Going forward?????

[Gazza01]

Hi all.
I have a bit of a conundrum which I can’t seem to get a definitive answer on line.
I wondered if anyone could shine a little light on.
Four years ago at the age of 53 I had an aortic valve replaced with OHS, and a large bovine valve fitted. I had no real say in the valve at the time. It was an emergency operation after a collapse during exercise.
The surgeon told me this valve would give me a normal life back without the need for warfarin etc.
She also said that she had given me the large valve, so when it needs replacing again she can use the valve in valve procedure via the groin.
All went well enough. I am back to my almost normal self again.
However, one thing struck a chord with me which has bothered me since.
if this valve lasts 10 years, and so does the next one. Well then that’ll mean having my chest cracked open in my mid 70s. If I should be lucky enough to get to that age of course.
So now I am hoping that the new polymer valves may be ready for TAVI before I need surgery again. Or I opt for OHS again and have a mech valve, in which case I surely would have been better off having that in the first place. Any thoughts please.

 

[Superman]

You’re not wrong.

I think surgeons, since the 2008 or earlier, were way too casual in selling tissue valves on the promise of TAVR and no second open heart when the time came for replacement. That was pure conjecture on their part and a false hope. They should have been required to add a, “or the second surgery is free!” clause.

The real differences remain less likely second open heart (consideration for related issues such as a subsequent aneurysm), but warfarin for mechanical vs less likely to need warfarin but likely second replacement for tissue. Allowing for that to be another open heart.

 

[MdaPA]

Four years ago at the age of 53 I had an aortic valve replaced with OHS, and a large bovine valve

if this valve lasts 10 years.....

As it looks like you have 6 more years until you reach the 10 year mark with your bovine AV, hopefully you can hold-off on thinking about your next surgery/procedure/valve selection for a good while. Also, you might be cutting your valve short as you could get 10-20 years with your bovine AV (my wife got 17 years at a much younger age with a bovine but in the MV position). It's good that you keep up with things and read this forum to stay current if/when that day ever comes.

 

[Michael O]

Age 56, opted for a tissue valve during OHS last month. 2 separate surgeons characterized it as "based on present technology, you can expect to get 10-15 years from this valve and 10 from the next one, both with TAVR. However, the likelyhood that we'll still be using the same tech 20 years from now is very low."

 

[Paleowoman]

Four years ago at the age of 53 I had an aortic valve replaced with OHS, and a large bovine valve fitted.

What make of bovine valve did you get ? Four years ago people were often getting the Edwards Inspiris Resilia valve in the UK which is supposed to have a longer life than the average 10 years of the previous generation of bovine valves such as the Edwards Magna Ease. Have a look on the little card you should have been given.

 

[Michael O]

<looks through wallet> hrmmmm - library card, vaccination card, medical pot card, Costco card, ah - there we go - it's a Citgo valve. (Damn you, Humana!!!)

Carpentier-Edwards PERIMOUNT Magna Ease pericardial aortic bioprosthesis with ThermaFix process‡ w/ a side of broccoli. Surgical aortic pericardial valves | Edwards Lifesciences

Edit: Sorry Paleowoman, I thought the comment was directed at me.

 

[Paleowoman]

Hi Michael - you've got the same type of valve as me....though I don't know if I had ThermaFix whatever that is. 10 years is what I was told was average with the Carpentier-Edwards PERIMOUNT Magna Ease.

But yes, it was Gazza I was asking what make of valve they got given because if it was the Carpentier-Edwards Inspiris Resilia that has a much longer life than 10 years !

 

[Michael O]

Yes - one surgeon hinted that I'm likely to get more time out of my valve because (unbelieveably given how much burbon and donuts I've consumed in my life), the rest of my heart was in very good shape. I think there's a lot of YMMV around valve life.

 

[nobog]

Age 56, opted for a tissue valve during OHS last month. 2 separate surgeons characterized it as "based on present technology, you can expect to get 10-15 years from this valve and 10 from the next one, both with TAVR. However, the likely hood that we'll still be using the same tech 20 years from now is very low."

I don't know about that - we are still using the exact same SJM mechanical valve as was introduced over 40 years ago. Tissue/polymer/whatever there might be advances but even if the "perfect" valve was introduced today, it would take 20 years for the track record to be clear.

 

[dick0236]

At some point in the future, you will most likely have to have your bovine valve replaced. Any decision about your next valve will be deferred until then. I would live my life now and worry about "what to do" then.

 

[Chuck C]

Hi all.
I have a bit of a conundrum which I can’t seem to get a definitive answer on line.
I wondered if anyone could shine a little light on.
Four years ago at the age of 53 I had an aortic valve replaced with OHS, and a large bovine valve fitted. I had no real say in the valve at the time. It was an emergency operation after a collapse during exercise.
The surgeon told me this valve would give me a normal life back without the need for warfarin etc.
She also said that she had given me the large valve, so when it needs replacing again she can use the valve in valve procedure via the groin.
All went well enough. I am back to my almost normal self again.
However, one thing struck a chord with me which has bothered me since.
if this valve lasts 10 years, and so does the next one. Well then that’ll mean having my chest cracked open in my mid 70s. If I should be lucky enough to get to that age of course.
So now I am hoping that the new polymer valves may be ready for TAVI before I need surgery again. Or I opt for OHS again and have a mech valve, in which case I surely would have been better off having that in the first place. Any thoughts please.

