Life Expectancy BAV Mechanical vs Tissue

[Bmorgan4]

Interesting for certain. I had my BAV surgery 4 years ago at 50. Life expectancy was 80, although I tried to contractually "lock that in" my doctors could not do so. Stay healthy, trim and get your sleep was the main advice. The "event risk" of valve replacement (hopefully TAVI procedure) likely to cause a spike (or 2), but hope to be trolling the planet for a long time. They estimate 107bln people have lived on planet Earth and 7.9bln of those are currently alive due to > life expectancy (-200mm due to wars in 20th century, -500mm Smallpox, -170mm genocide). JCG

What valve did you choose at age 50?

 

[jcgtok17]

What valve did you choose at age 50?

St. Jude Medical GT 27mm (tissue). Edwards is popular in Japan, 21mm avg. valve size.

 

[cldlhd]

digging around this article I would suggest that where they say

... The life expectancy of individuals with asymptomatic BAV who are identified in the community is excellent and similar to that of the general population.7 8 However, patients who undergo surgical aortic valve replacement (AVR) have a life expectancy that is approximately 2 years shorter than that of the general population.9 Furthermore, the prognosis of patients with BAV versus the general population after aortic valve surgery remains to be determined.​

that this is related to the very small number of complications that arise from surgery, discounting those issues I would not be surprised to find that its "similar to that of the general population" (and what the fcuk is 1.9 years if not similar)

points to note:

The mean follow-up period was 6.3 years (maximum 13.3 years)​

not much really, not even lenghty with many studies follwing up 10 years (and the study I was involved in 29 years).

ultimately they say themselves:

​

Conclusions The survival of patients with BAV following aortic valve surgery was excellent and similar to that of the general population.​

So I was wondering about this myself. I didn't read the stats or the article yet but I would imagine that if you had just a small percentage of people die shortly after surgery due to surgical complications that would skew the numbers a good bit. I still have my original BAV, my surgeon threw a few stitches in it and tuned it up back in February 2015 ( can't believe it's been that long..) and I had my aortic aneurysm replaced. He said the valve was in really good shape with good flow ( pressure gradients) and very little leakage. FWIW He seems to think I should have a normal life span as in if I take good care of myself I'll live longer if I don't I won't..... Also as he said something else might kill me first before something related to my valve.
All else being equal I would imagine that having a BAV and having to have any kind of heart surgery isn't going to make you live longer if anything it would have a slightly negative effect one would think. In other words if I had the exact same genetics I have now and the same lifestyle just not the bicuspid valve or aneurysm that would certainly be a plus.

 

[Astro]

I think that the paper/editorial numbers sound right. The best paper I could find on this topic was the SWEDEHEART Study (Loss in life expectancy after surgical aortic valve replacement, 2019, vol 74(1), Journal of the American College of Cardiology). This study was big; 23,528 patients. I am no statistician but the methods look reasonable to me.

It found that loss of life expectancy varied with age from 0.4 years for people > 80 years to 4.4 years for people less than 50 years.

This is SO MUCH BETTER than the life expectancy without surgery. It is SO MUCH BETTER than almost any cancer. We so are fortunate to live in an age with such effective treatment for our medical problem.

As Pellicle has stated, these are average life expectancy differences. Any individual may do better (or worse) than the average.

While I view these numbers as mostly encouraging, I also see room for improvement. I think that delaying surgery until permanent heart damage has occurred, will decrease life expectancy. Earlier surgery (but not too early - the valve must have a severe problem) is of benefit. The review, “Early valve replacement for severe aortic valve disease: effect on mortality and clinical ramifications, 2020, Journal of Clinical Medicine” outlines the arguments.

If my life expectancy is 4.4 years shorter, I intend to use my remaining time more wisely. I will get more things done by being more focussed, live life more fully so easily make up the difference.

 

[Bmorgan4]

I think that the paper/editorial numbers sound right. The best paper I could find on this topic was the SWEDEHEART Study (Loss in life expectancy after surgical aortic valve replacement, 2019, vol 74(1), Journal of the American College of Cardiology). This study was big; 23,528 patients. I am no statistician but the methods look reasonable to me.

It found that loss of life expectancy varied with age from 0.4 years for people > 80 years to 4.4 years for people less than 50 years.

