Have you had MV & AV replaced at the same time?

[MKM]

Hello everyone! I have to have 2 valves replaced at the same time. Have you had this duo surgery and if so, did you get tissue valve or mechanical? Age 65 and looking at surgery in the next few weeks. Been reading lots and lots and keep learning. This from Stanford is interesting but not helpful to me.
https://www.med.stanford.edu/news/all-news/2017/11/mechanical-heart-valve-often-the-safest-choice.html
Any input is appreciated.

 

[MdaPA]

I have to have 2 valves replaced at the same time. Have you had this duo surgery and if so, did you get tissue valve or mechanical?

Yes, my wife did at around age 50.
does anyone here have 2 or more mechanical valves?

This from Stanford is interesting but not helpful to me.
https://www.med.stanford.edu/news/all-news/2017/11/mechanical-heart-valve-often-the-safest-choice.html

This should reinforce you going with mechanical as you need your MV replaced and are under 70, right?

 

[MKM]

Yes, my wife did at around age 50.
does anyone here have 2 or more mechanical valves?


This should reinforce you going with mechanical as you need your MV replaced and are under 70, right?

Well, not really. I got confused when I read this statement... "The study shows that for patients undergoing mitral valve replacement, a mechanical valve is actually beneficial until the age of 70. On the other hand, for patients undergoing aortic valve replacement, the benefit of implanting mechanical valves ceased after the age of 55." And at age 65 I plan to get and aortic and mitral valves. In reading this paragraph, it indicates that one will cancel out the benefit of the other since I am over 55. Am I totally reading this wrong?

 

[MdaPA]

In reading this paragraph, it indicates that one will cancel out the benefit of the other since I am over 55. Am I totally reading this wrong?

Where are you getting that "one will cancel out the benefit of the other"?

From what I gathered, the study looked at getting either AV or MV replaced, not both together.

The study also found that unlike what’s recommended in the national guidelines, which say patients 50-70 years old undergoing aortic or mitral valve replacement should be given a choice of either a mechanical or biological valve, the best choice in fact can hinge on whether the aortic or mitral valve is being replaced.

As per this study, it says for AVR, "the benefit of implanting mechanical valves ceased after the age of 55." So at your age of 65, this is an indication for biological AVR.

But, for MVR, it says "a mechanical valve is actually beneficial until the age of 70". So at your age of 65, this is an indication for mechanical MVR (as you are 5 years away from 70).

But in your case, I don't think you can interpret these indications in isolation as you say you need both valves replaced. i.e. you wouldn't get a biologic AVR and a mechanical MVR in the same intervention, would you?

Multi/mixed valve disease is more complex and presents a different set of challenges that need to be discussed. Take a look at section 10: Mixed Valve Disease in the below link:

2020 ACC/AHA Guideline for the Management of Patients With Valvular Heart Disease

I think you mentioned you are going to CC so you will be in good hands and will be guided to make the best decision in your case.

Maybe one or both valves can even be repaired?

 

[MKM]

Where are you getting that "one will cancel out the benefit of the other"?

From what I gathered, the study looked at getting either AV or MV replaced, not both together.

The study also found that unlike what’s recommended in the national guidelines, which say patients 50-70 years old undergoing aortic or mitral valve replacement should be given a choice of either a mechanical or biological valve, the best choice in fact can hinge on whether the aortic or mitral valve is being replaced.

As per this study, it says for AVR, "the benefit of implanting mechanical valves ceased after the age of 55." So at your age of 65, this is an indication for biological AVR.

But, for MVR, it says "a mechanical valve is actually beneficial until the age of 70". So at your age of 65, this is an indication for mechanical MVR (as you are 5 years away from 70).

But in your case, I don't think you can interpret these indications in isolation as you say you need both valves replaced. i.e. you wouldn't get a biologic AVR and a mechanical MVR in the same intervention, would you?

Multi/mixed valve disease is more complex and presents a different set of challenges that need to be discussed. Take a look at section 10: Mixed Valve Disease in the below link:

2020 ACC/AHA Guideline for the Management of Patients With Valvular Heart Disease

I think you mentioned you are going to CC so you will be in good hands and will be guided to make the best decision in your case.

Maybe one or both valves can even be repaired?

I so appreciate your feedback. I will not be at the Cleveland Clinic (a previous post was inquiring what type of valve the CC was using) but will be at the Heart Center of the Rockies in Loveland CO. I appreciate the links to additional information. I'll delve into that later today. Many thanks!

 

[dornole]

Mitral valves degrade faster is what I was told. My main issue is mitral. Also being female and having rheumatic fever both of which applies to me. So mechanical most likely for me if and when another repair ain’t an option

 

[Dana]

Hello everyone! I have to have 2 valves replaced at the same time. Have you had this duo surgery and if so, did you get tissue valve or mechanical? Age 65 and looking at surgery in the next few weeks. Been reading lots and lots and keep learning. This from Stanford is interesting but not helpful to me.
https://www.med.stanford.edu/news/all-news/2017/11/mechanical-heart-valve-often-the-safest-choice.html
Any input is appreciated.

