your bio, but if your picture is accurate (read current) you're well over 60. I'll assume that is the case but if its not then my thoughts are no longer accurate

Since I have a valve with a predicted useful life of 12-15 years on the short end, I'm interested in 2 things:

1. How to increase the useful life of the valve I have (Edwards Perimount Magna Ease)

you can't really ... its a non serviceable item and from what I understand an item which does not have the tolerances and accuracies of manufacture that modern materials (like pyrolytic carbon or steel for instance) have.
If you're interested you can dig through this article (which is good and current) however I wouldn't disagree with the 12 ~ 15 year except to say "that's not the short end, that's the likely end".

https://www.ahajournals.org/doi/10.1161/JAHA.120.018506
If you get 20 that's pretty much where the rope runs out. I'll leave it to you do work out how old you'll be at the 20 year mark.

1. Advances in replacement of artificial valves such that stroke-risk is lessened. (TAVR Valve in valve is the current standard, but high stroke risk)

Guidance and expertise appreciated!

This last point is not supported by the evidence at hand. Claims are made in OpEd advertorials and then the underlying studies are seldom read by the target audience (the patient).

Either way I think there is nothing wrong with your choice, and as long as you were over 60 when you had the valve placed in that you stand a good chance of getting 15. The more active you are however the less likely you'll get 20 than 15. My reasoning here is that (not least) the mechanical wear on something that's flexing (not pivoting on a hinge) is cumulative in damage. Lets say you have an average HR during the day of 80 (including exerized, elevation after eating, stress, drinking a bit of booze and tea or coffee). This means that you have probably around 42 million valve actuations per year. This calculates out to 840.96 million beats in a 20 year period and assuming an average daily HR of 80bpm or 946.08 at 90pbm

Now if you add in some more exersize you may push that up to nearly to over a billion. So achieving the goal of 1 billion is not certain because of factors like this:

1. Many tissue valves will go to 1 billion cycle in-vitro - what's not said is what the standard deviation for failure is due to the extremely small sample size.

I've underlined his text (he didn't)

So its a craps shoot.

Bottom line is this: don't worry about things like extending valve duration. If you were worried about such things you made an incorrect choice to start with and instead just focus on having a good life and looking after your health with good diet, moderate exersize and healthy living.

Life is unpredictable at best, so just enjoy what you have and focus on what you can change.

(Stoic viewpoint)

Best wishes

 

[Innovativebrain]

What a wonderful and complete answer! I appreciate the time you put into this. Had my valve done when I was 62. 66 now.

 

[pellicle]

Had my valve done when I was 62. 66 now.

that's a good age to be picking as you indeed picked. There is to my mind no compelling case either way at that age.

Best Wishes

 

[Paleowoman]

Hi Bob - I got an Edwards Perimount Magna Ease valve in January 2014 for bicuspid aortic valve when I was 60 - it's still going strong, will be 10 years in January. I have annual checks from cardiologist and echocardiogram. I live life to the full, do weight lifting and lots of walking.

The 'patient prosthesis mismatch' I have doesn't seem to have led to any problems, it causes high pressure gradients on echo but nothing else....so far.

 

[Innovativebrain]

Hi Bob - I got an Edwards Perimount Magna Ease valve in January 2014 for bicuspid aortic valve when I was 60 - it's still going strong, will be 10 years in January. I have annual checks from cardiologist and echocardiogram. I live life to the full, do weight lifting and lots of walking.

The 'patient prosthesis mismatch' I have doesn't seem to have led to any problems, it causes high pressure gradients on echo but nothing else....so far.

Thanks for this response. It's encouraging! I too am very active, and plan/hope to stay that way! ;-)

 

[john b]

Thanks for this response. It's encouraging! I too am very active, and plan/hope to stay that way! ;-)

 

[john b]

Had an Aortic Edward’s Bovine Valve installed 2009 14 years of normal life still working fine. Age now 76, my wife has just had a tavi fitted and out of hospital the next day. Advise dental hygiene. Johnb

 

[dick0236]

Advise dental hygiene. Johnb

l brush, with OTC toothpaste, once per day, floss a few times a week
I take 2000mg of Amoxicillin one hour prior to dental appointment for any invasive treatment (cleaning, filling, etc)
I have my teeth cleaned 2X year

My dentist would like me to brush 2X/day.....I try......with very little success.

 

[john b]

l brush, with OTC toothpaste, once per day, floss a few times a week
I take 2000mg of Amoxicillin one hour prior to dental appointment for any invasive treatment (cleaning, filling, etc)
I have my teeth cleaned 2X year

My dentist would like me to brush 2X/day.....I try......with very little success.

The comment with tavi valve I valve giving higher stroke risk. My wife had a trial where a net is inserted while new valve is installed to catch any calcification and then withdrawn. This is the new technology. Local hospital doing 5 tavi procedures a day. Life is good! .

 

[Innovativebrain]

The comment with tavi valve I valve giving higher stroke risk. My wife had a trial where a net is inserted while new valve is installed to catch any calcification and then withdrawn. This is the new technology. Local hospital doing 5 tavi procedures a day. Life is good! .

Thanks for this, John. two questions:
The name of the particular hospital?
The name of the principle investigator or the clinical trial so that I can chase it down?

 

[john b]

Thanks for this, John. two questions:
The name of the particular hospital?
The name of the principle investigator or the clinical trial so that I can chase it down?

John Radcliffe Oxford England