Life Expectancy BAV Mechanical vs Tissue

[Jmprosser.lab]

Hey everyone,

hoping some can shed some light/positivity for a coworker of mind very discouraged by a new large Swedish study suggesting life expectancy post BAV replacement is significantly lower for younger patients. Can anyone provide some facts or info from their cardios/research.

The link to an overview of the study is below:
https://www.tctmd.com/news/life-expectancy-post-savr-varies-age-raising-questions-treatment-timing
I told him about how this website saved me after I found my diagnosis. All the experienced veteran OHS survivors made me feel so much better. He’s also hopeful that minimally invasive will be an option as his surgery is coming up.
Thanks

 

[pellicle]

Read the stats VERY carefully.

In Australia most younger patients were doing well after 30 years.
I had my first at 12, and I'm 56 now

 

[tom in MO]

That's a link to a summary covering a paper and an editorial on the original paper. One of the editorialists is an employee of Medtronic. My take on it is that one should read the original paper and the original editorial, not a summary. They are both available. Also, if one cannot understand it, don't get upset. Ask your surgeon or cardiologist what they think of the study.

My personal experience is that I had a BAV. I was given about 3-6 months to live if I didn't get it fixed. I got a mechanical valve by fully invasive surgery at age 55 and am now 62. That's a pretty good change in life expectancy and I'm still ticking

We all die. My Irish side of the family used to say a quick death is a gift from God. The man who worked at the delicatessen in my home town used to say "Live fast, die young, make a good looking corpse." Don't worry about life expectancy but enjoy the life you have now.

 

[slipkid]

We all die. My Irish side of the family used to say a quick death is a gift from God.

I agree totally. Lingering on for months with endless treatments and torture that they involve, which has happened to multiple friends/family is not how I want to go.

The man who worked at the delicatessen in my home town used to say "Live fast, die young, make a good looking corpse." Don't worry about life expectancy but enjoy the life you have now.

Great advice! Love that make a good looking corpse bit...

 

[Superman]

I have no idea what younger means in the context of this study. Nor do I know how young you or your co-worker are.

I had my valve replaced in 1990 when I was 17. Safe to say I was in n the young patient category. Probably still am. Had an aortic aneurysm repaired via open heart again when I was 36. I’m 47 now and spent nearly 30 of those years taking Warfarin.

I guess I would remind your friend how statistics work. At one time the general population had a life expectancy in their 30’s or 40’s. People used to die younger due to infections and other illnesses that are treatable today. I would have been one of those people back then. It does stand to reason that for people like us, there may be more comorbidities that lead to an early passing than the general population. This will impact our averages. It does not mean that every one of us will live 4.5 years less than our peers.

 

[pellicle]

I have no idea what younger means in the context of this study

probably "what the surgeon thinks"

It does not mean that every one of us will live 4.5 years less than our peers.

I'm willing to bet some of my other activities will play the larger part in that:

 

[user 16827]

@10.56 those ruts were nicely negotiated

 

[Brinntache]

It is my understanding that younger people wear our bio valves faster (in general) due to how certain elements in the blood affect the valve, accelerating AVD. It's a big reason why I am going mechanical in 12 days. As for your friend, the range of reasons a person in their 40's needs AVR is different than those in their 60's. When I was trying to find data to make my decision it was hard to find data that separated bicuspid issues from tricuspid issues, healthy active people from obese smokers, diabetic vs non-diabetic, clean living vs addicts.
The study did not look at any of that. " Differences in comorbidities as well as in the etiology and morphology of aortic stenosis across age groups might be at play, they comment. " It was a simple spreadsheet study, a 'maybe we should look at this' study.

 

[pellicle]

It is my understanding that younger people wear our bio valves faster (in general) due to how certain elements in the blood affect the valve, accelerating AVD.

That's pretty bang on.

It's a big reason why I am going mechanical in 12 days.

Best Wishes for a textbook procedure and an uneventful recovery.

 

[tom in MO]

They don't know what causes tissue valves to fail faster in some people than others. Blood components is a logical choice but they don't really know.

 

[Luckyguy17]

It is my understanding that younger people wear our bio valves faster (in general) due to how certain elements in the blood affect the valve, accelerating AVD.

I recently had a conversation with my surgeon on bio valves and longevity. He is convinced that it is more biometrics related, than age or activity related. In his experience, longevity of bio valves in a patient performed for a similar lifespan in multiple surgeries. In other words if my bio worked for 10 years, then it seems likely that a porcine or bovine replacement irregardless of brand would last about as long. For a patient that had a 20 year bio, a replacement would likely last similar length.