Yes, in 2017 at 65 I had three done at the same time along with a couple of bypasses for insurance. The AV and MV are mechanical and the tricuspid is tissue. Long surgery, phenomenal surgeon, but it's doable. The biggest factors for me were these questions. Do I want to be on blood thinners for rest of life? - No because I wanted badly to continue playing hockey which is not prudent on blood thinner. And do I want to go though this again at 80 to replace tissue valves? - No again.
Ultimately I left it to the surgeon who seemed to pick the worst of both but he said the mechanicals will not fall for as long as I live and the tissue valve can be replaced percutaneously, thereby avoiding a second OHS. Although not obvious to me prIor to the surgery, now I view this decision as absolutely the right thing to do. The professionals know best.

 

[MKM]

Ultimately I left it to the surgeon who seemed to pick the worst of both but he said the mechanicals will not fall for as long as I live and the tissue valve can be replaced percutaneously, thereby avoiding a second OHS. Although not obvious to me prIor to the surgery, now I view this decision as absolutely the right thing to do. The professionals know best.
[/QUOTE]
I really appreciate your insight and reply. I am learning so much as I go and I am also learning to 'let go.'

 

[Dodgy Ticker]

I have had both inserted as mechanical valves and at my last check (last week), both were working fine. I don't think there is any definitive proof of one vs the other. The key is to absolutely ensure that you get them checked every 6 months to be sure they're doing fine. More than that you can't do.

 

[fynky]

I had atrial and mitral replaced at age 72 due to stenosis and regurgitation. I was already on warfarin for a-fib, so I asked the doctor for his advice. He said he would wait to see what he found when he got in there. One of the valves was seriously calcified and required a lot of time to clean and he decided on bovine tissue for both.
That was 4 years ago and I have had zero problems since then.
As has already been stated, 6 month checkups are really necessary.
Best of wishes for your surgery.

 

[MKM]

I have had both inserted as mechanical valves and at my last check (last week), both were working fine. I don't think there is any definitive proof of one vs the other. The key is to absolutely ensure that you get them checked every 6 months to be sure they're doing fine. More than that you can't do.

Thanks, I will be sure to check in every 6 months as suggested. I appreciate the feedback.

 

[MKM]

I had atrial and mitral replaced at age 72 due to stenosis and regurgitation. I was already on warfarin for a-fib, so I asked the doctor for his advice. He said he would wait to see what he found when he got in there. One of the valves was seriously calcified and required a lot of time to clean and he decided on bovine tissue for both.
That was 4 years ago and I have had zero problems since then.
As has already been stated, 6 month checkups are really necessary.
Best of wishes for your surgery.

I appreciate your feedback. I will be sure to make my argument for a mechanical valve with the understanding that he makes the final decision after checking out my heart.

 

[esvaja]

I'm 66 yrs old & actI chose the bioprosthetic inspiris resilia valve because it's supposed to be calcium repellent ( 2nd replacement due to buildup & stiffening of 1st) & will mate with a TAVR if necessary in the future. I don't want to be tied to a drug & have to be monitored. I also worked in a hospital & I saw too much bruising on people who took warfarin. Sorry but I'm a bit vain & the sternal scar is as far as I'll go. I was lucky enough that though my mitral valve needed some repair they only used a band to tighten it up. Good Luck to you & wish you the best

 

[MKM]

Thanks for your comment and input. I am inclined to have a bioprosthetic valve as well. Next week at this time I should be waking up in ICU. This entire website has been so instrumental in my education I can't even begin to tell you. I am grateful beyond measure - Margie
Medical Center of the Rockies, Loveland Colorado

 

[NealR]

I had it done twice! first pair (MV and AV) in 2010, then again in 2019. First pair all EW's Bovines, 2nd pair, one EW (bovine then a Porcine in the MV position. The first surgery went without hitch. Was 50. Out in 4 days, back to work in 5 weeks. They performed well but became heavily calcified. The second surgery almost killed me but was related more to a reaction to the blood transfusion then the surgery. Had to go on ecmo for 4 days! Since, I am in great shape at 62 and feel superhuman again. Hope these last long enough were both can replaced through a catheter.

 

[NealR]

Thanks for your comment and input. I am inclined to have a bioprosthetic valve as well. Next week at this time I should be waking up in ICU. This entire website has been so instrumental in my education I can't even begin to tell you. I am grateful beyond measure - Margie
Medical Center of the Rockies, Loveland Colorado

Just checking if you made it ok. Wishing you the best