Hi Gazza and welcome to the forum.

You ask good questions and yes, you will face reoperation- almost certainly more than one reoperation. It is for this reason that most guidelines call for a mechanical valve if the patient is under 60 years old.

" Or I opt for OHS again and have a mech valve, in which case I surely would have been better off having that in the first place"

This is a possibility, but whether this is the best option will largely depend on how long your tissue valve lasts. If it lasts far longer than average- say 20 years, then perhaps you consider going tissue again. If it only lasts another 4 years, then maybe going mechanical is a reasonable choice to discuss with your cardiologist.

Having said that, it would be best to just to enjoy life and not worry about this until the imagery indicates that the time is approaching for your next procedure. Perhaps you are one of the fortunate ones and that date is many years away. It really does no good to worry now. However, it is good that you do due diligence, as you are, so that you come into the situation with some foundational understanding of the pros and cons of the choices before you when the time comes.

 

[Gazza01]

What make of bovine valve did you get ? Four years ago people were often getting the Edwards Inspiris Resilia valve in the UK which is supposed to have a longer life than the average 10 years of the previous generation of bovine valves such as the Edwards Magna Ease. Have a look on the little card you should have been given.

Hi. Thanks for taking the time to reply. I had no card given to me of that I am sure. I shall try to find out though. Thanks again. Gary.

 

[Paleowoman]

Hi Gary - you should have been given a little card when you were discharged from hospital which details the date you were given the valve, the name of the surgeon, what type of valve, the model number and serial number of the valve and the size. If the valve was made by Edwards Lifesciences you can register the valve and get a better card which you should carry with you to show any medical personnel. Which hospital did you have your surgery at ?

 

[Luckyguy17]

Hi. Thanks for taking the time to reply. I had no card given to me of that I am sure. I shall try to find out though. Thanks again. Gary.

Gary, I can confirm that i have registration cards and serial numbers, for each of my 3 prosthetics, from both St-Jude and Edwards. Your hospital/surgeon should have a record of your prosthetic.

i believe i read somewhere that the 1st UK implant of Edwards Inspiris/Resilia was done in 2018, about 3 years ago, so it seems unlikely that you would have received an Inspiris 4 years ago in UK.

in an emergency OHS as you describe, am not sure, but i believe a bio prosthetic may be selected because you cant be consulted.

A bio valve at 52 years of age is not an unreasonable choice. My 1st bio like Michael was at 56, my 2nd at 67, a few months ago and i have no second thoughts on the choice of bio prosthetic.

Gil

 

[Paleowoman]

It was in June 2017 that the first Inspiris Resilia valves were implanted in the UK at King's College Hospital and the Royal Brompton and Harefield NHS Trust: First procedures using Edward Lifesciences’ Inspiris Resilia aortic valve take place | Cardiovascular News

 

[Gazza01]

Hi Gary - you should have been given a little card when you were discharged from hospital which details the date you were given the valve, the name of the surgeon, what type of valve, the model number and serial number of the valve and the size. If the valve was made by Edwards Lifesciences you can register the valve and get a better card which you should carry with you to show any medical personnel. Which hospital did you have your surgery at ?

Hi. I had surgery at the Royal Brompton in London in June 2017. I still have a mountain of paperwork etc, but sadly no card. Don't ever remember having been given one.

 

[Gazza01]

Hi. I had surgery at the Royal Brompton in London in June 2017. I still have a mountain of paperwork etc, but sadly no card. Don't ever remember having been given one.

Late in June actually.
Could I possibly find out without being a pest do you think.

 

[Paleowoman]

Hi Gary - just contact the cardiac surgeon's secretary and ask about the card. It's often just a slip of paper from the hospital - you might have that in your mountain of paperwork - after which you register the valve and get a proper card from the valve manufacturer. Good luck !

Hi. I had surgery at the Royal Brompton in London in June 2017. I still have a mountain of paperwork etc, but sadly no card. Don't ever remember having been given one.

 

[Gazza01]

Hi Gary - just contact the cardiac surgeon's secretary and ask about the card. It's often just a slip of paper from the hospital - you might have that in your mountain of paperwork - after which you register the valve and get a proper card from the valve manufacturer. Good luck !

Thanks have just been through it all without much really. Best I can find is it's a 25mm perimount valve. 22nd June 2017. Surgeon Ms Yadav. I don't suppose it matters in the great scheme of things. I would have liked to have known though.
Thank you anyway.

 

[Paleowoman]

Hi Gary - just contact Ms Yadav's secretary as the card is quite important as it will give the model number and serial number of your valve, all valves have a unique serial number for reasons of traceability. If the secretary doesn't have the card she should be able to find the model and serial numbers and then you can register the valve with Edwards Lifscience as when you say Perimount that tells us it's one of their valves: Implant patient registry | Edwards Lifesciences