 

[Chuck C]

I recently had a conversation with my surgeon on bio valves and longevity. He is convinced that it is more biometrics related, than age or activity related. In his experience, longevity of bio valves in a patient performed for a similar lifespan in multiple surgeries. In other words if my bio worked for 10 years, then it seems likely that a porcine or bovine replacement irregardless of brand would last about as long. For a patient that had a 20 year bio, a replacement would likely last similar length.

I've attached a study published by Dr. Philippe Pibarot et al in 2018 titled: Hemodynamic Deterioration of Surgically Implanted Bioprosthetic Aortic Valves

They did find some markers which correlated with Hemodynamic Valve Deterioration of bioprosthetic valves.

From their conclusion:
"A dysmetabolic profile characterized by elevated plasma Lp-PLA2, PCSK9, and HOMA index was associated with increased risk of HVD"

 

[Bmorgan4]

Hey everyone,

hoping some can shed some light/positivity for a coworker of mind very discouraged by a new large Swedish study suggesting life expectancy post BAV replacement is significantly lower for younger patients. Can anyone provide some facts or info from their cardios/research.

The link to an overview of the study is below:
https://www.tctmd.com/news/life-expectancy-post-savr-varies-age-raising-questions-treatment-timing
I told him about how this website saved me after I found my diagnosis. All the experienced veteran OHS survivors made me feel so much better. He’s also hopeful that minimally invasive will be an option as his surgery is coming up.
Thanks

Yes - there is an answer to this that I have found and printed. Need to get it out of my files. But this study is not BAV specific - so when young people are getting aortic valves replaced (non BAV)it is typically because they are extremely unhealthy. When BAV folks are getting them replaced, it is due to the more obvious reasons and their health is generally better. See two attachments here.

 

[pellicle]

Hi

and welcome

interesting study ...

Yes - there is an answer to this that I have found and printed. Need to get it out of my files. ...

1.9 years ... not much really and given the "confidence" ratings nearly zero. I'm willing to bet that healthier living (not smoking, moderate exersize) could close that gap to probably "living longer"

PS: I believe this is the referenced study here
https://heart.bmj.com/content/early/2021/02/22/heartjnl-2020-318733

 

[pellicle]

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.​

 

[Chuck C]

I'm willing to bet that healthier living (not smoking, moderate exersize) could close that gap to probably "living longer"

I would agree with this statement. There are so many things that we have control over which are correlated with longer life expectancy. To those that you mention I would add: maintaining a healthy BMI, controlling blood pressure, eating a healthy diet and controlling insulin resistance. We don't have control over the fact that we were born with BAV, but if living longer is really important to us, there are several actions within our control to extend our life expectancy significantly.

 

[pellicle]

but if living longer is really important to us, there are several actions within our control to extend our life expectancy significantly

So, you're saying the motorbike and scooter have to go?

;-)

 

[Chuck C]

So, you're saying the motorbike and scooter have to go?

;-)

We all have to weigh the relative risks and decide how we live our lives. The last time I renewed my life insurance policy, in answering one of their questions, I had to disclose that I scuba dive. This led to a series of follow up questions, including how deep I went when I dove. It ended up costing me a bit more for the renewal policy, but apparently it was still worth insuring me in their estimation.

Interesting that they did not ask about my free diving, nor the location, which happens to be in Northern California (that's in the US for those not sure) which is inhabited by many Great White Sharks.

 

[pellicle]

We all have to weigh the relative risks and decide how we live our lives

exactly ... I was being tongue in cheek.

I do accept that a basic "off" on my motorbike will likely mean my death. My surgeon seemed to frown at this discussion time (2011) and I said "well I've been doing it since I was 15 and across 3 continents" ... he knows I'm like him in some ways. Hard to dissuade. ;-)

Northern California (that's in the US for those not sure) which is inhabited by many Great White Sharks.

well great whites are either testing what you are (and you need stitches or a prosthetic) or hunting (in which case you won't suffer long). Also I doubt there are many people on the planet who don't know where California is but maybe a few (in say Korea, India, Japan) who don't know where New Hampshire is ... or Vermont or even that North and South Carolina are distinct states ;-) On boards like this even fewer non-Americans know NV from NB.

 

[jcgtok17]

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