This is SO MUCH BETTER than the life expectancy without surgery. It is SO MUCH BETTER than almost any cancer. We so are fortunate to live in an age with such effective treatment for our medical problem.

As Pellicle has stated, these are average life expectancy differences. Any individual may do better (or worse) than the average.

While I view these numbers as mostly encouraging, I also see room for improvement. I think that delaying surgery until permanent heart damage has occurred, will decrease life expectancy. Earlier surgery (but not too early - the valve must have a severe problem) is of benefit. The review, “Early valve replacement for severe aortic valve disease: effect on mortality and clinical ramifications, 2020, Journal of Clinical Medicine” outlines the arguments.

If my life expectancy is 4.4 years shorter, I intend to use my remaining time more wisely. I will get more things done by being more focussed, live life more fully so easily make up the difference.

This study was followed up on - and they found that the relative life expectancy for BAV was the same across all age groups. BAV patients are typically younger and healthy, compared with unhealthy TAV patients which is why shorter life would be expected. Some images here from the study showing different age groups after valve replacement vs general population. Hope it’s helpful. But I agree - 4.4 is nothing . I don’t want to live to 90 anyways!! I want to live now!!

 

[pellicle]

Hi

I don’t want to live to 90 anyways!! I want to live now!!

well I want to live as healthy as I can, because even at the age of 57 I can say that the choices you make at 25 impact your health at 55. I'm very glad I made good choices then.

As to 90 ... all I can say is that its no fun living and watching everyone you know and love die from age, cancer or mishap. The answer lies (in my view) in being able to keep making friends who are (preferably) younger than you. I find there's a dual benefit to that and that is they drag you forward into new things (but then I've always been an early adopter anyway) ;-)

 

[pellicle]

Hi

long time no see ... hope all's well there

So I was wondering about this myself. I didn't read the stats or the article yet but I would imagine that if you had just a small percentage of people die shortly after surgery due to surgical complications that would skew the numbers a good bit.

indeed this is exactly right and an important thing to always keep in mind with statistics. An outlier or two can make a change to the average, especially with a smaller sample size

age​

80​

75​

82​

23​

81​

77​

Average = 69.6666666666667​

 

[Astro]

Thank you Bmorgan4 for detailing Glaser's 2021 article. It is reassuring for BAV patients.

This design does have a limitation. It compares people who have had surgery. No one who has a serious secondary problem, for example cancer, will be included. The study population is compared against a population registry which would include people who have cancer or other problems that might exclude major surgery.

I agree with your statement about living until age 90.

 

[Al3x]

I know this is an old post but you may find this paper interesting. Essentially it compares life expectancy for BAV and TAV patients. It found that BAV patients have a similar life expectancy to the age matched population post surgery whereas TAV patients fare a little worse. The average age of study participants was relatively young.

Must studies look at survival across all AVR patients and don't consider valve morphology in their results. Hopefully this will provide a little comfort.

 

[pellicle]

The average age of study participants was relatively young.

interesting study, I think its actually been posted here before. Considering the OP is under 30 I don't think he's going to consider those ages young ... and relative is not even right IMO (being over 50) as the data given was:

Age (years)​

72 (65-78)​

72 (64-78)​

73 (65-78)​

72 (65-78)​

 

[Al3x]

interesting study, I think its actually been posted here before. Considering the OP is under 30 I don't think he's going to consider those ages young ... and relative is not even right IMO (being over 50) as the data given was:

Age (years)​

72 (65-78)​

72 (64-78)​

73 (65-78)​

72 (65-78)​

I agree with the age point. There is a complete dearth of studies looking at the under 40s though (I say this as a 34 year old having surgery next month). I guess the take-home for me is that there is so much research out there and you have to approach it all critically and ask how relevant each study is to your situation and what the quality of each study is.

 

[pellicle]

I agree with the age point. There is a complete dearth of studies looking at the under 40s though (I say this as a 34 year old having surgery next month). I guess the take-home for me is that there is so much research out there and you have to approach it all critically and ask how relevant each study is to your situation and what the quality of each study is.

Your conclusion is perfectly correct.

In 1992 I was a 28 yo getting my first valve (which was somebody elses). I got 20 years out of that spare part.

