Life expectancy after a repair vs replacement

[Gorkemhazar]

Hello to all friends here. 22 years ago before and after my surgery this site hekped me a lot. I had a mitral valve repair in 2002 at tge age of 27. I had great 22 years afterwards. I had regurgitation before surgery ( had a rheumatic fever from 11 years ols) . Now still trace regurgitation but have mild stenosis with 1.4 cm2 ( no symptoms yet). Also mild aortic regurgitation. Seems like in 5 to 10 years second OHS might be on horizon.Im very active in terms of sports. have been watching lots of videos on YouTube recently about the advantages of valve repair. We all know main advantages of valve repair but both surgeons and cardiologists were implying that after repair patient's life expectancy is no different than anyone at tge same age group without a heart issue( if surgery is done before any irreversible damage point). However they said life expectancy changes after replacement. I thought if you dont get stroke or endocarditis, your life expectancy is not effected after a replacement. Aortic repairs are rare and also second time mitral repairs as well is work of art. ( my anterior leaflet was repaired. Tgey did not touch to posterior. While Im a strong candidate for a valve replacement, Any comment on changes in life expectancy after a valve replacement?

 

[LondonAndy]

You say "life expectancy changes after replacement" - replaced with what? Mechanical = longer, bio = shorter?

 

[dick0236]

.......... While Im a strong candidate for a valve replacement, Any comment on changes in life expectancy after a valve replacement?

Doctors have told me for decades that it is unlikely that "mechanical valve failure" will be the reason I die. In a little over a week I will turn 88 years old on a 56+ year old mechanical valve. I guess you could say my old mech valve has extended my life expectancy by a LOT.......with only minor interruptions to my lifestyle.

 

[Superman]

I’ve been under the impression that my valve has a lifetime guarantee.

 

[pellicle]

Hi

Seems like in 5 to 10 years second OHS might be on horizon

so, seems like plenty of time to review and monitor the state of the art as it unfolds.

however earlier you said:

I had a mitral valve repair in 2002 at tge age of 27.

so do they do repairs of repaired valves?

then you also say:

Now still trace regurgitation but have mild stenosis with 1.4 cm2 ( no symptoms yet). Also mild aortic regurgitation. Seems like in 5 to 10 years second OHS might be on horizon.

so on which valve are you talking? I think (I who am not posessed of much information and am not your doctor) they don't (prudently) do repairs on older stenotic / calcified aortic valves.

We all know main advantages of valve repair

we know the advantages of this --> for valves which are good candidates <--

but both surgeons and cardiologists were implying that after repair patient's life expectancy is no different than anyone at tge same age group without a heart issue

seems about what I see in the literature, and in my own life.

However they said life expectancy changes after replacement.

Waaaayyyy too many parameters in that, I'd stick with the above of "life expectancy more or less unchanged" (esp if you pick a mechanical and follow strictly and properly with more than due dilligence your ACT therapy guidelines).

Any comment on changes in life expectancy after a valve replacement?

see above.

I've had one repair (aortic) two replacements (homograft and mechanical) sprinkled throughout my 60 years on this planet and while I'm not the fittest 60yo I'm a lot fitter than some and fitter than many with no other health problems than being fat couch potatoes.

Live life, make good decisions, stick by them. Be a good human, shoulder the load and roll that rock. Don't be lobstered.

Best Wishes

 

[Protimenow]

You raised two interesting issues: stroke and endocarditis.

You can get endocarditis in many ways - none of which are directly related to valve replacement.

As far as stroke, if you have a mechanical valve and keep your INR in a safe range, you should not be at risk of stroke - or, at least, no more than your genes set for you.

I had a stroke in 2011 (IIRC) because my INR meter was defective (later removed by the FDA), reporting an INR of 2.6, when the hospital's test showed that it was more like 1.7.

I had a TIA a few months ago - my INR was in range - and I'm not exactly sure WHY it happened. '

But as far as stroke risk because you have a mechanical valve, if you maintain your INR in a safe range, this shouldn't be an issue.

 

[Gorkemhazar]

Thank you for all your comments folks.
Just to clarify I had mitral valve repair that has now stenosis at 1.4cm2. Before it had only regurgitation. As many knows after ring placement, in a long run stenosis might happen.
My aort valve has mild regurgitation. It was never operated. Its not bicuspid.

'' You raised two interesting issues: stroke and endocarditis''
I see that stroke part is somewhat manageable . Doctors also mention hemodynamics of heart and blood. They literally say, valves do not only open & close, they have lot to do with hemodynamics and especially the more active you are the more you need good hemodynamics. Mechanical and tissue valves are not there yet there in terms of hemodynamics while they kind of damage or disturb the bloodflow. I was frustrated a bit after hearing this. I think more than warfarin etc. This is the main issue of the valve replacement.

 

[pellicle]

Mechanical and tissue valves are not there yet there in terms of hemodynamics while they kind of damage or disturb the bloodflow. I was frustrated a bit after hearing this.

I'm a bit lost here
neither mechanical nor tissue are prefect, but both have better haemodynamics than your native (now stenotic) one.

what does this mean?

I think more than warfarin etc. This is the main issue of the valve replacement.

Warfarin is not an issue for 99% of people (mental issues aside)

 

[pellicle]

assuming that some one wants to actually know

https://www.ncbi.nlm.nih.gov/pmc/articles/PMC6306127/

as previously suggested by Dr Schaff of the Mayo


more current video

I think more than warfarin etc. This is the main issue of the valve replacement.

https://www.medscape.com/viewarticle/838221

take your time, there's a lot to read and listen to in all that

 

[pellicle]

also worth reading:
https://www.ahajournals.org/doi/full/10.1161/circulationaha.108.778886

Despite the marked improvements in prosthetic valve design and surgical procedures over the past decades, valve replacement does not provide a definitive cure to the patient. Instead, native valve disease is traded for “prosthetic valve disease,” and the outcome of patients undergoing valve replacement is affected by prosthetic valve hemodynamics, durability, and thrombogenicity. Nonetheless, many of the prosthesis-related complications can be prevented or their impact minimized through optimal prosthesis selection in the individual patient and careful medical management and follow-up after implantation.​

the pithy truth