How much have valve replacements actually improved over the years?

[Nocturne]

Replacement valves have been around for decades, but they are still not perfect (hence the discussions about the relative merits and flaws of bio prosthetics and mechanical valves).

I am wondering how much replacement valves have improved over the years. What concrete advantages does a modern recipient have over someone who had AVR a decade ago? Two, three, or four decades ago?

Obviously we don't have as much data on the truly modern valves, because they haven't been studied as thoroughly yet, but in general, what kind of progress have we seen?

 

[FredW]

Interesting timing on your question. I had my after surgery visit today with my cardiologist and he commented on how today's tissue valves only get better. My valve, St Jude Trifecta Gt, has a average of lasting 17.5 years. Don't know how they determine that for it has only been approved by the FDA in April this year for use in the US. Company quotes life cycle to be 8 - 20 years.

 

[Warrick]

I'm a second generation valver as my dad has a mechanical aortic as well due to rheumatic fever as a baby, his surgery was back in the early 80's, from what I can see it's more the survivability has improved 10 fold ,

on the day of his surgery there were 3 others operated on and he was the only one who survived. not good odds

He has a ball in cage st Jude valve that is way quieter than my modern equivalent although he has paravalvular leakage which I think was there from the day of installation probably due to the techniques used at the time, this put him off work permanently in his mid forties. Although extremely rare I have read about leaflet failure on my model but not for his valve.

He was still pulling so called "dissolvable" stitches out of his chest 2 years after his operation whereas now the "glue" fixes that

 

[dick0236]

The first valve implanted in 1960 was the "ball in cage" Starr-Edwards mechanical valve. That valve continued to be produced, with few changes, until Edwards Lifesciences stopped production in 2007 in favor of their tissue type products. The bi-leaflet mechanical valves and the family of tissue valves began showing up in the 1970s. The trade off between mechanical and tissue is durability. A typical valve completes 40,000,000+ "beats" per year and only mechanical valves have been shown to last for decades with that kind of punishment. The trade off is AC therapy which has dramatically improved over the years.

I visit OHS patients weekly at a local hospital and have found that the vast majority of OHS patients are "bypass patients" (75%) rather than "valve or other heart disorders". The biggest change I have noticed is "time in the hospital". In 1967 I was in the hospital for fourteen days and now the typical stay is about 4 to 5 days.

 

[neil]

fred warrick and dick think your all spot on, its moved forward and will continue till we ge

 

[neil]

get the complete valve which lasts a lifetime and doesn't need anti coags,

 

[Zoltania]

I suspect that there has been a lot of process improvement over the years in areas like nursing care and bypass machine operation. It's not just valve design that has gotten better.

 

[Nocturne]

Dick, I think it is very good of you to visit OHS patients. No doubt your story and experience helps them. FWIW, I'm impressed.

 

[dick0236]

Dick, I think it is very good of you to visit OHS patients. No doubt your story and experience helps them. FWIW, I'm impressed.

Look and see if "mended hearts" has a chapter in your town. They can always use volunteers to visit local hospitals.....and yes, those patients appreciate a conversation with someone who has already walked the path. I get as much out of the visits as the new patients do......and I certainly don't want that surgery again.

 

[QuincyRunner]

Dick - Since my surgery I have had a very strong desire to share my story with other's facing OHS, mainly because I remember how scared and lonely I felt when I was going through it. It would have done me a world of good to have met someone that had been through it and could assure me that a normal and full life was still possible. After I heard about Mended Hearts and made inquiry I was disappointed to discover that there were no chapters in the Tallahassee, FL area. After being on a conference call with several key representatives of Mended Hearts, including the southern regional director, I was further disappointed to learn that MH would be happy for me to start a chapter but was not willing to assist other than to send me a bunch of literature to distribute. I ended up visiting with the volunteer coordinators and rehab directors at both of the hospitals in Tallahassee but found great resistance to MH and in the end I was unsuccessful in getting anything going. I even tried to volunteer as an individual visitor in the cardiac units but that met with negative results as well. The experience has left me pretty disillusioned and I'm afraid I now have a bad attitude about the whole thing. You are lucky to be in an area where MH is active and where there is a hospital that is receptive.

 

[pellicle]

I visit OHS patients weekly at a local hospital and have found that the vast majority of OHS patients are "bypass patients" (75%) rather than "valve or other heart disorders". The biggest change I have noticed is "time in the hospital". In 1967 I was in the hospital for fourteen days and now the typical stay is about 4 to 5 days.

very laudable Dick.