If I was doing it again, with the technology we have now I'd be taking a mechanical, but only if you don't have any likelihood of aneurysm

 

[cldlhd]

Hi


well I want to live as healthy as I can, because even at the age of 57 I can say that the choices you make at 25 impact your health at 55. I'm very glad I made good choices then.

As to 90 ... all I can say is that its no fun living and watching everyone you know and love die from age, cancer or mishap. The answer lies (in my view) in being able to keep making friends who are (preferably) younger than you. I find there's a dual benefit to that and that is they drag you forward into new things (but then I've always been an early adopter anyway) ;-)

If I end up all alone I don't think I'd want to live to 90 but if I'm healthy, for 90, and I have my wife (barely hear her at that point....), my son , some grandkids, maybe great grandkids nearby I'll take it. Like a lot of dummy's I could never picture myself being one of those "old people"... but it happens

 

[cldlhd]

Your conclusion is perfectly correct.

In 1992 I was a 28 yo getting my first valve (which was somebody elses). I got 20 years out of that spare part.

If I was doing it again, with the technology we have now I'd be taking a mechanical, but only if you don't have any likelihood of aneurysm

So is there a way ,other than measurements, to tell if future aneurysm is likely? If so and getting a mechanical valve I'd want it all done at once. My surgeon claimed he could tell the difference in the tissue once he lays eyes in it but who knows? I ended up getting all the way up to the hemi arch replaced

 

[pellicle]

If I end up all alone I don't think I'd want to live to 90

I believe I know exactly what you mean

 

[pellicle]

So is there a way ,other than measurements, to tell if future aneurysm is likely?

the presence of Bicuspid Aortic Valve (BAV) is in itself a metric for likely. As far as I know its a highly reliable predictor for "increase likelihood" ... as for "certainty" that can never happen without measurements. Such is the stuff that allows Casinos to make money.

 

[kentuckyed]

Cldlhd and Pellicle's comments immediately bring to mind the closing scenes in The Green Mile. Where the Tom Hanks character, Paul Edgecomb explains that he feels cursed for killing John Coffey. God has punished him with a long, long life with only Mr. Jingles as continuing company. Classic movie. Maybe I'll try to find it and watch again later tonight. Pretty sure that I won't be cursed with a long, long life.

 

[Chuck C]

My surgeon claimed he could tell the difference in the tissue once he lays eyes in it

This occurred during my surgery. My aorta was only 3.5cm when Dr. Shemin replaced my BAV. However, he was able to tell by the look of the tissue that my aorta was likely to aneurism at some point in the future. He made the judgement call to replace my aortic root and part of my ascending aorta during the surgery, so that I would avoid a future OHS. I'm very grateful that he made that call.

 

[jcgtok17]

What valve did you choose at age 50?

Due to sizing issues, the St. Jude Medical Trifecta GT (27mm). Avg. size in Japan is 21mm, Edwards values more typically used. There was no discussion of mechanical values.

 

[cldlhd]

I think that the paper/editorial numbers sound right. The best paper I could find on this topic was the SWEDEHEART Study (Loss in life expectancy after surgical aortic valve replacement, 2019, vol 74(1), Journal of the American College of Cardiology). This study was big; 23,528 patients. I am no statistician but the methods look reasonable to me.

It found that loss of life expectancy varied with age from 0.4 years for people > 80 years to 4.4 years for people less than 50 years.

This is SO MUCH BETTER than the life expectancy without surgery. It is SO MUCH BETTER than almost any cancer. We so are fortunate to live in an age with such effective treatment for our medical problem.

As Pellicle has stated, these are average life expectancy differences. Any individual may do better (or worse) than the average.

While I view these numbers as mostly encouraging, I also see room for improvement. I think that delaying surgery until permanent heart damage has occurred, will decrease life expectancy. Earlier surgery (but not too early - the valve must have a severe problem) is of benefit. The review, “Early valve replacement for severe aortic valve disease: effect on mortality and clinical ramifications, 2020, Journal of Clinical Medicine” outlines the arguments.

If my life expectancy is 4.4 years shorter, I intend to use my remaining time more wisely. I will get more things done by being more focussed, live life more fully so easily make up the difference.

In addition to having the surgery done before permanent heart damages done also knowing about this and having this situation could lead you to better health choices such as diet and exercise. Which would help in regard to longevity obviously