I'm often not in a place where I can be of benefit directly, which is why I do what I can here.

 

[dick0236]

The experience has left me pretty disillusioned and I'm afraid I now have a bad attitude about the whole thing. You are lucky to be in an area where MH is active and where there is a hospital that is receptive.

I'm sorry you've had difficulty. Here is the contact person for the Southern district of Mended Hearts. Hopefully she can hook you up with a chapter close to your home. The Kentucky chapter has been around for many years and has the full support of the major heart hospitals in this area.

Dr. Fredonia Williams
[email protected]
(256)837-7354

Good Luck!

 

[epstns]

I remember being visited by the hospital's MH rep shortly after my valve/bypass surgery. He was a kind old gent who really only knew what to expect after bypass surgery. He hadn't had any experience or training regarding valve patients. I filled him in on a lot of things. I also think he wasn't really prepared to counsel a patient who, although "of an age" was just waiting to be able to get back to the gym. If that hospital wasn't a terrible commute from my home, I might have volunteered. I think once I retire, I may enquire at one of the suburban hospitals closer to home.

 

[dick0236]

............... only knew what to expect after bypass surgery. He hadn't had any experience or training regarding valve patients. .

Yep Steve.....this is the problem I have, only in reverse. I kinda understand the valve surgery but know little about bypass surgery......except bypass surgery seems to be more involved than valve surgery.
I try to stay away from details and view my story as proof that "life after surgery" will be a normal life. My big surprise was in finding only about one in eight OHS was for valve replacement.........plumbing problems (bypass) seem to be a much bigger problem around here.

 

[Paleowoman]

Dr James le Fanu is the author of a fascinating book ‘The Rise and Fall of Modern Medicine’ - one of the most interesting chapters describes how open heart surgery started in the 1950’s. Many of the operations ended in disaster on the operating table as the surgeons were operating, in a sense, in the dark, they were real pioneers. The invention of the heart lung machine advanced things considerably of course. Until the 1960s the heart operations were only on children with heart defects, then they turned to adults with heart valve problems: https://www.amazon.com/Rise-Fall-Mo...&qid=1472141378&sr=8-1&keywords=james+le+fanu You might be able to read some of the chapter on open heart surgery on the ‘look inside’ feature on Amazon, page 96 of the book.

 

[Paleowoman]

My big surprise was in finding only about one in eight OHS was for valve replacement.........plumbing problems (bypass) seem to be a much bigger problem around here.

Yes, bypass surgery is the bread and butter of cardiac surgeons - that's how I've heard it put !

 

[Warrick]

Yep Steve.....this is the problem I have, only in reverse. I kinda understand the valve surgery but know little about bypass surgery......except bypass surgery seems to be more involved than valve surgery.
I try to stay away from details and view my story as proof that "life after surgery" will be a normal life. My big surprise was in finding only about one in eight OHS was for valve replacement.........plumbing problems (bypass) seem to be a much bigger problem around here.

Seems true here to, when I did the cardiac rehab classes of the 10 of us one had had a tripple bypass and the rest had just had stents for the plumbing

 

[pellicle]

Seems true here to, when I did the cardiac rehab classes of the 10 of us one had had a tripple bypass and the rest had just had stents for the plumbing

so, like you were the only valver?

 

[cldlhd]

Dr James le Fanu is the author of a fascinating book ‘The Rise and Fall of Modern Medicine’ - one of the most interesting chapters describes how open heart surgery started in the 1950’s. Many of the operations ended in disaster on the operating table as the surgeons were operating, in a sense, in the dark, they were real pioneers. The invention of the heart lung machine advanced things considerably of course. Until the 1960s the heart operations were only on children with heart defects, then they turned to adults with heart valve problems: https://www.amazon.com/Rise-Fall-Mo...&qid=1472141378&sr=8-1&keywords=james+le+fanu You might be able to read some of the chapter on open heart surgery on the ‘look inside’ feature on Amazon, page 96 of the book.

It's amazing when you think how until relatively recently there was nothing they could do about many of these heart issues.

 

[epstns]

Dick - Your observation about bypass patients being the majority seems true here, too. I guess I am in a definite minority having both, and more so by also having the pacemaker. I guess my story might give all kinds of patients the sense that these things are much less of a burden than they might think.

I'm not doing the volunteer thing so far, though, because it would get in the way of my 50-60 hour/week day job. . . although now that I think about it, the fact that I can still do the heavy work schedule ("at my age") might give hope to the younger patients who have been through heart surgery.